Purpose <p>Endometriosis, a prevalent gynecological condition, significantly impacts physical, psychological, and social well-being. This study explores the relationship between attachment styles, emotion regulation difficulties, and quality of life in women with endometriosis. Drawing on attachment theory, the study hypothesized that secure attachment would correlate with fewer emotion regulation difficulties and higher quality of life, while insecure attachment styles would correlate with greater difficulties and lower quality of life.</p> Methods <p>The study included 354 Italian women diagnosed with endometriosis. Participants completed the Relationship Questionnaire to assess attachment styles, the Difficulties in Emotion Regulation Scale—Short Form to evaluate emotion regulation, and the WHOQOL–BREF to measure quality of life. Data analysis employed structural equation modeling to examine the direct and indirect effects of attachment styles on quality of life, mediated by emotion regulation difficulties.</p> Results <p>Results confirmed the hypotheses: secure attachment was associated with better emotion regulation and higher quality of life, whereas preoccupied and fearful attachment styles were linked to greater emotion regulation difficulties and lower quality of life. The dismissing attachment style did not show significant associations.</p> Conclusions <p>The findings underscore the importance of addressing emotion regulation in therapeutic interventions for women with endometriosis.</p>