Endometriosis and Pain Management

Endometriosis - the invisible pain.....

The pain associated with Endometriosis is the most difficult symptom to cope with for most women. For many, the agony they suffer can severely interfere with every day life. It can be constant or it can be cyclical and normally coincides with a woman’s period.

Endometriosis pain management

What is causing your pain?

As well as coinciding with menstruation the pain symptoms can also be present at other times of the month. There can be severe discomfort with ovulation, as well as pain associated with adhesions, or caused by inflammation in the pelvic cavity, and problems caused during bowel movements.

It can sometimes occur during urination, as well as during general bodily movement i.e. exercise, from standing for too long. And the final insult, pain can develop during or after intercourse.

Normal or Suspicious Pain!

The fact that society in general views pelvic/menstrual pain as normal means that women themselves also believe it to be normal. This is why it takes so long for them to realise that something is actually wrong. They may start to discuss and compare their menstrual symptoms with others and gradually they realise that the amount of discomfort they feel is not normal.

So if you are reading this and suspect that you may have Endometriosis because of the amount of pain you suffer with your periods, you are well advised to get this checked out.

Location of pain

Most sufferers with Endometriosis experience pain that is focused in the pelvic area. It is often severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs.

Occasionally discomfort may occur in other regions. Implants can also occur in the bladder (although rare) and cause distress and even bleeding during urination. Endometriosis can also invade the intestine and cause painful bowel movements or diarrhoea. Large cysts commonly rupture and cause very severe symptoms in various locations of the pelvic cavity.


The level of discomfort  varies widely and is not related to the extent of the disease. A woman can have very small or few implants and have severe symptoms, while those with extensive Endometriosis may have very few signs and not suffer much. There is no logic as to how severe the discomfort of Endometriosis will be, but on the whole this disease causes severe pain for most sufferers.

Help with managing your pain

endometriosis pain

There are options available for the management of pain. These can include a variety of drug treatments as well as natural remedies, diet changes and supplements. Drug treatment is not the best option for relief because of the long term side-effects.

The two pain relief drugs that are used most commonly for Endometriosis are:

Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

These are a class of drugs which are designed to relieve pain as well as reduce inflammation. These drugs may vary in degrees of analgesic versus anti-inflammatory activity. This means that one drug may have a great anti-inflammatory properties, but provides little in the way of pain reduction. Whereas another drug may primarily have better painkiller benefits but has little ability to reduce inflammation.

There are many versions of these drugs which are available both by prescription and over the counter. Aspirin is a common NSAID; others include ibuprofen, naproxen, ketoprofen, all of which are sold under a trade name, so ask your pharmacist for advice. These drugs block the prostaglandins which are inflammatory factors strongly associated with Endometriosis, which increase uterine contractions and cause cramping and pain.

Please note: Drugs containing codeine should not generally be used for Endometriosis pain management. They can cause pelvic congestion and constipation, which could exacerbate symptoms.

GnRh Agonists

The GnRH class of drugs are becoming more widely used as a means to control the symptoms of Endometriosis. GnRH stands for Gonadotropin Releasing Hormone and they are regularly prescribed for treatment of Endometriosis with the aim to reduce the symptoms.

They alter the natural hormone levels of the body and chemically induce a state of menopause. This is to provide time for the Endometriosis implants to shrink, because they are not being fed by the natural cycle of hormones, namely oestrogen.

This method of treatment appears to be relatively effective for some women in helping to relieve the symptoms as well as temporarily working to shrink the implants. But these drugs have various side-effects, causing different problems for those who use them.

These drugs are only approved for use for six months of treatment. This is due to the possibility of loss of bone mass, which is supposed to be recovered after discontinuing treatment. The option to stop bone loss during this treatment regime is to give additional hormone therapy called 'Add-Back' therapy.

T.E.N.S for symptom relief

Transcutaneous electrical nerve stimulation (TENS) is a drug-free method of symptom relief that has been used to treat a wide variety of muscle and joint problems, as well as many other painful conditions.

TENS uses electrical impulses to stimulate the nerve endings at, or near the site of pain, diminishing the symptoms and replacing it with a tingling or massage-like sensation. 

TENS can be used in a health-care setting, but most often people use it at home, by purchasing their own equipment. It is a safe, non invasive, drug-free medically proven method of pain management.

Supplements for Pain Relief

Many sufferers have found that various natural remedies have helped with their pain. These may include vitamin and mineral supplements, herbs and diet changes.

Evening Primrose oil has had good results for many, both for Endometriosis and PMS. It contains a polyunsaturated fatty acid known as gamma linolenic acid, which seems to block the releases of cytokines and prostaglandins, substances that are manufactured by the endometrium and are involved in uterine muscle contraction and cramping. Foods that contain gamma linolenic acid are black currant oil and cold-water fish.

There are many changes you can make in your diet that will improve symptoms and in turn will improve the pain. This also includes an array of supplements and herbs which will help to cleans your system, boost your immune system, increase your energy and improve your overall health. For more advice and tips on supplements, vitamins, healing and the immune system read further here

Natural pain relief options for endometriosis


Studies have shown that massage can alleviate muscle and tissue-injury problems.  The long term effects of massage may also be useful for persistent symptoms like pain, and deep massage may help with adhesions - this will need to be done by someone who has experience of this type of treatment.


Certain essential oils can stimulate endorphin production and, when used with massage, they can encourage relaxation. The stress and anxiety caused by long-term illness can cause the muscles to become tense.

This may accentuate the perception of symptoms, creating a self-perpetuating downward spiral. So the use of aromatherapy can help to break the cycle caused by long-term illness.


Acupuncture is said to work partly by stimulating the release of endorphins and prostaglandin-suppressing corticosteroid hormones. The insertion of needles in appropriate acupoints may also help relieve anxiety and depression associated with persistent pain.


Yoga is believed to reduce symptoms by helping the brain's pain centre regulate the gate-controlling mechanism located in the spinal cord and the secretion of natural painkillers in the body.

Breathing exercises used in yoga can also reduce pain. Because muscles tend to relax when you exhale, lengthening the time of exhalation can help produce relaxation and reduce tension. Awareness of breathing helps to achieve calmer, slower respiration and aid in relaxation and pain management.


This product is produced for the relief of menstrual cramps, and is receiving a lot of good feed-back for the relief of pain associated with Endometriosis.

Menastil is topically-applied (applied to the skin), using a roll-on applicator. Many women have noted how fast and effective it is at relieving their  cramps. It is a homeopathic preparation and is available without prescription. The active ingredient is Calendula oil, which is effective as a topical analgesic and for pain relief.

It works by inhibiting the pain signals as they travel from one nerve cell to another. The junction, where these nerve cells connect with each other, is called a synapse. When applied topically, at the location of the pain, Menastil causes the endings of the nerve cells to retreat from each other and retract towards the cell body. This results in a reduction of the intensity of these impulses travelling to the brain and therefore a lessening in the amount of discomfort that is being registered by the brain.


Endorphins are nature’s pain killers. DL-Phenylealanine (DLPA) does not actually block the symptoms. It works instead by protecting the body’s naturally produced pain killing endorphins (the body’s morphine), effectively extending their life span in the nervous system. It slows the activity of "enzyme chewing" enzymes which destroy endorphins thereby giving them more time to act on areas of pain.

It is a powerful antidepressant and in clinical studies has been proven to be as effective as commonly prescribed antidepressant drugs - without the side effects. DLPA can also relieve symptoms of PMS and has had great success in dealing with the pain of Endometriosis.

Arnica Gel and Cream

Arnica is a homeopathic remedy, taken internally in pill form and used for bruises, wounds, sprains, injury, as well as for tiredness after prolonged exertion. Arnica is also prepared in a roll-on lotion and used for the above problems, and is effective for pain relief. You could experiment with both.


Methyl Sulphonyl Methane (MSM) is the full name of this natural compound. The common name is Sulphur.

MSM can help relieve symptoms in a variety of ways. It blocks pain messages that travel to the brain along nonmyelinated nerve fibres called C fibres. This results in relief of the deep aching sensation that is characteristic of chronic conditions like Endometriosis.

This natural compound can alleviate symptoms in other ways. It reduces the swelling and heat associated with inflammation, which in turn, relieves pressure on surrounding nerves and other tissues. It is also very good at relieving muscle spasm.

MSM goes beyond pain relief and is able to support healing of injured tissues by increasing blood flow. It also alters the cross-linkages of collagen, reducing scar tissue to promote motion and flexibility.

Learn more about the healing benefits of MSM and why this supplement is vital for optimum health HERE


Probably the last thing on your mind to help with pain is to do exercise, but it does help. This happens because when we exercise the body produces chemicals in the brain called endorphins. Endorphins actually bring pain relief and  will surge round the body, thereby easing the symptoms of Endometriosis.

The compounds found in endorphins are of similar structure and mimic the effects of morphine, a powerful narcotic pain reliever. Ten minutes of moderate exercise is all the body needs to start producing these safe pain relievers.

For some, exercise may be too difficult at times. Low impact activities may help. These include swimming, walking and yoga. Taking some form of exercise will help to relieve stress and tension and may reduce oestrogen levels in the body.

As well as trying some of the natural pain solutions above you can also reduce the symptoms of pain through diet.

Also, reducing the use of toiletries that contain chemicals can also be a huge help to reduce the symptoms of endometriosis. This helpful article HERE describes how you can avoid using chemical laden toiletries and a few ideas how you can make your own. 

Further details of pain medications for endometriosis discussed HERE

What actually causes the pain of endometriosis -  you can reduce pain through the prostaglandin pathway. Learn more ........

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