Everything You Should Know About Endometriosis Flare-Ups

An endometriosis flare-up is a period of increased severity of endometriosis, resulting in increased pain and worsened symptoms. Endometriosis is an inflammatory condition, so there are several factors that can increase or trigger inflammation in the body and cause flare-ups.

This article will review endometriosis flare-up symptoms, causes, and management strategies. 

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Endometriosis Flare-Up Symptoms

Symptoms of endometriosis flare-ups are the same as those of endometriosis but are typically much worse. Increased pelvic pain is the most common symptom of an endometriosis flare-up caused by increased inflammation from endometrial lesions. Other symptoms that may occur alongside increased pain during a flare-up include:

  • Painful urination and bowel movements
  • Heavy menstrual bleeding
  • Fatigue
  • Depression
  • Constipation and diarrhea 
  • Painful sex

How Long Do Flares Last?

Endometriosis flare-ups can vary in length. For many, hormonal changes trigger flare-ups that occur during the menstrual cycle and can last a few days from the start to the end of menstruation. For others, other factors that cause increased inflammation and last up to several weeks can trigger flare-ups. 

Causes of Endometriosis Flares

Though the exact cause of endometriosis isn't clear, bodily changes that increase inflammatory processes with endometriosis can trigger flare-ups. You can control some of these triggering factors, while others you cannot. 

Hormonal Changes

Endometriosis is an estrogen-dependent condition that fluctuating levels of estrogen hormones trigger. The normal hormonal changes that occur during the menstrual cycle often trigger flare-ups as well.


Like other inflammatory conditions, endometriosis is associated with high levels of chronic stress. Researchers believe that high amounts of stress are associated with increased pain severity and duration of symptoms due to increased inflammation throughout the body.

Lack of Sleep

Lack of sleep commonly results from endometriosis because the pain it causes can make falling asleep difficult. In turn, sleep disruption can weaken the immune system, causing an abnormal increase in inflammatory processes. This increased inflammation can then stimulate more pain, resulting in an ongoing cycle of pain and poor sleep.

Alcohol and Caffeine

Alcohol use is often linked to estrogen-dependent conditions because it activates enzymes that increase estrogen levels in the bloodstream. Because of this, alcohol use has been associated with an increased risk of endometriosis. Long-term alcohol use also impairs the functioning of the immune system, which increases the risk of developing inflammatory diseases.

Though there is no specific evidence that suggests caffeine increases the risk of endometriosis flare-ups, caffeine use is a known contributing factor to the development of hormone-dependent conditions. Because endometriosis is triggered by changing levels of estrogen, it is possible that caffeine use, in combination with other triggers, can worsen symptoms of endometriosis.

Inflammatory Foods

Inflammatory foods, such as those that are heavily processed with artificial colors, flavors, high amounts of sugar, and refined seed oils, are known to increase inflammation throughout the body, which can lead to the worsening of endometriosis symptoms. Anti-inflammatory foods and supplements that contain omega-3 fatty acids, curcumin from turmeric, and green tea are currently undergoing studies for their potential use in decreasing pain from endometriosis.

Identifying and Managing Triggers

Identifying triggers of endometriosis flare-ups is important for managing endometriosis and lessening your pain and other symptoms. Keeping a journal of symptoms you experience, how long they last, and information about your lifestyle habits can help. This includes diet, exercise, alcohol use, sleep quality, and stressful events. 

Over time, you may notice a common trend in your journal entries. If you can identify and avoid triggers, you can help manage and reduce flares. This may include making certain lifestyle changes or learning ways to manage stress effectively. 

Endometriosis Pain Relief and Coping Tips

Pain from endometriosis can be severe and debilitating. Current treatment for endometriosis includes pain-relieving and/or hormone-suppressing medications and surgery to remove lesions if necessary. But sometimes, these methods aren’t enough to alleviate pain.

Self-care methods may help reduce your pain and manage your symptoms in addition to medical treatment. These include methods like using a heating pad or taking a warm bath, finding ways to manage stress, and exercising. 

When to Seek Care for a Flare

If pain during a flare-up is so severe it interferes with your daily activities and work or school, you should schedule a visit to see a healthcare provider. Your healthcare provider may want you to try several different types of medications to reduce your symptom severity. If you have large endometriosis lesions that are continually flaring, your healthcare provider may also recommend surgery to remove them.


Endometriosis flare-ups are periods of worsened pain and other symptoms that hormonal changes and increased inflammation trigger in the body. These triggers can occur with stress, lack of sleep, alcohol use, and inflammatory foods. Medication, surgery, and self-care treatment strategies like avoidance of triggers, stress management, heat, and exercise can help reduce your symptoms and the severity of your flare-ups.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Endometriosis Foundation of America. Endometriosis: fast facts.

  2. Saunders PTK, Horne AW. Endometriosis: etiology, pathobiology, and therapeutic prospects. Cell. 2021 May 27;184(11):2807-2824. doi:10.1016/j.cell.2021.04.041

  3. Reis FM, Coutinho LM, Vannuccini S, et al. Is stress a cause or a consequence of endometriosis? Reprod Sci. 2020 Jan;27(1):39-45. doi:10.1007/s43032-019-00053-0. 

  4. Ishikura IA, Hachul H, Pires GN, et al. The relationship between insomnia and endometriosis. J Clin Sleep Med. 2020;16(8):1387–1388.

  5. Parazzini F, Cipriani S, Bravi F, et al. A metaanalysis on alcohol consumption and risk of endometriosis. Am J Obstet Gynecol. 2013 Aug;209(2):106.e1-10. doi: 10.1016/j.ajog.2013.05.039.

  6. Kechagias KS, Triantafyllidis KK, Kyriakidou M, et al. The relation between caffeine consumption and endometriosis: an updated systematic review and meta-analysis. Nutrients. 2021 Sep 29;13(10):3457. doi:10.3390/nu13103457. 

By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.