Pain management

Pain management in endometriosis

Chronic pain is the most burdensome symptom for many women with endometriosis. It can disrupt work, relationships, sleep and daily functioning. Pain in endometriosis has its own characteristics - it is not only menstrual pain, but often month-long pelvic pain requiring a comprehensive approach.

Pain management in endometriosis is a discipline in its own right and should ideally run alongside hormonal or surgical treatment - not instead of it.

Why is pain in endometriosis complex?

Pain caused by endometriosis does not always correspond to the extent of disease. In some women, central sensitisation develops - the nervous system becomes hypersensitive and pain persists even after lesions are removed. Therefore, in chronic endometriosis, pain should be approached as a separate problem deserving its own treatment.

NSAIDs - non-steroidal anti-inflammatory drugs

NSAIDs are the first-line choice for menstrual pain caused by endometriosis. They work by blocking prostaglandin production - substances causing inflammation, pain and uterine contractions. Prostaglandins are overproduced in women with endometriosis.

A key rule most women don't know: NSAIDs do not block existing pain - they block the production of substances that cause pain. They must therefore be taken before pain starts:

• start NSAIDs at least 24 hours before expected menstruation
• with an irregular cycle, start a week before the estimated start
• take them every 6 hours regularly throughout menstruation - not only when pain is severe
• always take with food or milk - NSAIDs irritate the stomach lining

Most commonly used NSAIDs for endometriosis:

• Ibuprofen (Nurofen, Advil) - the most accessible option
• Naproxen (Aleve, Naprosyn) - longer action, fewer doses needed
• Mefenamic acid (Ponstan) - particularly effective for heavy menstrual bleeding
• Ketoprofen (Ketonal)

NSAIDs also reduce menstrual bleeding - an added benefit. If one preparation doesn't work, try another - effectiveness varies and it may be necessary to try 2-3 preparations before finding the right one.

Analgesics

Paracetamol (Panadol) relieves pain by a different mechanism than NSAIDs. It can be combined with NSAIDs for stronger pain, does not irritate the stomach. For very intense chronic pain, a doctor may consider stronger preparations - always under specialist supervision.

Medications affecting the nervous system

For chronic pelvic pain with central sensitisation, medications originally developed for depression or epilepsy are sometimes used - for example amitriptyline or gabapentin. These preparations do not affect mood, but reduce nervous system hypersensitivity to pain. They are prescribed by a pain specialist.

Pelvic floor physiotherapy

Physiotherapy focused on the pelvic floor is one of the most effective non-pharmacological methods for pain management in endometriosis. Chronic pain causes the pelvic floor muscles to remain permanently tense - and this tension itself maintains and amplifies pain.

A physiotherapist specialising in the pelvic floor can:

• release chronically tense pelvic floor and lumbar muscles
• work with scar tissue after surgery
• teach you techniques for managing pain in daily life
• improve bladder and bowel function affected by endometriosis

TENS

TENS (transcutaneous electrical nerve stimulation) is a non-invasive method in which electrical impulses through the skin suppress the transmission of pain signals to the brain. The device is small, portable and can be used at home. Particularly suitable for acute menstrual pain or chronic pelvic pain, with no side effects and can be combined with other treatment.

Heat

Applying heat to the lower abdomen or lower back is a simple but effective method of menstrual pain relief. Heat releases muscle tension and improves blood flow. A hot water bottle, heat patch or warm bath can significantly relieve acute cramps.

Psychological support

Chronic pain always has a psychological component - not because pain is "in the mind", but because the brain plays a key role in how it is processed. Long-term pain leads to anxiety, depression and social isolation, which further amplify pain.

• Cognitive-behavioural therapy (CBT) - helps change the way the brain processes pain and develops coping strategies
• Mindfulness and relaxation techniques - reduce tension and nervous system hypersensitivity
• Support groups - sharing experiences with other women with endometriosis helps overcome feelings of loneliness

Diet and lifestyle

Endometriosis.org notes that dietary changes can relieve pain, particularly for women who cannot or do not wish to take NSAIDs:

• Reduce animal fats, caffeine and alcohol - these promote the production of pro-inflammatory prostaglandins
• Add flaxseed oil, fish oil and olive oil - omega-3 fatty acids promote anti-inflammatory prostaglandin production
• Exercise - regular gentle exercise (walking, swimming, yoga) releases endorphins and reduces inflammation; intense exercise during acute pain may worsen the condition
• Sleep - lack of sleep lowers the pain threshold; good sleep hygiene is part of chronic pain management

Pain management centre

For severe chronic pain that does not respond to standard treatment, referral to a specialist pain management centre is appropriate. Our centre works with pain specialists and will help you find the right path. You don't have to endure pain.

Information on analgesic treatment: endometriosis.org - Painkillers.