Endometriosis can cause debilitating pain. Symptoms of endometriosis range from mild to severe. These symptoms can include bloating, gastrointestinal problems, bleeding, and sometimes infertility — but the primary symptom is chronic or recurring pelvic pain.
Endometriosis is a condition caused by the growth of endometrial cells (which normally line the uterus) in locations outside of the uterus. Endometriosis adhesions commonly occur on the ovaries, fallopian tubes, and the lining of the pelvis. Adhesions can also occur on the intestines, bladder, and other organs throughout the pelvis and abdomen, leading to different experiences of pain.
Here’s how to find relief.
The best way to prevent pain due to endometriosis is typically to treat the underlying cause. There are several treatment options for endometriosis, including surgery and different types of hormonal therapies.
Conservative laparoscopic or robotic surgery to remove endometriosis lesions and adhesions can help eliminate symptoms of endometriosis. For severe endometriosis that has not improved with other treatments, hysterectomy and oophorectomy may be options. These treatments are more radical surgical treatments that can decrease or eliminate symptoms of endometriosis at the cost of fertility and normal estrogen production.
Read more about hysterectomy for endometriosis.
Endometriosis pain is primarily caused by the response of endometriosis adhesions to changes in estrogen levels during the menstrual cycle. Hormone therapies help decrease symptoms by controlling estrogen levels and sometimes by preventing menstruation.
Hormonal birth control, taken orally, by injection, or by intrauterine device, can control symptoms in many people with endometriosis. Other hormonal therapies include gonadotropin-releasing hormone (GnRH) receptor antagonists, such as Orilissa (elagolix), or GnRH agonists, such as Lupron (leuprolide), to decrease the body’s production of estrogen.
All of these treatments may help reduce pain and other symptoms by addressing the underlying causes of endometriosis, but there are other treatments that directly address pain.
Pain prevention is important, but often you need relief from the pain that you are already experiencing. Pain relief can come in many forms. Over-the-counter and prescription medications, physical therapy, and complementary and alternative therapies can all help you control the pain associated with your endometriosis and improve your quality of life.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are analgesics (pain relievers) that disrupt the body’s normal process of producing pain and inflammation. NSAIDs can often help treat both acute and chronic mild to moderate pain. NSAIDs may also help prevent side effects of endometriosis, such as headaches.
Brand name and generic over-the-counter NSAIDs are widely available, including aspirin, Motrin and Advil (ibuprofen), and Aleve (naproxen). Prescription NSAIDs include Cataflam (diclofenac) and high-dose ibuprofen.
Tylenol (acetaminophen) is an over-the-counter pain medication and fever reducer. Acetaminophen is not an NSAID, but it is used in the same way as NSAIDs to treat acute and chronic pain.
Opioid analgesics are prescription pain relievers that work by changing how nerve cells transmit pain to the brain. Opioid medications are typically used to treat moderate to severe pain. Opioids are very effective against acute pain, but these drugs generally should not be used to treat chronic pain because they have a high addictive potential. Long-term opioid use can also have side effects such as constipation and increased sensitivity to pain.
Opioids that can be used to treat endometriosis pain include:
Opioids are also often combined with acetaminophen or aspirin to enhance their effectiveness. Examples of opioid combination medications include Norco and Vicodin, which combine hydrocodone and acetaminophen, and Percocet (oxycodone/acetaminophen).
Prescription antidepressants are sometimes used “off label” (outside of U.S. Food and Drug Administration-approved use) to treat chronic pain. Different classes of antidepressants can be used to treat endometriosis pain.
Selective serotonin reuptake inhibitors that may be used for endometriosis pain include drugs such as:
Serotonin and norepinephrine reuptake inhibitors that may be prescribed for endometriosis pain include:
Other antidepressants, such as the norepinephrine and dopamine reuptake inhibitor Wellbutrin (bupropion hydrochloride), are also sometimes used to help treat endometriosis pain.
Physical therapy, or physiotherapy, can help treat and prevent endometriosis pain by strengthening the pelvic floor muscles. Many physical therapy exercises, as well as treatments such as transcutaneous electrical nerve stimulation (TENS), can be performed at home. TENS uses a small, portable device and electrodes attached to the skin to reduce pain through electrical stimulation. This method is effective for endometriosis pain as well as chronic back pain and other conditions.
Acupuncture uses small needles placed into the skin by a trained acupuncturist at very specific points on the body. Acupuncture has been used for thousands of years, and scientific research has found that acupuncture is effective for treating chronic pain.
Read more about acupuncture for endometriosis.
Cannabidiol (CBD) is one of the two main active ingredients in cannabis (also called marijuana), along with THC. Unlike THC, CBD is not psychoactive and does not cause the “high” often associated with cannabis. CBD is also found in industrial hemp, which does not contain THC or only has trace amounts.
CBD oil has shown effectiveness in treating endometriosis pain as well as anxiety, depression, and other symptoms. While CBD oil is legal in most places in the United States, CBD oil derived from marijuana (THC-containing cannabis) is illegal in some states. CBD oil derived from industrial hemp is legal by federal law, but state laws vary.
Read more about CBD oil for endometriosis.
Medical cannabis (medical marijuana) can help relieve endometriosis pain in some people. The THC found in cannabis is known to help treat chronic pain, and recent research using mice models has found beneficial effects of THC in treating endometriosis-related pain.
Cannabis use, even medical cannabis, is still very restricted in the United States. Many states have legalized medical marijuana with many restrictions, including which conditions can be treated and the forms of cannabis that are allowed. Talk to your doctor if you think medical cannabis may be a good option for you. They can advise you on any restrictions and make a recommendation on which forms to try.
Sometimes simple solutions are effective. Using a heating pad or hot water bottle can help relieve menstrual cramping by relaxing muscles and increasing blood flow. Massage therapy and yoga can often help relieve stress and pain. Even light exercise may help manage pain by increasing endorphins. Ask your health care provider for medical advice about what types of pain-relieving treatments might be best for you.
There are many ways to treat endometriosis pain, but no universal treatment can help everyone. Try different ways to treat your pain and find out what works for you. Talk to your doctor about what you have tried to ease your pain. They will likely have insights and recommendations for your particular situation. Most importantly, don’t give up. If you aren’t getting the pain relief you need, don’t stop searching until you find what helps you live the best life that you can.
MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 121,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.
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