Managing Endometriosis Pain

There’s no one way to ease endometriosis pain. But there are a lot of options that may help you find relief. And you may have to try several approaches before figuring out what works best for you.

“Endometriosis treatment should be tailored to each individual,” says minimally invasive gynecologic surgeon Megan Billow, DO. “Your pain symptoms, reproductive goals and quality of life all play an important role in determining the best treatment plan. Nobody knows your body better than you do.”

Approaches to endometriosis pain relief

The most important first step in coping with endometriosis is talking with a healthcare provider about your symptoms and treatment goals. Their treatment recommendations may depend on factors like:

• Your age
• The severity of your symptoms
• Whether you want to become pregnant

You may benefit from combining self-care strategies, lifestyle changes and medical treatments.

At-home options and lifestyle changes

Certain changes you make and steps you take may help relieve endometriosis pain. Dr. Billow explains.

Healthy diet

“There isn’t a single ‘endometriosis diet,’” Dr. Billow clarifies. “But maintaining overall healthy habits may help support your body’s inflammatory response.”

Focus on:

• Eating a balanced diet rich in fruits, vegetables and whole foods
• Limiting highly processed foods
• Paying attention to foods that seem to worsen symptoms

Some women report improvement with diets like veganism or keto eating patterns. But research hasn’t shown that one specific diet works best for endometriosis.

“Be cautious of claims that diet alone can cure endometriosis,” Dr. Billow urges. “Endometriosis isn’t caused by the foods you eat, and changing your diet won’t eliminate the disease.”

Regular exercise

There are several reasons why exercise may help reduce endometriosis symptoms. Physical activity has been shown to:

• Improve circulation
• Support your body’s natural anti-inflammatory processes
• Release endorphins, hormones that influence how your body perceives pain

“Strengthening and mobility exercises — including yoga and Pilates — can be especially helpful for many people with endometriosis,” Dr. Billow says.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen may help manage pain from endometriosis.

“These medications can be helpful for short-term symptom relief,” Dr. Billow notes. “But they don’t treat the underlying disease, and they shouldn’t be relied on as a long-term solution without medical guidance.”

Always talk with your healthcare provider before using these medications.

Talk therapy

Living with chronic pain from endometriosis can be a lot to handle. But a therapist may be able to help. Cognitive behavioral therapy (CBT) is a type of structured talk therapy that can benefit people who are living with medical conditions that cause chronic pain.

A review of studies into CBT for women living with endometriosis found that this type of therapy helped:

• Lessen the perception of pain
• Reduce depression and stress related to living with endometriosis
• Improve overall quality of life

“Living with endometriosis affects both physical and emotional well-being,” Dr. Billow empathizes. “Working with a therapist can help you develop coping skills, manage stress and better regulate your nervous system.”

Stress management

“Stress and pain often reinforce one another,” Dr. Billow says. “Chronic stress can amplify pain signals, while persistent pain increases stress levels.”

That makes it especially important to find healthy ways to manage life’s stressors. Strategies that may help regulate stress include:

• Meditation
• Mindfulness techniques
• Deep breathing exercises

“Anything that helps calm your nervous system may also help reduce how intensely you experience pain,” she adds.

Heat therapy

Heating pads or heat wraps may help ease pelvic cramping and muscle tension. Although research specific to endometriosis is limited, many women report that heat therapy is one of their most helpful self-care strategies.

“With endometriosis, it’s common to develop pelvic floor muscle tension in response to chronic inflammation and pain,” Dr. Billow explains. “Heat can help relax those muscles and reduce the spasms that often worsen pelvic pain.”

Complementary therapies

You may want to explore complementary therapies to help manage endometriosis symptoms, like:

• Acupuncture
• Massage therapy
• Meditation

“Research on these therapies is still evolving,” Dr. Billow notes. “While results are mixed, these approaches are generally considered safe for most people when performed by trained professionals.”

Always discuss complementary treatments with your healthcare provider first.

Medical treatments

If lifestyle strategies aren’t enough to manage your endometriosis symptoms, medical treatment options may help.

Hormone suppression

Many medications used to treat endometriosis work by suppressing estrogen, the hormone that drives the growth and activity of endometriosis lesions. These medications may include:

• Hormonal birth control
• Progestin therapies
• Gonadotropin-releasing hormone (GnRH) medications

But if you’re hoping for pregnancy, this may not be the right route for you right now.

“If you’re trying to conceive, hormonal suppression may not be appropriate,” Dr. Billow cautions. “That’s why treatment planning should always include a discussion about your fertility goals.”

Pelvic floor therapy

Endometriosis can cause pelvic floor muscle dysfunction, which can contribute to pelvic pain. A pelvic floor physical therapist can help identify muscle tension patterns and guide you through targeted techniques to relax and strengthen those muscles.

“Pelvic floor therapy can be an extremely helpful part of treatment,” Dr. Billow says. “It helps retrain muscles that have been guarding or tightening in response to chronic pain.”

Surgery to remove lesions

In some cases, your provider may recommend surgery to treat endometriosis and reduce pain.

The goal of surgery is to identify and remove endometriosis lesions. Your surgeon will use small incisions and specialized instruments to carefully excise (remove) the endometriosis tissue from its base, rather than simply destroying the surface of the lesion.

“By removing the lesions themselves, we can address a major source of inflammation and irritation that contributes to pain,” Dr. Billow says. “The tissue can also be sent to pathology so we can confirm the diagnosis.”

Surgery may be recommended if you:

• Have persistent pain despite medical therapy
• Have severe disease
• Are experiencing infertility related to endometriosis

“For many people, surgery is one part of a comprehensive treatment plan, which may also include hormonal therapy, pelvic floor physical therapy and other pain management strategies,” she adds.

Hysterectomy

If your symptoms are severe and other treatments haven’t worked, your provider may discuss hysterectomy as an option. But it’s important to know that removing your uterus doesn’t necessarily eliminate endometriosis. That’s because the disease can exist outside your uterus.

“A hysterectomy may help certain symptoms, like severe uterine pain or adenomyosis,” Dr. Billow explains. “But it’s not a cure for endometriosis.”

It’s important to have a detailed conversation with your healthcare provider about which treatment decisions are right for you and for your health priorities.

Are there other therapies for endometriosis?

You might’ve heard of other treatments to help reduce endometriosis pain, but research in these areas is still developing. Examples include:

• Trigger point injections: These injections are sometimes used to treat myofascial pelvic pain, which can occur alongside endometriosis.
• TENS unit: Transcutaneous electrical nerve stimulation (TENS) uses low-voltage electrical currents to help relieve pain. But evidence for endometriosis, specifically, is limited.
• Virtual reality (VR) therapy: Early studies are exploring whether virtual-reality-guided movement or exercise programs may help reduce chronic pain. But research is still in its early stages.

Final thoughts

Endometriosis is a chronic condition that can affect every facet of your life. Finding effective ways to manage your pain often requires patience — and a personalized approach.

“You might’ve grown up learning that severe period pain is normal,” Dr. Billow empathizes. “But if pain is interfering with your work, relationships or daily activities, it’s important to know that help is available.”

Talk to your provider every step of the way so they can continually reassess your needs.