Women who suffer from endometriosis often find it difficult to sleep. There are many factors relating to endometriosis and its symptoms that can disturb sleep patterns:

Pain and discomfort

Most women with endometriosis report moderate to severe pelvic pain that increases before and during their period, as well as during and after sex. This pain is associated with endometrial inflammation.

A painful night can affect your sleep. Pain is the most debilitating symptom on a daily basis for many women with endometriosis, and the associated sleep loss can exacerbate that pain even further.

Hot flashes

Women with endometriosis sometimes experience symptoms similar to the uncomfortable hot flashes often associated with menopause. This is believed to be caused by hormone fluctuations or as a side effect of medications commonly used to treat endometriosis.

Hot flashes cause a corresponding surge in adrenaline and are associated with chronic sleep loss.


Women with endometriosis experience higher rates of depression and anxiety than women who suffer from any other gynecological disorder. Chronic pelvic pain and infertility exacerbate anxiety.

Anxiety activates our fight-or-flight response, ramping up the areas of our brain that helps with sleep regulation. This often contributes to a feedback loop, in which people struggling with anxiety and insomnia suffer from chronic worry about not being able to fall asleep, leading to a domino effect that creates a pattern of sleep loss.

Having to go to the bathroom at night

Endometriosis is associated with a range of bladder and bowel symptoms, including frequent urination. This is because, in women with endometriosis, cells that should be in the womb end up elsewhere–like in the bladder or bowels. The body sometimes responds with negative symptoms like an overactive bladder.

Frequent urination during the night disrupts sleep and some women may have trouble falling back asleep due to pain or other troubling symptoms.


Women with endometriosis are likelier to experience migraines. Migraine sufferers are 2 to 8 times likelier to experience sleep problems, according to the American Migraine Association.

Longer and heavier periods

Endometriosis causes longer periods, shorter and more frequent cycles, and heavier menstrual flows for many women. It can also worsen PMS symptoms, from cramps to headaches and bowel-related issues, all of which can disturb sleep.

Because the hormone fluctuations associated with monthly cycles sometimes lead to sleep disturbances, including both hypersomnia and insomnia, it makes sense that women with atypically long periods would experience severe sleep disruption.

Estrogen dominance and deregulation of cortisol

Estrogen dominance as a common imbalance for women with endometriosis and insomnia is a symptom of this. Balanced blood sugar is a key way to manage our hormones. Sleep deprivation negatively affects our blood sugar by causing heightened insulin resistance resulting in higher blood sugar levels. This imbalance causes a cascade of imbalances in the body, including with our hormones.

Perhaps the chronic stress of living with endometriosis is causing cortisol deregulation, which in turn can cause insomnia, disturbed sleep, and a host of other problems that may sound familiar.

Cortisol follows a pattern throughout the day that allows our body to wake up feeling alert, and then unwind, and fall asleep. If this pattern is disturbed, we may find it difficult to wake up or fall asleep, or we may just feel tired all day long.