Endometriosis flare-up: Understanding the basics and coping

An endometriosis flare-up is a temporary condition in which your daily endometriosis symptoms worsen and become more intense. Although it may occur during or before menstruation due to hormonal fluctuations and higher inflammation, flare-ups are rather unpredictable and can take place at any time. The severity and duration can also vary–from mild worsening that lasts for minutes or hours to very intense symptoms lasting for days and weeks. The main endo flare-up symptoms include intensified period pain and bleeding, pain during or after sex, and pain during urination or bowel movements.

The four primary causes of flare-ups include:

• High estrogen
• Low progesterone
• Chronic stress
• Sleep issues

Luckily, there are some ways to prevent flare-ups and cope with them. These include pain management, hormonal therapy, lifestyle adjustments, and alternative therapies.

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Endometriosis is a condition that affects about 10% of women in their reproductive years globally. It causes the tissue similar to endometrium (the uterus lining) to grow outside of your uterus, potentially affecting other organs, including the ovaries, fallopian tubes, and others. Similarly to PCOS, endometriosis affects your hormonal balance and can lead to irregular or missed periods, as well as other hormonal symptoms.

If you are also diagnosed with endometriosis, there is one more thing you need to know beyond the basic definition and key symptoms of this condition. This thing is called endometriosis flare-up and this article is about to explore it in detail.

What Is an Endometriosis Flare-Up?

An endometriosis flare-up is a temporary phenomenon that causes the typical symptoms of your condition to become more intense and severe.

In order to understand this, you need to know that endometriosis is a condition associated with chronic inflammation and hormonal fluctuations. These and some other related issues can occasionally ease your symptoms or worsen them. Respectively, flare-ups aren’t rare, though they may not affect all women with endometriosis–some of them continue leaving with daily symptoms, without significant changes.

When Does Endometriosis Flare-Up Occur?

As you already know, an endometriosis flare-up can happen due to a number of causes. Most often, it takes place during or around the time of your period.

This can happen because of natural hormonal fluctuations–every cycle, during ovulation, your estrogen levels increase. Changes in hormones make your uterus lining thicken, preparing it for a possible pregnancy–and when it doesn’t happen, your endometrial tissue will degrade and expel from your body as menstrual bleeding. The problem with endometriosis though is that your tissue gets trapped and cannot leave the body, which can potentially cause more severe inflammation and symptoms worsening around the time of your period.

However, it’s also worth noting that flare-ups can happen randomly–whether during your period or at any other time of the cycle. Hence, predicting them with 100% accuracy is not possible.

How Long Do Endometriosis Flare-Ups Last?

Although an endo flare-up is a rather common thing, it’s also rather unpredictable. It can be triggered by a variety of factors and can greatly vary in terms of intensity and duration.

Some women might experience mild flare-ups that last minutes or hours. Others, in turn, may face more prolonged symptom worsening that lasts from several days to a few weeks.

As for the symptom intensity, it can also vary greatly. For some women, it’s easy to manage their flare-ups at home, whereas others might need emergency hospital attention.

Endo Flare-Up Symptoms

Since flare-ups just worsen your condition, the symptoms remain the same as those you typically have with endometriosis, such as:

• Pelvic pain and cramps that take place before and during a menstrual period.
• Heavy period bleeding.
• Lower back and stomach pain.
• Pain during or after sex.
• Pain during urination or bowel movements, especially before or during your period.

Endometriosis is also associated with infertility. Although there is no direct evidence that flare-ups can worsen this symptom, potentially, it can be harder to conceive due to worsening pain and inflammation that might affect both your sexual drive and further interrupt the work of your reproductive system.

Some additional symptoms that may become more intense include fatigue, diarrhea, constipation, bloating, and nausea.

Main Causes of Endometriosis Flare-Up

Now that we are clear on the definition, details, and symptoms, let’s figure out what causes endometriosis flare-ups.

Generally, there are four primary things that can lead to flare-ups:

High Estrogen

Estrogen is one of the essential female hormones that naturally fluctuates during a typical menstrual cycle. The first rise in estrogen levels takes place around the middle of your follicular phase, before ovulation. The second rise occurs around the middle of your luteal phase. Apart from natural causes, high estrogen levels might be associated with excessive body fat, liver issues, stress, exposure to environmental toxins, and certain medications.

Regardless of the cause, high estrogen might be one of the reasons why flare-ups happen. According to the Endometriosis Foundation of America, this hormone can further promote inflammation, making your symptoms more severe.

Low Progesterone

Progesterone is another crucial sex hormone in your body–and its levels also fluctuate throughout your cycle. Progesterone naturally drops at the end of a typical menstrual cycle, right before your periods start. Other factors that might cause low progesterone include thyroid issues, PCOS, certain medications, and extreme dieting or over-exercising.

According to studies, progesterone can alleviate endometriosis by inhibiting inflammation and uterine cell proliferation. Respectively, when its levels are low, you can have the opposite effect and experience an endo flare-up.

Stress

It’s no secret that stress can exacerbate many chronic diseases. When you are in a constant state of stress, your body releases too much cortisol, which can weaken your immune system, stimulate weight gain, worsen your mental health, create muscle weakness and bone loss, disrupt sleep, and lead to many other issues. It’s also commonly associated with higher inflammation markers and more severe chronic pain.

According to studies in rat models, reducing cortisol levels can reduce inflammation, pain, and mental health issues in women with endometriosis. Respectively, when you experience prolonged stress, you can face a reverse effect and experience more intense symptoms.

Sleep Problems

Lastly, a lack of proper sleep might be one more reason that can lead to an endometriosis flare-up. Many experts relate proper sleep to improvements in different medical conditions. Unfortunately, studies show a rather high prevalence of insomnia in people with endometriosis.

Poor sleep can contribute to higher inflammation, more intense pain, and, also, higher cortisol levels. All these things can worsen your current endometriosis symptoms.

Effective Tips for Coping With Endo Flare-Up Symptoms

If you are dealing with an endometriosis flare-up, unless it’s so intense that you need emergency help, there are a few coping techniques that can help:

• Find a pain management tactic that works for you. Using over-the-counter painkillers, TENS units, and heating pads are the most common tips for relieving the pain during flare-ups.
• Consider using hormonal therapy. If your flare-ups take place due to abnormal hormonal fluctuations, receiving treatment with birth control or GnRH agonists can help balance your hormones and prevent flare-ups.
• Make changes in your daily lifestyle. Following the right diet and engaging in mild exercise can help you balance hormones and reduce inflammation, potentially leading to no or rarer flare-ups. Important: consult with a healthcare provider about the diet and exercise that will improve your condition and not make it worse.
• Try alternative solutions. Lastly, certain alternative treatments, such as supplements, acupuncture, and pelvic floor therapy may offer a significant improvement in inflammation and pain, potentially preventing flare-ups.

Given a diversity of causes, the best way to combat flare-ups is by detecting the primary cause and avoiding your trigger. For example, if your primary cause is stress, you should embrace stress-management techniques in your daily life–for example, practicing meditation, yoga, and mindfulness can help avoid excessive stress. If you are dealing with insomnia and it triggers flare-ups–focus on developing good sleep hygiene.

In any case, don’t hesitate to consult a healthcare provider for diagnosing, tracking, and managing your flare-ups effectively. A professional can help you find the most effective coping technique and boost your health and quality of life.

FAQ

What is an endo flare-up?

An endometriosis flare-up is a temporary condition in which your endometriosis symptoms become more intense. It’s an uncontrolled condition that can happen at different stages of your cycle and vary significantly in terms of intensity and duration.

What causes endometriosis flare-ups?

Flare-ups are caused by four primary triggers–high estrogen levels, drops in progesterone, prolonged stress and high levels of cortisol, and poor sleep. Everyone may have an individual trigger, which is why it’s important to see a healthcare professional for diagnosis and finding the best management option. 

When to seek medical help?

Women who have mild and short flare-ups should be able to cope with them at home, using pain management, hormonal therapy, proper lifestyle, and stress management techniques. However, if none of the coping techniques work and your symptoms become severe, continue for too long, and significantly interfere with your daily life, you should consider getting emergency medical assistance.

Conclusion

An endometriosis flare-up is always a rather distressing and unpleasant phenomenon. Lasting from minutes to weeks, it can cause significant discomfort and interfere with your daily life. Although it’s rather common, many women with endometriosis don’t fully understand why flare-ups happen and what they can do to ease their symptoms.

After reading this guide, you should have a fuller understanding of flare-ups, their causes, symptoms, and other details. Use this knowledge to educate yourself on this matter and find effective coping techniques that will help you improve your quality of life. And don’t forget that flare-ups can vary a lot in terms of duration and severity, which is why it’s highly recommended to seek personalized medical assistance to manage this condition properly.

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