Endometriosis affects one in ten women during their reproductive years.

Endometriosis is a disorder in which tissue similar to that which forms the lining of the uterus continues to grow outside of the uterine cavity. This tissue is referred to as the endometrium and in the case of endometriosis, it continues to grow on the ovaries, the lining of the pelvis, and even the intestines. When endometrial tissue grows outside of the uterus, it is referred to as an endometrial implant.

These endometrial implants are still affected by the hormonal changes of the menstrual cycle, causing these areas to become inflamed and painful. Due to the inflammation, this tissue of the implants will thicken and break down. Once the tissue is broken down, it is trapped in the pelvis region which can cause a variety of problems including:

  • Adhesions (that bind organs together)
  • Severe internal scarring and irritation
  • Fertility complications
  • Severe period pain

Read “Understanding Endometriosis: Stages, Symptoms, & More".

What Is A “Flare-Up”?

As with any chronic condition, endometriosis symptoms and pain can be present and persistent for long periods of time. A flare-up, or flare, occurs when symptoms that have been present become even more severe. Flares are known to intensify the symptoms of endometriosis and can be characterized by

  • Extreme pelvic pain
  • Pain during intercourse
  • Pain during urination or bowel movements
  • Pain in the abdomen, lower back, and/ or thighs
  • Inflammation and swelling of the stomach (known as “endo belly”)
  • Fatigue
  • Trouble sleeping

An endometriosis flare-up can be excruciating to undergo, however, as this condition is linked to hormonal cycles, eventually, the pain subsides.

What Causes An Endometriosis Flare-Up?

Menstrual Cycle

As touched on above, endometriosis is tied to hormonal changes of the menstrual cycle, meaning endo pain often correlates to certain times of the month. It is common to start experiencing pain and/or the worsening of symptoms one to two days prior to menstruation. For some, this pain may continue throughout the period. This is when a flare-up is most likely to occur.


As with nearly every condition, stress commonly exacerbates endometriosis symptoms. Unfortunately, because endometriosis flare-ups are a stressful experience, it is unclear if stress is a cause or a result of the flare-ups themself. However, studies show that repeated, uncontrolled stress “promotes disease mechanisms and accelerates lesion growth in rodents.”

Lack of Sleep

A lack of sleep has been shown to increase pain levels and exacerbate other symptoms of endometriosis. This is because a lack of sleep can increase inflammation and inflammatory compounds are involved in the development of endometriosis and the worsening of endo pain.

Moreover, even just one night of poor sleep can disrupt hormone function. According to Sara Gottfried, MD, a clinical assistant professor in the department of integrative medicine and nutritional sciences at Thomas Jefferson University, “When you don’t sleep well, cortisol is high when you wake up in the morning. That can disrupt the tango between estrogen and progesterone.” A disruption in estrogen levels is likely to trigger a flare-up in endometriosis symptoms, especially when paired with increased inflammation.

The symptoms of such a flare-up are then exacerbated by the fact a lack of sleep increases one’s sensitivity to pain while decreasing the brain’s supply of natural pain relievers such as dopamine.

Lack of Movement

A lack of movement is not necessarily a direct trigger of a flare-up but a long-term sedentary lifestyle is likely to elicit more frequent and severe flare-ups compared to those who lead an active lifestyle. Exercise, even if it is just light or moderate, is proven to reduce inflammation, balance hormone levels, and release endorphins, all of which ease the symptoms of chronic conditions like endometriosis.

Additionally, exercises such as yoga and pilates are particularly beneficial for those with endometriosis as the pain and discomfort associated with endometriosis can elicit a “guarding” mechanism in the body, meaning muscles in the body tighten to brace itself for the pain. This bracing can affect the pelvic floor, abdominal wall, and hip flexors. Exercises such as yoga and pilates are excellent ways to strengthen and lengthen these muscle groups in order to help release the tension held in the anterior area.

Alcohol and Caffeine

Alcohol and caffeine can both influence hormone regulation, particularly estrogen balance. Thus, these substances can negatively disrupt the endocrine system as well as promote inflammation, both of which can lead to further pain or progression of endometriosis.

Inflammatory Foods

Research shows that there is a link between a diet high in trans fats and endometriosis pain. Dr. Stacey Missmer of Brigham and Women’s Hospital and Harvard Medical School in Boston stated, “We know that trans fats increase the body’s level of many inflammatory markers and these are inflammatory factors that have been shown to be associated with the establishment of endometriosis and progression.” Thus, it is crucial to avoid food high in trans fats such as fried, processed, and fast foods.

Foods containing gluten can possibly worsen the symptoms of endometriosis, particularly the pain experienced by patients. In a study of 207 women with endometriosis, 75% experienced a decrease in pain after eliminating gluten from their diet. This is likely due to gluten’s inflammatory properties.

Learn more about the endometriosis diet.

Final Thought

Endometriosis is an incredibly difficult condition to manage, but you are not alone. At Holtorf Medical Group, our board-certified physicians have decades of experience in treating conditions associated with hormonal dysfunction. We can help you successfully manage your symptoms and improve your quality of life. Book your appointment today.

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