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Does endometriosis cause trouble only during periods?

Period pain is not something that women look forward to. The difference between pain due to endometriosis and normal period pain is that the former is unbearable. Endometriosis is a health condition where the tissues similar to the inner lining of the uterus grows outside the uterine cavity. This pain associated with endometriosis varies from person to person. Endometriosis causes trouble for women not just during their menstruation but also before or after that. The pain usually manifests as pelvic pain, pain in the lower back, leg pain, pain during sexual intercourse or while passing urine and stools. So to say that endometriosis cause trouble only during periods may not be true.

What to expect pre & post periods?
Pain in your pelvic area, pre and/or post the menstrual cycle is the most common symptom of endometriosis. This is primarily caused due to the hormone fluctuations that happen during the monthly menstrual cycle that results in the body shedding the endometrial tissues. The shedding results in pain that might be severe to moderate in nature. It can also include cramping and heaviness in the pelvic area, pain in the lower back, stomach or even legs.

What is normal period pain?
Menstrual pain can be considered normal if:
1.The pain is there only in the first one or two days of the menstrual cycle.
2.The pain goes away after taking pain medications or a contraceptive pill.

How is endometriosis pain different from typical menstrual pain? 
1.Endometriosis cramps mostly occur in lower abdomen and back or pain in the hips and thighs. 
2.It can be accompanied by nausea or lightheadedness, abdominal bloating, constipation, or diarrhea.
3.Can be more severe and longer than normal menstrual cramps. Cramps can also start earlier in the menstrual cycle.

In 10% women, menstrual pain results in impairing daily activities for 1-3 days every month2. Sometimes these painful periods can also be due to adenomyosis which most often occurs during late childbearing years. 

How to Keep Endometriosis Pain in Control?

One should avoid the following:
1.Foods that contain caffeine and salt
2.Tobacco and alcohol consumption
3.Refined foods such as white sugar, white bread and white pasta.
4.Trans-fatty acids found most often in commercially-prepared foods like French fries, cookies, etc.

It is important to avoid the following as these can further increase pain and inflammation. Reducing the total intake of fats in diet can help relieve painful periods.

Things that help ease endometriosis pain:
1.Place a heating pad or a hot water bottle on the lower abdomen.
2.Take a hot shower.
3.Regular exercise and relaxation regimens such as yoga, meditation, acupuncture and acupressure, etc.
4.Proper and timely rest.
5.Drink More Water- helps in ease bloating
6.Eat to Reduce Pain- anti-inflammatory foods like cherries, blueberries, squash, tomatoes, and bell peppers. Food high in omega-3 fatty acids and more calcium-rich beans, almonds, and green vegetables which helps in combating inflammation
7.Over-the-counter pain relievers such as NSAIDs can be used. Besides relieving pain, NSAIDs reduce the number of prostaglandins that uterus makes and lessen the cramps.
8.Natural health supplements that contain highly bioavailable curcumin, vitamin D, resveratrol, n-acetyl cysteine, etc. These supplements are effective and safe and have been validated by several clinical studies.

Can supplements help and how long should one take them?
Due to several downsides of NSAIDS such as limited efficacy and a range of unwanted side-effects, women are left looking for other solutions that are safe and effective and help with the long term pain management associated with endometriosis. Nutrition based supplements can be a viable treatment option for pain reduction. 

Deficiency of certain important nutrients may be an underlying cause of period pain. Supplements can have strong physiological effects on the body. The amounts of certain nutrients in the system can affect how well the uterus functions, and how one experiences pain.

Certain commonly used supplements for menstrual heath are mentioned below:
Vitamin E – reduces menstrual pain in some women. May increase bleeding.
Vitamin D – helps in the absorption of calcium and can reduce inflammation which further helps in pain relief.
Magnesium – Reduces menstrual pain. 
Calcium citrate – Sustains muscle tone which relieves the menstrual cramps. 
Curcumin – One of the best natural anti-inflammatory and anti-oxidants. Proven to help with pain associated with menstruation.
Resveratrol – Reduces inflammation and pain associated with endometriosis.

Symptoms between periods
There is a lot of variation in the symptoms of endometriosis, some women may have very few symptoms, meanwhile, others suffer to a much greater extent – pelvic pain is often the primary symptom of endometriosis. Although most of the women experience cramps during their menstrual periods, those with endometriosis typically describe menstrual pain that’s far worse than usual and that persists after the periods.

The severity of the pain may increase over time. This pain can happen repeatedly, before, during and after the menstrual cycle —with time also during other times of the month — for more than six months. Sometimes the pain is so severe that OTC pain relievers will not be able to provide pain relief.

Curcumin reduces pain & inflammation
Curcumin is a naturally occurring phytochemical. It has anti-inflammatory, antioxidant, anti-angiogenic, anti-neoplastic properties.

Curcumin reduces inflammation and provides relief from menstrual cramps and pain associated with menstruation. Several studies also reported that curcumin may have positive benefits on the prevention and treatment of endometriosis. Inflammation plays a key role in the development of endometriosis and curcumin has anti-inflammatory properties. Thus, it can be a valuable agent in the prevention and treatment of endometriosis.

Treatment with curcumin helps in reducing inflammation through the suppression of inflammatory cytokine expression, stops invasion, attachment, and angiogenesis of endometrial lesions and works to lessen the inhibition of cell proliferation.

It is a phytoestrogen, a natural polyphenolic compound known to have antiproliferative and anti-inflammatory properties.

As resveratrol has a higher affinity for ESR2 (Estrogen receptor -2) and because ESR2 is dramatically overexpressed in endometriosis, this preferential binding of resveratrol to ESR2 blocks the ability of estrogen to induce its own receptor.

The anti-inflammatory effect is manifested through the inhibition of prostaglandin synthesis via the inhibition of COX enzyme synthesis, activated immune cells and pro-inflammatory cytokines.

By suppressing the expression of COX-2 and aromatase enzymes it helps in reducing the endometriosis-related pain.

The resistance to oral contraceptive treatment might be associated with high levels of aromatase expression in endometriotic lesions. A combination of an oral contraceptive pill with aromatase inhibitors, resveratrol seemed to be beneficial as it leads to a significant reduction in pain.

NAC reduces cell proliferation and decreases cell locomotory behavior, particularly relevant in endometriosis. In addition, NAC also downregulates inflammatory protein activity and gene expression.

Along with this, NAC eases oxidative stress and may also help to keep the liver detoxified. N-acetyl-cysteine is reported to reduce endometriosis and improve fertility too.

Vitamin D
Study showcases that women with the low blood concentrations of the vitamin D had the largest ovarian endometrioma, or ovarian cysts. Vitamin D reduces inflammatory responses, and regulates effects on the immune system. 

DISCLAIMER: The information published above is for educational purposes only and should not be used in any other manner. The information is not intended to substitute medical/professional advice. The information should not be used to diagnose or treat a health problem or disease without consulting a qualified healthcare practitioner.

References:, last accessed on 30th Jan 2020 [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Period pain: Overview. 2008 Feb 22 [Updated 2019 Aug 1],, last accessed on 30th Jan 2020 last accessed on 30th Jan 2020, last accessed on 30th Jan 2020

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