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Managing Endometriosis Flare-Ups

Posted on September 14, 2022
Medically reviewed by
Dan Martin, M.D.
Article written by
Sarah Winfrey

If you’re living with endometriosis, you may notice that your symptoms come on strong during flare-ups (when you feel worse). Many people with the condition experience painful menstrual periods, pain in the ovaries during ovulation, and severe pelvic pain during flares. Then the symptoms lessen for a bit of time, which is referred to as remission.

Endometriosis flares may be triggered by various factors. Some people find that their symptoms worsen with stress, while others notice that symptoms happen during their menstrual cycle. The pain experienced during these flare-ups can be excruciating and debilitating, often interfering with daily life.

Luckily, there are ways to manage endometriosis flares. You can work with your health care provider to identify your triggers and deal with flares when they arise.

What Do Endometriosis Flare-Ups Feel Like?

People experience endometriosis flare-ups in different ways. As one MyEndometriosisTeam member shared, “It is possible to feel many different symptoms at once."

“Another endometriosis flare ... lots of nausea, stomach, and pelvic cramps, and irritability x 10. I just want some relief,” another member said. A third member noted that they were “starting to feel that familiar painful bloat again.”

Pain is one of the distinct symptoms of an endometriosis flare. This pain can vary from sharp and stabbing to dull and throbbing. One member shared their experience with pain during a flare: “It feels like my insides are throbbing and just punching the inside wall of my abdomen. I also feel super nauseous and very irritable.”

Depending on how endometriosis presents, you might experience acute or chronic pelvic pain, cramping, nausea, irritability, constipation, bloating, and more. The key is to learn what endometriosis feels like to you. That way, you can pinpoint when it is starting to flare, so you can take action right away.

Managing Endometriosis Flare-Ups

There are many ways you can manage the symptoms of endometriosis during flare-ups. Some will require you to go to your doctor, while others can be done at home. It may take trial and error, but you can figure out what works for you when you’re experiencing a flare.

Prepare for Flare-Ups

If you don’t experience endometriosis pain all the time, it can be easy to get caught unaware when it returns. Many people find it helpful to keep track of what makes their endometriosis worse. You might find that your symptoms appear or worsen during ovulation or when your period starts. When you know what triggers your endometriosis, you can better prepare yourself to manage a flare before it happens.

Medication for Endometriosis Flares

There are many hormonal endometriosis treatments, including progestin-only therapy, estrogen/progestin therapy (found in many birth control drugs), medications that lower overall estrogen levels (which help manage endometrial tissue production), and androgen therapy. Certain antidepressants can also help you manage endometriosis flares by changing the way your body responds to pain. You will need to work with your doctor or gynecology expert to determine which of these medications might work for you.

You will need to take these medications regularly, not just when you are experiencing a flare — this could reduce the number of flares you experience and lower the severity of those you still have.

Medication for Pain Management

There are many pain medications that you can take for acute pain management. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. You can get several of these over the counter, although stronger doses require a prescription.

If NSAIDs don’t offer pain relief, your doctor may prescribe a codeine-based painkiller. These pain relievers are stronger but can come with side effects like intestinal upset, which can actually make endometriosis symptoms worse.

Heat for Endometriosis Pain Relief

Some people find that applying heat to their abdomen can temporarily relieve endometriosis pain. This can be as simple as curling up around a heating pad, lying down with a hot water bottle on your lower back, or using a wheat bag that you can heat in the microwave. Even taking a warm bath could help you feel better.

Evaluate Your Diet

Some people find that dietary changes help them manage endometriosis flares. However, you may need to use trial and error to find out what diet works for you. In general, dietary changes may be more useful for people with bowel-related endometriosis symptoms. Always talk to your doctor before making any changes to your diet.

“I went to a gastrointestinal specialist and went on an elimination diet to figure out what triggers my symptoms,” wrote one MyEndometriosisTeam member. Another said, “I find that being on an anti-inflammatory diet is most helpful.” You can work with a doctor or a dietitian to determine whether any particular diets might help you find symptom relief. Changing your diet can be challenging, and professional support can help.

Transcutaneous Electrical Nerve Stimulation

Transcutaneous electrical nerve stimulation (TENS) can help interrupt and change how the body processes pain signals. TENS units are small machines with electrodes that are applied to the skin on areas that are causing pain. The unit sends electricity through these electrodes — it just feels like a tiny tingle — and may make the pain less severe.

One study of 22 women with deep endometriosis (a more severe form of the condition) found that the use of TENS helped relieve pain, leading to a better quality of life. Research is ongoing about how TENS can help individuals with endometriosis.

TENS is not a good idea for everyone, so talk to your doctor before trying one of these machines.

Ask Your Doctor About Cannabidiol and Cannabis

If it is legal where you live, ask your doctor whether cannabidiol (CBD) or cannabis products might help manage your pain. One study out of Australia showed cannabis to be among the most effective home remedies for endometriosis pain relief.

Get Active

Exercise may be key to lessening the pain of endometriosis flares and even helping to avoid them. If nothing else, exercise releases endorphins into the body, which can help you feel better overall, even if the pain is still there.

Frequent exercise can also reduce the overall estrogen in your system, which may lower the severity of your endometriosis symptoms. You may want to consult with a physical therapist experienced in working with endometriosis to create a tailor-made exercise routine for you.

Pursue Stress Relief

Stress has been found to make endometriosis worse — both its symptoms and the condition itself. Lowering stress is an important goal when you feel an endometriosis flare coming on.

Reducing stress is not the same for everyone. Getting more sleep can help, as can massage and meditation. No matter what it takes, lowering your stress levels can play a big role in helping you feel better. Reducing stress can be considered one form of complementary therapy for endometriosis, meaning you use it in addition to the treatment plan that you’ve created with your doctor.

Find Your Team

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 127,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

How do you manage endometriosis flare-ups? Share your thoughts and tips in the comments below or by posting on MyEndometriosisTeam.

    All updates must be accompanied by text or a picture.
    Dan Martin, M.D. is the scientific and medical director of the Endometriosis Foundation of America. Learn more about him here.
    Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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