Endometriosis flare-ups: If you know, you know about the debilitating pain it can cause for at least 7-15% of women worldwide. For some people, their endometriosis gets worse around their monthly period, but there are other more sneaky triggers of flare-ups in endometriosis pain, like certain aspects of your diet. 

The best way endometriosis warrior Jacqueline Solivan, Director of Partnerships at Rescripted, can describe a flare-up is the equivalent of tightly twisting a balloon animal into a shape — but the balloons are your organs. Having excruciating internal and back pain that takes her out each month led her to track her triggers and attempt to ward them off ahead of time. 

Keep on reading to better understand — and avoid — certain endometriosis triggers and get ahead of the flare-ups as best as you can. 

woman with back cramps due to endometriosis flare-up

Does endometriosis only cause pain during your period? 

“A hallmark of endometriosis is pain with menstruation, but there can be pain or flare-ups at other times in the cycle as well,” says Jessica Ryniec, MD, a Boston-based double board-certified OB/GYN and reproductive endocrinologist. For example, Solivan shares that though she has very heavy, uncomfortable periods (the kind that causes you to continuously go through a super-plus tampon and an overnight pad), her flare-ups of most intense pain typically happen around ovulation. 

Endometriosis involves tissue that’s similar to the lining of the uterus, or endometrial tissue, growing outside of the uterus. Once that tissue has formed outside the uterus, the symptoms can be exacerbated by inflammatory changes (keep reading for the common triggers of inflammation and therefore endometriosis flare-ups), or by the development of scarring in the tissue that can become irritated and increase pain, explains Dr. Ryniec. Because the tissue is growing outside of the uterus and causing tenderness and inflammation, it can alter your anatomy and cause issues in other systems, such as bowel and bladder dysfunction and pain, Dr. Ryniec adds. 

What are endometriosis flare-up symptoms? 

Flare-ups can vary for each person, especially depending on their timing in the menstrual cycle. Some of the most common symptoms include the following, according to Dr. Ryniec:

  • Heavy menstrual bleeding

  • Urinary urgency and frequency

  • Low back pain

  • GI issues: Diarrhea, constipation, nausea, vomiting, or bowel cramping

  • Chronic fatigue or lack of energy 

  • Pain with vaginal penetration

woman suffering from endometriosis

Common endometriosis triggers 

One of the most prominent inflammatory triggers of endometriosis flare-ups is chronic stress. However, it’s kind of a chicken-or-egg situation. “There is a link between elevated stress and higher pain levels and worsening of chronic medical conditions in general, but it's tough to know whether this is related to the body's reaction to stress or the hormones that are released or altered in times of stress,” says Dr. Ryniec. “It also probably goes in both directions, where stress can cause flare-ups, and flare-ups can increase stress,” she says. 

Sleep has a similar “chicken or egg” relationship to endometriosis. You may not sleep well because you’re in pain with an endometriosis flare-up, and also sleep disruptions can raise inflammatory markers in the body, which can worsen endometriosis pain, according to Dr. Ryniec. 

Another trigger is related to diet: Some foods (like sugar and processed foods, red and processed meats) are known to be inflammatory in general, and certain foods might be inflammatory to a particular person with endometriosis, especially if that person also has a GI condition like IBS compounding the inflammation. For Solivan, that triggering food group is dairy, and causes lactose intolerant-like symptoms. Foods that tend to be inflammatory can increase your overall systemic inflammation and cause more pain in the body, explains Dr. Ryniec. But there are ways to temper the inflammation with your diet and decrease flare-ups, she adds. 

Alcohol is not necessarily directly part of your diet, but drinking is another habit that can induce flare-ups. Here’s how it happens: Drinking significant amounts of alcohol is known to increase estrogen levels. “Since endometriosis flares can be mediated by estrogen, there is an increased risk of flares,” says Dr. Ryniec. And chronic heavy alcohol use can cause immune system dysfunction, kicking inflammation and pain into high gear, according to Dr. Ryniec. 

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How to manage or prevent endometriosis triggers 

Once you get an endometriosis diagnosis (which can take up to 10 years, by the way), it’s a good idea to look for patterns in your personal endometriosis triggers and try to avoid or minimize those triggering foods or habits. Sometimes you can’t help it and don’t sleep well or eat foods that end up bothering you, though. Dr. Ryniec suggests working with an endometriosis specialist if there is one in your area, who can help craft a treatment plan for your case of endometriosis. Here are some general rules of thumb in avoiding endometriosis triggers as best as you can: 

  • Manage stress and your sleep habits. One great strategy for consistently managing stress is working on cognitive behavioral therapy (CBT), a therapy technique that helps you shift negative thought patterns to more manageable or productive ones, Dr. Ryniec suggests. Part of the stress puzzle is practicing good sleep hygiene (that means no scrolling on your phone in bed!) and prioritizing a solid sleep routine, she adds. 
  • Keep a food diary. Solivan recommends keeping a log of all the foods you eat, and looking for patterns—she’s found that dairy and sugar have led to flare-ups in general and has learned to stay away from them as much as possible (she substitutes refined sugar with coconut sugar when cooking or baking).
  • Watch out for your trigger foods. Once you know the foods that contribute to an endometriosis flare-up (which can include bowel dysfunction), you can try to get ahead of it by cutting back on those foods. “Consider adding anti-inflammatory foods or supplements to your diet,” says Dr. Ryniec. For Solivan, that looks like eating mostly plant-based and staying away from the more inflammatory animal proteins as much as possible — but not everyone can go fully vegetarian or vegan and cut out animal products from their diet altogether.
  • Move your body. “Regular physical activity may help through reduction of inflammation and release of endorphins; it also may be beneficial to prevent muscle tension, which can worsen symptoms,” says Dr. Ryniec. On days when she’s able to stretch and doesn’t feel too tight, Solivan tries to do some stretching, walking on a walking pad, and somatic exercises like barre and yoga. On other days, walking can feel like too much pressure on her lower back. But when she focuses her energy on a combination of these types of movement, cutting back on inflammatory foods, and tempering stress, she can go two months without an endometriosis flare-up, she says.

Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.