Neurobiological Signatures of Endometriosis: Characterizing Pain, Cognition, and Brain Morphology

Abstract

Endometriosis affects approximately 10% of reproductive-age women worldwide and is associated with substantial pain and mental health burden, yet its neurobiological correlates remain poorly characterized. Neuroimaging studies of endometriosis are particularly limited. Here we present a comprehensive, multidimensional investigation of the neurobiology of endometriosis, integrating structural and diffusion neuroimaging, biofluid measures, neuropsychological testing, and detailed health and psychosocial phenotyping in individuals with and without endometriosis. Compared with controls, individuals with endometriosis exhibited higher levels of pain, depression, and anxiety and performed worse across multiple cognitive domains. Global and regional brain morphometric measures did not differ between groups; however, endometriosis-specific pain was associated with altered gray matter volume and white matter microstructure across distributed pain-related neural circuits. These findings identify pain-related neurobiological signatures of endometriosis and establish a foundation for mechanistic and translational studies of its central nervous system effects.