Endometriosis is a condition that is often misunderstood and underestimated yet, ironically, affects millions of people with uteruses worldwide. Classically, it has been defined as the presence of endometrial-like tissue outside the uterus, this condition is more than just a gynecological concern. It is a chronic systemic inflammatory condition that can be found in almost every major organ of the body. These lesions cause internal inflammation, resulting in pain, cramping and a myriad of other symptoms that can be physically, mentally and socially debilitating. 

Endometriosis flare-ups are times when the condition is more severe and discomfort and symptoms worsen. These flare-ups are extremely daunting. They can be unexpected and hard to anticipate due to the complex and sensitive nature of this inflammatory condition. However, understanding their triggers and effective coping strategies can make a significant difference. Whilst endometriosis has no cure, gaining knowledge of how this condition affects your specific body and what your unique triggers may be, can provide a sense of control and awareness that allows you to be more informed and confident when advocating for yourself. In short, managing endometriosis is not a quick fix; it requires holistic and integrative approaches that address not just symptoms but the entire person. 

What Triggers Endometriosis Flare-ups?

Inflammatory Foods

Endometriosis itself is marked by inflammation, but additional factors like a high-fat or high-sugar diet, caffeine, and alcohol consumption potentially worsen it. A 2010 study found that palmitic acid, a saturated fat acid derived mainly from meat and dairy products, as well as trans fat, was associated with heightened inflammation in those with endometriosis. One study shows that omitting gluten from your diet significantly can improve pain and symptoms. Any foods that you find produce digestive issues for yourself, should also be avoided, as they can cause an immune system response, leading to further inflammation. 

Lack of Sleep

This one is a bit of a doozy: sleep is necessary for restoration and healing in the body, however, pain disrupts one's sleep cycles. And so, a vicious cycle ensues. Stretching before bed and any other pain management techniques that you feel help you sleep can be vital tools.

Stress 

What major stressors do you have in your life? It is well-known that physical and emotional stress manifests as inflammation in the body, meaning that for those with endometriosis, stress is a major concern for further inflammation. Not all stressors can be removed, such as work, past traumas, and family dynamics, but acknowledging them as a factor in your flare-ups is a brave first step in creating sustainable and healthy coping routines in the future. 

How Long Do Endometriosis Flare-ups Last?

Flare-ups vary in duration. Hormonal changes during menstrual cycles often trigger shorter flare-ups lasting a few days. However, factors causing prolonged inflammation can extend flare-ups to several weeks, significantly impacting daily life.

How to Calm Down an Endometriosis Flare-up?

Your own unique body will have unique triggers for flare-ups, so there isn’t a one-size-fits-all approach. However, here are some broad and multifaceted approaches to consider when experiencing an endometriosis flare-up. 

In the moment, consider: 

Medication 

There can be a stigma around medication however, integrative and holistic approaches to endo pain center on the individual and what is going to allow that person to experience the best quality of life when it comes to their pain. Therefore, there is no shame in reaching for Ibuprofen or any other non-steroidal, anti-inflammatory Drugs (NSAIDs), especially if it is going to improve your overall well-being and ability to move through daily tasks and life with slightly more ease. Hormone-based birth control can prevent endo flare-ups for some people, but like other medications are not considered to be a cure-all and should not be the only line of defense for endometrial flare-ups.

Natural Pain Relief 

Many natural plant-based medicines have been proven to ease flare-up symptoms and intense endo inflammation and have been used for millennia in many realms of natural healthcare and pain relief. Some examples include: 

• Arnica Flower: known for its anti-inflammatory properties
• Wintergreen: known for its analgesic properties 
• Castor Oil: contains ricinoleic acid, which is pain relieving and anti-inflammatory. This is also safe to combine with TTC fertility programs and hormone replacement therapies.
• Calendula: known to soothe muscle contractions and reduce inflammation. 
• Chamomile: known for its calming effect. 
• Heat therapy: Heat increases circulation, opens up blood vessels, and relaxes muscles which in turn affects pain receptors in the body. Dry heat (heat pads) and wet heat (baths and warm wet towels) are both effective ways to address inflammation in the moment of the flare up. 

Some products that incorporate the above ingredients as well as other natural pain relievers are Somedays Cramp Cream, Somedays Flaxseed Heatpad, or my personal every day favourite, the Somedays Mess-free Castor oil set.

Mindfulness practices

Endo flare-ups and their physical toll can be emotionally distressing which can worsen the experience significantly. Having mindfulness routines, rituals and practices to turn to in times of extreme pain can provide coping mechanisms in times of intense discomfort. Some examples to consider include: 

Diaphragmatic breathing: Lie on your back with your knees bent. Place one hand over your abdomen and one over your chest. Start with 2-3 slow, deep abdominal breaths. In through your nose and out through your mouth, so that your tummy swells out and in. 

Affirmations:  Write down some positive and reflective affirmations for yourself to reach for when experiencing a flare-up. An example from the Somedays Somatic Care Deck is “My symptoms are the most incredible way my body learned to survive and adapt”. Consider writing down what your pain feels like in your body in terms of color, shape, and other metaphors. 

A Flare-Up Care Kit: Create yourself a care kit to reach for in an endometriosis flare-up. This could be a small pouch in your bag at work with a few affirmations, your favorite essential oil, a small stone or crystal to roll in your hands; or any items or small sensory experiences that bring you comfort and joy. 

In the long run, consider: 

Food Modifications

Your diet is one thing that you do have a lot of control over. Over time, evaluate what foods may be causing inflammation for you. Keeping a food journal of your daily meals can be a great way to track any relationships between food and flare-ups. Here are some anti-inflammatory foods to consider slowly adding into your diet if you have not incorporated them already: 

• Omega 3 Fatty Acids: DHA-rich oily fish such as salmon, tuna, sardines and mackerel. 
• Antioxidant-Rich Foods: Foods rich in Vitamin C and E such as raw vegetables, nuts and seeds and extra virgin olive oil. 
• High Fibre Foods: Aim for at least 30 grams of fiber a day. 
• Low Glycemic Foods: Low GI foods contain less sugar and are therefore less likely to contribute to the production of insulin in the body. Examples are green vegetables, most fruits, raw carrots, kidney beans, chickpeas and lentils. 
• Magnesium-Rich Vegetables: Spinach, swiss chard, okra, broccoli

Lifestyle Modifications. 

Most people don’t have the privilege of changing careers, families and traumas to improve their pain (nor may they want to!). However, awareness of lifestyle factors that create more stress and in turn, more inflammation, can allow you to anticipate and move through endo flare-ups. Exercise can be a stressor, especially intense interval training and cardio. Evaluating the frequency and type of exercise you do can help alleviate flare-up symptoms. 

Moving through endo flare-ups is a process of building sustainable resilience through holistic approaches that honor the individual. Everyone’s experience is going to be different and dynamic. Remaining patient and generous with yourself is vital as this process isn’t linear.

While endometriosis flare-ups pose challenges, they also present opportunities for holistic management, emphasizing the importance of tailored strategies and ongoing support. Remember, your symptoms are the most incredible way your body has learned to survive and adapt. 

Much love.