Pain Management
Managing Pain While Healing the Cause
An Important Distinction
Treating Disease vs Managing Symptoms
It’s important to recognize that endometriosis care involves two distinct yet complementary goals: treating the disease itself and managing its symptoms. These are often mistaken as one and the same, resulting in some patients receiving only symptom relief while the underlying disease continues to progress. This “band-aid” approach may temporarily ease pain but fails to target the true source—the endometriotic lesions that can lead to organ damage, adhesions, and fertility challenges.
Quality of life is essential, and no one should have to endure unnecessary suffering while seeking definitive treatment. Even after optimal surgical excision, some patients may still experience pain due to factors such as central sensitization, adhesions, fibrosis, or overlapping conditions.
This page outlines evidence-based methods to manage endometriosis-related pain—strategies that provide meaningful relief and improved function as you collaborate with your surgical team to address the root cause. Think of pain management as a bridge—supporting your quality of life during treatment and helping you thrive beyond surgery.
The Many Faces of Pain
Understanding Endometriosis Pain
Endometriosis pain is extremely complex and multifaceted. It can include pelvic pain, dysmenorrhea (painful periods), dyspareunia (pain with intercourse), and chronic pain that persists beyond menstruation. It can also produce pain in other areas such as the upper abdomen and even in the chest. Understanding that endometriosis pain involves both peripheral (at the site of lesions) and central (brain and spinal cord) mechanisms is crucial for effective treatment. The following is just a primer to cover some of what is available to help you. It is not exhaustive, but it introduces what we might discuss with you at Lotus.
When the Nervous System Becomes Part of the Problem
The Role of Central Sensitization
Over time, persistent pain signals from endometriosis can lead to central sensitization - a condition where the central nervous system becomes hypersensitive to pain signals. This can result in any of the following:
Pain may persist even after lesions are removed
Normal sensations may be perceived as painful
Pain may spread to areas beyond the original site
The nervous system "learns" to maintain pain and has a hard time “forgetting”
Understanding central sensitization helps explain why some patients continue to experience pain after surgical treatment and why a multimodal approach to pain management is usually necessary for the best outcomes.
Evidence-Based Options for Relief
Medication & Procedural Approaches
Managing endometriosis pain often requires a combination of medical, interventional, and supportive therapies tailored to each patient’s unique presentation. The right approach depends on the nature of the pain—whether inflammatory, hormonal, neuropathic, or musculoskeletal—and how the body has adapted over time. Medical pain management can provide meaningful relief, especially when used thoughtfully alongside surgical and integrative care. The following overview outlines common evidence-based options, from first-line medications to advanced and interventional strategies, that may be part of a personalized pain management plan at Lotus.
These medications are typically the starting point for managing endometriosis pain because they are well-studied, generally accessible, and can provide significant relief for many patients. They work through different mechanisms to interrupt pain signals and reduce inflammation.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
Examples include ibuprofen, naproxen, and mefenamic acid. These medications work by reducing inflammation and blocking prostaglandin production, which helps lessen both pain and cramping. They are most effective when started before pain becomes severe and should always be taken with food to help protect the stomach lining.
Hormonal Therapies
Hormonal therapy can help with symptom relief, but does not treat the underlying disease despite common misconceptions. Hormonal treatments can also carry significant risks with limited long-term benefits, so they should always be used under the supervision of an endometriosis specialist. Common options include oral contraceptives, progestin-only therapies (pills, IUDs, implants, or injections), GnRH agonists / antagonists, and in select cases aromatase inhibitors.
Personalizing the Path to Relief
Important Considerations
Pain management for endometriosis is highly individual—what brings relief for one person may not work for another. Often, the most effective results come from combining different treatments rather than relying on a single approach. Ongoing follow-up is essential to fine-tune your plan as your body and symptoms change. In addition, lifestyle factors such as sleep quality, stress management, and nutrition play a significant role in how pain is experienced and controlled.
Beyond Medication
Non-Pharmacological Mainstream Approaches
These evidence-based non-medication and non-invasive treatments are crucial components of comprehensive pain management. They address the physical, neurological, and psychological aspects of chronic pain without the side effects of medications. Research shows that combining these approaches with medical management often yields the best outcomes for long-term pain control and quality of life improvement.
TENS (Transcutaneous Electrical Nerve Stimulation)
Non-invasive electrical stimulation for pain relief
Can be used at home with proper instruction
Works through gate control theory and endorphin release
Electrode placement and settings should be guided by healthcare provider
Generally safe with few contraindications
Cognitive Behavioral Therapy (CBT)
Evidence-based approach for chronic pain
Helps identify and modify pain-related thoughts and behaviors
Teaches coping strategies and stress management
Can reduce pain catastrophizing
May be offered individually or in groups
Pain Psychology
Specialized psychological support for chronic pain
Addresses emotional aspects of living with pain
Techniques include mindfulness, relaxation training, and biofeedback
Helps break the pain-stress cycle
A Strategy That Works for You
Creating Your Pain Management Plan
Developing an effective pain management plan for endometriosis takes time, teamwork, and careful coordination. Because every case is unique, the best outcomes come from a structured, multimodal approach that adapts to your specific needs and responses. By combining medical, physical, and lifestyle strategies under expert guidance, patients can achieve meaningful and sustainable relief.
Work with a multidisciplinary team – Collaborate with an endometriosis specialist, pain specialist, physical therapist, and mental health provider to address every aspect of pain.
Track your symptoms – Use a pain diary or app to recognize patterns, triggers, and treatment responses.
Start with conservative approaches – Introduce treatments gradually to gauge effectiveness and tolerance.
Be patient – Some therapies require weeks or months to reach their full benefit.
Communicate openly – Share what works and what doesn’t with your care team. Results are highly individual, but experience helps guide what’s most likely to succeed.
Guided by Science
References
Central Changes Associated with Chronic Pelvic Pain and Endometriosis
Brawn, J., Morotti, M., Zondervan, K. T., Becker, C. M., & Vincent, K.
Human Reproduction Update, 20(5), 737–747 (2014).Nonsteroidal Anti-Inflammatory Drugs for Pain in Women with Endometriosis
Brown, J., et al.
Cochrane Database of Systematic Reviews, Issue 1 (2018).Low-Dose Naltrexone for the Treatment of Fibromyalgia: Findings of a Small, Randomized, Double-Blind, Placebo-Controlled, Counterbalanced, Crossover Trial
Younger, J., et al.
Arthritis & Rheumatism, 65(2), 529–538 (2014).Medical Treatment of Endometriosis-Related Pain
Vercellini, P., et al.
Best Practice & Research Clinical Obstetrics & Gynaecology, 51, 68–91 (2018).Interdisciplinary Multimodal Endometriosis Treatment Improves Pain and Psychosocial Outcomes
Allaire, C., et al.
Journal of Obstetrics and Gynaecology Canada, 45(1), 45–52 (2023).Systematic Review and Meta-Analysis of Complementary Treatments for Women with Symptomatic Endometriosis
Mira, T. A. A., et al.
International Journal of Gynecology & Obstetrics, 151(1), 12–23 (2020).The Effectiveness of Self-Care and Lifestyle Interventions in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis
Armour, M., et al.
BMC Complementary and Alternative Medicine, 19, 22 (2019).Management of Endometriosis (ACOG Practice Bulletin No. 114, Reaffirmed 2018)
Obstetrics & Gynecology, 116(1), 223–236 (2010).
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