7 tips to help relieve endometriosis pain

What does endometriosis pain feel like?

Pain is the most common symptom of endometriosis, but each woman's experience of endometriosis pain, and how this affects their quality of life, is slightly different. For example:

• Severity - endometriosis pain can range from mild to extremely painful.

• Frequency - endometriosis pain is chronic, meaning its reoccurrences are ongoing. It's usually worse during your period but can happen during other times of the month. For some, pain can last all through the month, with changing intensity. Sometimes, sexual intercourse and going to the toilet make it worse.

• Where in the body - it's most common to experience this pain in the lower part of your tummy, called pelvic pain, where regular period pain occurs. But you might feel pain in other places, such as your lower back, rectum, or legs, depending on where your endometriosis cells grow.

If you're living with endometriosis, the cycle of chronic pain can be difficult to cope with and can affect your mental health. Keisha Meek, a 31 year old from Leeds, has lived with endometriosis for 20 years. Read about Keisha's story of endometriosis pain and how she found life-changing support here.

What helps endometriosis pain?

Your doctor or endometriosis specialist may help you get your pain under control with the following treatments:

1. Pain medication - medication that manages pain, may include paracetamol if pain is mild, non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen, or codeine if pain is severe.

2. Hormone treatment - for example, methods of contraception such as the contraceptive pill or the intrauterine system (IUS).

3. Surgery - for example, keyhole surgery, known as laparoscopy, to remove endometriosis tissue, or surgery to remove the womb in more severe cases, known as hysterectomy.

For many women, at home or complementary pain relief can work alongside these treatments to effectively ease pain. For some, it could be that pain medication isn't enough on its own, or that side-effects have eliminated some options.

1. Plenty of fluids

This tip is for everyone, because proper hydration - where your pee runs clear in colour - is important for your overall health. As for endometriosis symptoms, drinking plenty of water can help reduce bloating and the intensity of period cramps¹.

2. Heat therapy

Heat can be used to treat lots of types of pain, endometriosis included. It can loosen and soothe muscles in areas that cramp up in response to endometriosis pain. You have several at-home and cheap choices to try - a hot water bottle or heating pad may be enough to free you from discomfort.

"Having a warm bath works for me," says Keisha.

3. Light to moderate exercise

Some people have reported that exercise helps during flare ups: "for me, walking, yoga, and going to the gym eases my body up when areas have cramped in pain," says Keisha.

Experts think light to moderate exercise may ease pain by:

• Improving your fitness, posture, muscle balance, and joint mobility, which is shown to help with a range of painful conditions.

• Reducing oestrogen levels, a hormone that contributes to inflammation and pain in women with endometriosis.

• Releasing endorphins, the happy hormones that help relieve pain and stress.

Mind-body exercises like yoga may improve pain control and have the added benefit of supporting mental wellbeing². No matter what physical activity you try when in pain, keep it light to moderate, start small, and work within your body's limits - which may change from day to day.

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The organs inside a woman's pelvis include the womb (uterus), the bladder and the back passage (rectum). Normally, these are supported and held in position by certain structures including ligaments and the muscles at the bottom of the pelvis (pelvic floor muscles). Pelvic organ prolapse (also known as genitourinary prolapse) occurs when these normal support structures are weakened and are no longer effective. The result is that one (or more) of the organs inside the pelvis drops down (prolapses). The space available for the organ(s) to drop down into is the vagina. There can be different degrees of prolapse, depending on how much, or how far, the organ(s) might have dropped down into the vagina. Sometimes, the prolapse can be so much that it causes the walls of the vagina, or the uterus, or both, to protrude outside the opening of the vagina.

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4. Endometriosis diet

The relationship between food, inflammation, and endometriosis symptoms is a relatively new research area. There are many anecdotal claims that adopting what's sometimes called an endometriosis diet can help fight endometriosis pain and other symptoms.

Scientific evidence is also growing. One 2023 study³ found that diets that increase inflammation - specifically diets high in meat and bad fats found in processed foods - may increase endometriosis pain, while plant-based diets with anti-inflammatory properties may improve pain. It also suggested that consuming foods high in vitamins C, D, and E can significantly reduce pain and other symptoms.

Other research suggests a gluten-free diet may offer endometriosis pain relief, because gluten may promote inflammation in people with the condition⁴. However, cutting any food groups from your diet need to be reviewed with a doctor.

Data on endometriosis and diet is limited, and results of existing research is mixed. However, most people can benefit from following a healthy diet that's rich in anti-inflammatory foods, like berries and fatty fish, and low in inflammatory foods, like processed meats and refined carbs.

5. TENS machine

A transcutaneous electrical nerve stimulation (TENS) machine is a small device with sticky pads that attach to your skin and deliver mild electrical pulses. These don't hurt but may feel ticklish. The idea is that the electrical pulses block pain by either disrupting pain messages travelling in your nerves, or by encouraging the release of endorphins, your body's natural pain-relievers.

A TENS machine is small, lightweight, and easy to use on the move - you can clip it to your belt, put it in your pocket, or hold it in your hand. It doesn't work for everyone, so before buying your own you may wish to borrow one from your pain specialist or physiotherapist.

It's best to get medical advice before buying your own, but TENS machines are generally considered safe for most people and are available to purchase in pharmacies. Prices can vary from around £20 to £100, but the more costly options aren't necessarily better, so product reviews may be the best indication of quality.

For Keisha and many others, these machines are a more natural and effective alternative or addition to pain medication⁵, but research on this type of short-term pain relief is still ongoing.

6. Acupuncture

If you favour a more traditional approach to pain relief, acupuncture is an ancient Chinese therapy that works in a similar way to TENS machines. By inserting very fine needles into your skin at specific points, an acupuncture practitioner may relieve pain by interfering with pain pathways and stimulating the release of endorphins. Several studies demonstrate the ability of acupuncture to soothe endometriosis pain⁶.

7. Osteopathy and massage

Some people turn to osteopathy and other forms of massage during endometriosis flare ups. Osteopathy practitioners use their hands to massage areas of soft tissue abnormalities - like endometrial tissue - and the surrounding muscles that may have seized up in response to pain, which can help alleviate this symptom⁷. Therapeutic massage applies less physical pressure but focusses more on relaxation, making it a good mind-body option for some people who find osteopathy uncomfortable.

Further reading

1. Torkan et al: The role of water intake in the severity of pain and menstrual distress among females suffering from primary dysmenorrhea: a semi-experimental study.

2. Gonçalves et al: A qualitative study on the practice of yoga for women with pain-associated endometriosis.

3. Barnard et al: Nutrition in the prevention and treatment of endometriosis: A review.

4. Marziali et al: Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?

5. Mira et al: Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS).

6. Xu et al: Effects of acupuncture for the treatment of endometriosis-related pain.

7. Sillem et al: Osteopathy for endometriosis and chronic pelvic pain.