What Causes Endometriosis Pain and What Can You Do About It?

November 25, 2024  By: Women's Health Team

Woman touching her stomach experiencing abdominal pain at home

Content medically reviewed by Jeffrey Johnson, MD

Endometriosis is a condition that affects more than 11% of women between the ages of 15 and 44 in the United States. If you are one of them, you may know how painful it can be and how it can impact your daily activities. But you don’t have to accept endometriosis pain as a way of life. With treatment and lifestyle changes, you can manage your symptoms and prevent complications.

Understanding Endometriosis Pain

Endometrium is the tissue that lines your uterus. When you have endometriosis, tissue similar to the uterine lining grows in areas other than the uterus, potentially causing abdominal pain and more severe menstrual cramps. Usually, endometriosis forms on –

  • Ovaries
  • Fallopian tubes
  • Tissues holding the uterus in place and lining the abdominal cavity

Although endometriosis growths, typically referred to as implants, are not cancerous, they can cause problems because they may swell and bleed according to your menstrual cycle, just like the uterine lining does every month. However, growths from endometriosis are within the body, most commonly the abdomen. This leads to inflammation and eventually fibrosis and scar tissue. For example, when these growths cover or expand into your ovaries, the blood has nowhere to go and can form cysts.

Adhesions, a type of tissue that can cause your organs to bind together, can also develop from endometriosis.

“The most common sign of endometriosis is pelvic pain, which happens due to the scar tissue and adhesions that form as endometrial tissue expands,” said Dr. Jeffrey Johnson, OB/GYN at Essentia Health. “Pain is often worse during your menstrual period. But some women experience other types of pain as well as additional symptoms that affect quality of life.”

Is It Endometriosis Pain or Something Else?

Pelvic pain is just one possible symptom of endometriosis. You may also experience other types of pain, such as –

  • Chronic lower back pain
  • Pain during or after sex, often described as a deep pain
  • Pain in the intestines
  • Pain when urinating or painful bowel movements during your period
  • Very painful cramps during your period, which may worsen over time

Having any of these symptoms along with pain can be a clue that you could have endometriosis –

  • Digestive problems, such as constipation, diarrhea, bloating, or nausea, which may get worse during your period
  • Infertility
  • Spotting between periods or very heavy periods

If you have symptoms of endometriosis, make an appointment with your health care provider. They will do a pelvic exam and may order imaging tests, such as an ultrasound, to look for ovarian cysts.

Sometimes, these tests are enough to make a diagnosis. But the only definitive way to know if you have endometriosis is to have laparoscopic surgery. The surgeon will insert a thin camera, called a laparoscope, through a small cut near your belly button. They will look for areas of endometriosis and may also take a tissue sample for a biopsy.

What You Can Do About Endometriosis Pain

If you are diagnosed with endometriosis, your provider will discuss ways to reduce your pain and other symptoms. Because endometriosis symptoms often flare up when hormone levels are high, treatments often focus on hormone management.

“There is no cure for endometriosis, and medications do not make existing endometriosis implants go away,” Johnson said. “But they can slow the growth and prevent new scars from forming, which will help reduce symptoms. Treatment for endometriosis depends on factors like your age, the severity of your symptoms, and whether you want to become pregnant.”

Options include –

  • Hormonal birth control. This is usually the first treatment for women who are not trying to get pregnant. Extended-cycle (which means you only have a few periods per year) or continuous cycle (which means you have no periods) birth control pills or shots can help stop pain and bleeding. An intrauterine device (IUD), which is a small device inserted directly into the uterus, can also reduce or eliminate these symptoms.
  • Gonadotropin-releasing hormone (GnRH) agonist. In patients who birth control is ineffective, your provider may prescribe a GnRH agonist, which prevents the body from making hormones responsible for the menstrual cycle and the growth of endometriosis. While it triggers a temporary menopause, it stops endometriosis from continuing to grow. Once you stop taking it, you may have a better chance of becoming pregnant. Most providers recommend staying on this type of medication for six months at a time to prevent complications like bone density loss or heart problems. Other side effects, such as hot flashes, trouble sleeping, vaginal dryness, depression, and muscle and joint stiffness, can also occur.
  • Surgery. People with endometriosis who do not find relief with medications or who are having problems with fertility may opt to have surgery, in which endometriosis growths are removed or destroyed with heat. In some cases, providers recommend having a hysterectomy, a surgery that removes the entire uterus. If the ovaries also have severe damage, the surgeon may also remove the ovaries and fallopian tubes.

“Hormone therapy works best for women who do not have severe symptoms,” Johnson said. “If you have severe pain or trouble getting pregnant, surgery may be the best route. At Essentia Health, we offer minimally invasive procedures like laparoscopy and robotic-assisted surgery for diagnosing and treating endometriosis, which helps make recovery faster and easier.”

If your pain is mild, you can also try some of these alternative methods of managing your symptoms –

  • Over-the-counter medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs)
  • Acupuncture
  • Chiropractic care
  • Supplements, such as vitamin B1, omega-3 fatty acids, or magnesium

For some, pain from endometriosis also improves after menopause when the implants slowly shrink due to a lack of estrogen. If you take hormone replacement therapy after menopause, your endometriosis symptoms may continue. Your provider can talk to you about the treatment options that are best for you.

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