Utilizing Painkillers for Menstrual and Endometriosis Discomfort

In endometriosis, tissue similar to the endometrium settles outside the uterus, where it does not belong. This leads to the formation of tissue islands, referred to as endometriosis foci.
Such settlements often result in painful experiences for individuals, particularly during their menstrual periods.

However, what strategies exist to alleviate this cramping discomfort? Is taking aspirin a viable option for managing period pain?

Today, we provide you with an overview of appropriate painkillers and offer insights into when obtaining a doctor’s prescription becomes essential.

Why does the Pain Occur Mainly During the Period?

Understanding the reason behind your heightened discomfort during your menstrual cycle is crucial. Endometriosis presents a significant challenge to your body in relation to the female hormonal cycle. The presence of unwanted tissue outside the uterus responds to your hormonal shifts. As your uterine lining thickens and sheds during your cycle, the endometriosis lesions also grow, leading to intensified cramp-like pain, often accompanied by abdominal and back pain.

Were you aware that these endometriosis lesions bleed with every menstrual period? However, there’s a complication: the blood cannot exit properly, resulting in the formation of blood accumulations or cysts. Your body is tasked with absorbing and breaking down this blood, a process that takes time.

Meanwhile, the recurrent blood accumulations irritate the surrounding tissues, potentially causing inflammation. Over time, this can lead to the formation of adhesions or “chocolate cysts,” which are cavities filled with clotted blood [1].

Good to know!

Experiencing mild discomfort during your period is a common occurrence, attributed to the natural contraction of the uterus as it sheds the uterine lining in the absence of fertilization. However, if your periods are consistently accompanied by intense pain or excessive bleeding, it might be indicative of a more profound issue like endometriosis.

Please note: It’s important to note that not all cases of endometriosis exhibit the classic symptoms. Astonishingly, only about 65% of individuals with endometriosis experience these typical indicators [2].

Pain Relief for Endometriosis: Medications that Offer Relief

Managing the pain caused by endometriosis often involves the use of different medications. Yet, not all options are equally effective. Let us delve into the array of painkillers available, shedding light on which ones can provide reliable relief from abdominal cramps and related discomfort.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Many individuals with endometriosis turn to non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate their pain. This category includes well-known active ingredients such as ibuprofen, diclofenac, paracetamol, and acetylsalicylic acid (ASA). NSAIDs are effective in easing pain, particularly during the menstrual period. Over-the-counter options are available in modest dosages and can effectively reduce mild to moderate pain. However, if the pain is severe, over-the-counter medications may not be sufficient. In such cases, consulting your gynecologist for prescriptions with higher dosages is recommended.

When to Consider Using NSAIDs

You might already be familiar with the versatility of medications like paracetamol and acetylsalicylic acid, which fall under the NSAID category. These drugs can be taken for both acute and chronic pain. With their combined analgesic, anti-inflammatory, and antipyretic properties, they are especially effective in cases involving inflammation. Beyond inflammation, they are also beneficial for addressing common headaches and pain resulting from injuries.

Potential Side Effects of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Despite the widespread use of medications like aspirin, paracetamol, and diclofenac, it is important to be aware of their potential side effects. While stomach discomfort, nausea, and headaches are common unwanted effects, most users tolerate these medications relatively well. However, a notable consideration arises when it comes to acetylsalicylic acid (ASA) in relation to endometriosis, ASA possesses blood-thinning properties that can intensify your already heavy menstrual bleeding. Consequently, the professional gynecological association recommends avoiding ASA-containing preparations if you experience heavy menstrual bleeding.[3]


For instances of intense cramp-related pain, opioids can be considered. These medications, categorized as opioids, possess the capability to effectively alleviate even severe pain. They operate by targeting the brain’s opioid-binding sites, exerting their impact directly at that level. Interestingly, your body also generates its own pain-alleviating compounds, known as endogenous opioids, which not only relieve pain but also address anxiety and stress. This unique trait makes them subjects of research for potential therapies, including applications for anxiety disorders [4] Opioid drugs essentially emulate the effects of these natural compounds within the body.

When are Opioids Appropriate?

Despite the potential for severe distress caused by endometriosis, opioids are seldom employed as a treatment option for the condition. This is attributed to the fact that while the discomfort can be intense, it primarily coincides with menstruation. Furthermore, opioids are inaccessible without a prescription and can only be obtained from pharmacies under a doctor’s authorization. Physicians will judiciously evaluate the risks before contemplating an opioid prescription. This is particularly crucial as there is currently insufficient data to ascertain the effectiveness of opioid usage for managing menstrual pain associated with endometriosis [5].

What are the Side Effects of Opioids?

The controlled availability of opioids is rooted in their potential for addiction, particularly with prolonged usage, especially when potent formulations are involved. Moreover, opioids can give rise to undesirable side effects like nausea, vomiting, constipation, dizziness, headaches, dry mouth, or fatigue. Typically, these side effects are transient, manifesting only during the initial days of use and subsiding thereafter. However, constipation might persist for an extended duration, stemming from the medication’s impact on intestinal motility [6].

Alternative Approaches to Pain Management

Balancing effective pain control with gentler treatment methods is a priority for individuals with endometriosis. While painkillers offer relief, targeting the root cause—the endometriosis adhesions—alongside other therapeutic measures can potentially reduce the reliance on painkillers. The following strategies are worth considering:

  1. Hormonal Treatment: Hormonal substances like progestins, oral contraceptive pills or GnRH analogs can immobilize tissue islands, leading to pain relief. However, if pregnancy is desired, ovulation-preventing options may not be suitable. Consult your gynecologist for guidance on appropriate choices.
  2. Surgical Intervention: Adhesions can often be removed via laparoscopy or abdominal incision, conducted under general anesthesia using techniques like lasers, scalpels, or specialized probes. Eliminating endometriosis lesions can alleviate symptoms associated with the condition [7, 8].
  3. Alternative Therapies: Methods such as homeopathy, acupuncture, nutritional supplements, and herbal preparations are explored by some endometriosis patients. However, empirical evidence supporting their pain-relieving efficacy is limited [5]. Some individuals find solace in relaxation techniques like yoga, progressive muscle relaxation, or autogenic training. Traditional remedies like using a hot water bottle can also help mitigate cramps and pain.

Good to know!

In the realm of multimodal pain therapy, autogenic training stands out as a valuable technique. This self-relaxation method involves a concentrated focus on inducing relaxation within oneself. A study underscores its significance, revealing that individuals grappling with chronic pain experience more substantial pain relief through autogenic training than standard therapy alone. [9] As part of our commitment to enhancing your well-being, we offer the opportunity to delve into autogenic training in the Relaxation module of our Endo-App.

Seeking Medical Attention for Endometriosis Pain

While some individuals with endometriosis may grow accustomed to enduring monthly pain, seeking medical attention remains pivotal for optimal management. Regular visits to your gynecologist, especially if you’ve been diagnosed with endometriosis, offer valuable insights into disease progression and guide potential therapy adjustments.

Beyond routine check-ups, consult a doctor if:

  • You experience abnormally heavy bleeding.
  • Pain becomes exceptionally severe.
  • New symptoms, like back pain or urinary issues, arise.
  • Pain substantially diminishes your quality of life.

Given that endometriosis can advance despite prior interventions, vigilant self-awareness is crucial. Fresh lesions or adhesions, particularly in sensitive regions like the urinary system, may necessitate distinct treatments. Don’t hesitate to consult your gynecologist between scheduled appointments, ensuring comprehensive care for your well-being.

Where Can I Find a Gynecologist Supportive of Endometriosis Care?

If you find that your current gynecologist is not adequately addressing your symptoms or concerns, take a look at our doctor search: Here you can find gynecologists who have received recommendations from fellow endometriosis patients.

Short and to the Point

While menstruation induces discomfort for many, endometriosis patients endure heightened pain. This agony stems from endometriosis lesions growing alongside the menstrual cycle, resulting in cramp-like lower abdominal and back discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) like paracetamol or acetylsalicylic acid (ASA) offer respite. These over-the-counter aids effectively alleviate mild to moderate pain. However, ASA-containing medications may escalate bleeding due to clot reduction.

Therefore, my tip: Consider opting for paracetamol or ibuprofen over aspirin to avert this effect. Research supports the use of relaxation techniques like autogenic training for pain relief. Opioids, although rarely used in endometriosis cases, come with substantial side effects and the risk of dependency.

In general: if severe pain or unfamiliar symptoms arise, promptly consult your gynecologist for guidance.


  1. Berufsverband der Frauenärzte e.V. (BVF): Endometriose ” Krankheitsbild ” (frauenaerzte-im-netz.de), retrieved 24.02.2022.
  2. Diedrich, Klaus. Gynecology and obstetrics (Springer textbook) (German Edition) (p.303). Springer Berlin Heidelberg. Kindle version.
  3. Berufsverband der Frauenärzte e.V. (BVF): Acetylsalicylic acid unsuitable as analgesic for menstrual pain: www.frauenaerzte-im-netz.de, accessed 02/24/2022.
  4. Winters BL, Gregoriou GC, Kissiwaa SA, Wells OA, Medagoda DI, Hermes SM, Burford NT, Alt A, Aicher SA, Bagley EE. Endogenous opioids regulate moment-to-moment neuronal communication and excitability. Nat Commun. 2017 Mar 22;8:14611. doi: 10.1038/ncomms14611. PMID: 28327612; PMCID: PMC5364458.
  5. Foundation for Quality and Efficiency in Health Care: Treatment options for endometriosis (gesundheitsinformation.de), accessed 2/24/2022.
  6. Enno Freye. Opioids in medicine. Springer-Verlag Berlin Heidelberg 2010.
  7. Riley KA, Benton AS, Deimling TA, Kunselman AR, Harkins GJ. Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial. J Minim Invasive Gynecol. 2019 Jan;26(1):71-77. doi: 10.1016/j.jmig.2018.03.023. epub 2018 Mar 30. PMID: 29609032.
  8. Grimbizis GF, Mikos T, Tarlatzis B. Uterine-sparing surgical treatment for adenomyosis. Fertil Steril. 2014 Feb;101(2):472-87. doi: 10.1016/j.fertnstert.2013.10.025. Epub 2013 Nov 26. PMID: 24289992.
  9. Kohlert A, Wick K, Rosendahl J. Autogenic training for reducing chronic pain: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Behav Med. 2021 Oct 27:1-12. doi: 10.1007/s12529-021-10038-6. epub ahead of print. PMID: 34705227; PMCID: PMC8548271.

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