If you search for endometriosis symptoms online, pain is likely the first one you’ll see. Pain is a frequent, though not universal, symptom of endometriosis.

Some people describe endometriosis pain as an aching or cramping sensation. Others say it’s a burning or sharp feeling. It can be mild enough to manage, or so severe that it affects your quality of life.

Even the timing of the pain can differ from person to person. It can come and go with your menstrual cycle or flare up at unpredictable times throughout the month.

With endometriosis treatment, sometimes the goal is pain reduction. But, even with treatment, you may not be pain-free. In fact, many studies use a clinically significant reduction in pain as an endpoint.

There are several different treatments — from medications to surgery — to relieve the pain. With the right doctor, and some trial and error, you can find the treatment that helps you feel better.

Experiencing the least amount of pain is one of the main goals of endometriosis treatment. But goals may shift based on the effectiveness of regimens and surgeries. If these interventions don’t work, your doctor may search for the best option to relieve your pain as much as possible.

The pain you feel with endometriosis starts when tissue similar to the one that grows inside the uterus is in other parts of your abdomen, such as on your bladder, ovaries, or fallopian tubes.

Endometrial-like tissue in other parts of your abdomen acts in the same way as tissue in your uterus. It swells up each month during your menstrual cycle. Yet inside your abdomen, it has nowhere to go.

The misplaced tissue can press on nerves and other structures in your pelvis, causing pain — especially during periods. Endometriosis can also occur outside the pelvis, although this is more rare.

Pain relievers are often the starting point for endometriosis treatment. Your doctor may recommend that you first try an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin) or naproxen (Aleve).

These drugs work by blocking the release of prostaglandins, which are chemicals that make you feel pain. Because NSAIDs can cause side effects like stomach upset and bleeding, they’re not meant for long-term use.

Opioids are stronger pain relievers that can reduce severe pain. But they come with a big warning. Because opioids can be addictive, they typically aren’t recommended for treating chronic pain. Over time they’ll work less, or you’ll need higher dosages.

Pain relievers reduce endometriosis pain but they don’t address the underlying cause. If you’ve been taking NSAIDs or other pain relievers but they’re not helping relieve pain, consider talking with your doctor about other treatment options.

Taking NSAIDs for 2 to 3 days in a month to relieve intense period cramps, for example, is generally OK if you don’t have other risk factors.

Hormonal treatments prevent you from ovulating. They can shrink existing endometriosis growths and stop new ones from forming. Hormonal therapies also lighten heavy periods.

Hormone treatment options include:

  • birth control pills, patch, or vaginal ring
  • progestins, which are synthetic versions of the hormone progesterone
  • gonadotropin-releasing hormone agonists (GnRH agonists), such as nafarelin (Synarel), leuprolide
    (Lupron), and goserelin (Zoladex)

Hormone treatments like the GnRH agonists relieve pain — even severe pain — in many people who take them.

Endometriosis treatments don’t always require a prescription from your doctor or a trip to the drugstore. A few home remedies and alternative treatments might also help relieve pain.

  • Heat. When cramps get intense, you can put a heating pad on your belly or take a warm bath. The heat may relax the muscles in your pelvis and this can ease painful cramps.
  • Acupuncture. Although research on acupuncture for endometriosis is still limited, a few studies have shown that the practice of stimulating pressure points around the body with fine needles eases
    endometriosis pain.
  • Exercise. When you’re in pain, the last thing you might want to do is go for a run or take a spin class. Yet exercise can help ease your pain. When you work out, your body releases natural pain relievers called endorphins.

Your doctor may present surgery, along with medication, as an option to help treat endometriosis. You and your doctor will work together to decide if surgery is the best way forward.

The most conservative surgical treatment removes just the endometrial-like tissue from your abdomen — along with any scar tissue that’s formed. When surgeons perform this procedure through tiny incisions, it’s called laparoscopy.

A 2016 study found that 50 percent of people who have endometriosis surgery find relief from pain. That relief can be dramatic.

However, the pain might come back a few months later. Between 8 and 10 people who develop pain will experience it again within 2 years of having surgery. One way to prolong your pain-free time is to start on hormone therapy after your surgery.

As a last resort when conservative surgery isn’t enough, doctors can perform a hysterectomy. A hysterectomy consists of removing the uterus, and possibly the cervix, ovaries, and fallopian tubes.

Removing your ovaries will stop estrogen production and prevent any more endometrial-like tissue from depositing. But a hysterectomy won’t cure endometriosis if all the tissue that’s already deposited isn’t removed.

Having a hysterectomy, to remove the uterus, or a bilateral hysterectomy, to remove the uterus, tubes, ovaries, and cervix, is a big decision.

After this surgery, you won’t be able to get pregnant. However, if your ovaries are not removed, you could potentially use a gestational surrogate to grow your family.

Before you agree to a hysterectomy, make sure you fully understand the benefits and repercussions.

If endometriosis is causing you pain, talk with your doctor to get help.

Try to be open and honest with your doctor about how you feel. Try to describe your pain in as much detail as possible.

Keeping a journal can help you explain what you’re experiencing. Write down when you hurt, what it feels like (stabbing, burning, shock-like), and what you were doing (for example, exercising) when it started. Your notes can help your doctor pinpoint the source of your pain and find the right treatment for you.

If you start on one medicine and it’s not helping, let your doctor know. Complete pain relief may not be possible for every person. However, you can always consider a second opinion.