If you search for endometriosis symptoms online, pain is likely the first one you’ll see listed. Pain is a constant with this disease, although the quality and intensity can differ from woman to woman.

Some women 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 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.

Pain is never normal, and you don’t need to live with it. There are several different treatments — from medicine to surgery — to relieve the pain and help you get back to your life. With the right doctor, and some trial and error, you can find the treatment that helps you feel better.

The pain you feel with endometriosis starts when tissue that normally lines your uterus grows in other parts of your abdomen — like on your bladder, ovaries, or fallopian tubes. Each month, this tissue swells up as your body prepares for pregnancy. When an egg isn’t fertilized, the endometrial tissue breaks apart and sheds during your period.

Endometrial 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 or other structures in your pelvis, causing pain — especially during periods.

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

These drugs work by blocking the release of prostaglandins — 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 painkillers that can relieve even 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 will work less, or you will need higher dosages.

Painkillers won’t do more than mask endometriosis pain because they don’t address the underlying cause. If you’ve been taking NSAIDs or other pain relievers and they’re not cutting through the pain, it’s time to have a discussion with your doctor about other treatments.

NSAIDs may be more effective if you take them with hormone therapy. 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
  • progestin
    — man-made 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 up to 80 percent of women who take them. You won’t be able to get pregnant while you’re on these medicines.

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, put
    a heating pad on your belly or take a warm bath. The heat will relax muscles in your pelvis, which can ease painful
  • 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 might be just the thing to ease your pain. When you work out, your
    body releases natural painkillers called endorphins. Plus, exercising regularly
    lowers the amount of estrogen in your body — just like the hormonal medicines
    your doctor prescribes to treat your endometriosis.

At some point, the pain might become too intense for medicines and other conservative treatments to cut through. That’s when you need to have a discussion with your doctor about surgery.

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

More than 80 percent of women who have endometriosis surgery find relief from pain. That relief can be dramatic. However, the pain might come back a few months later. Between 40 and 80 percent of women develop pain again within two 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 — removing the uterus, and possibly the cervix, ovaries, and fallopian tubes. Removing your ovaries will stop estrogen production and prevent any more endometrial tissue from depositing. But even a hysterectomy won’t cure endometriosis if the surgeon doesn’t remove all of the tissue that’s already deposited.

Having a hysterectomy is a big decision. After this surgery, you won’t be able to get pregnant. Before you agree to the procedure, make sure you fully understand the benefits and repercussions.

Having a conversation about your reproductive health might not be easy, but it’s necessary. Your doctor can’t prescribe treatments to relieve pain that they don’t know about. If endometriosis is causing you pain, see your doctor to get help.

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, that’s also information you need to share with your doctor. Don’t settle for subpar pain relief. An effective treatment is out there for you. It just might take a few tries for you to find it. And if your doctor isn’t offering any solutions, consider looking for a new doctor.