Endometriosis and Persistent Pelvic Pain: Conservative Management

Written By Megan May

Persistent pelvic pain is complex and can involve multiple systems in the body. When it comes to endometriosis, although the diagnosis involves confirming the presence of endometrial-like tissue outside of the uterus, we now understand that the amount of pain doesn’t always correlate with the amount of lesions. Endometriosis is a common yet frequently under-recognised condition affecting one in nine Australian women. When it comes to chronic pain anywhere in your body, the first step is often confirming your diagnosis and ruling out any serious conditions. Once we know that we’re dealing with chronic pain, one part of treatment might involve helping you to feel empowered to cope better with your pain and thus over time, decreasing your body’s sensitivity and pain response.

Below we have delved into the explanations of how chronic pelvic pain works and scroll down for our EH Pelvic Pain Flare Up Toolkit list of tips and tricks.

Some key drivers of chronic pelvic pain include:

  • Local mechanisms - the tissues of your vulva and pelvic floor that may be highly sensitive or have experienced trauma or injury

  • Regional Contributors - including the function of your bladder, bowel, reproductive organs, the musculoskeletal system eg low back hips etc, the gut and your nerves

  • Central mechanisms - how long you have had your pain for, unhelpful thoughts and beliefs about your pain, emotions, socio-cultural factors, past experiences and trauma

All of these factors may combine to send lots of messages to your brain. Over time, this means that your pain system gets altered. It becomes more sensitive.

Your body can then be stuck in an unhelpful loop where your tissues are tight, tender and painful and giving feedback to your brain that they are unhappy, which in turn increases the protective pain response by your brain. We will work together to change this feedback loop.

With the right care team and approach, over time your flare ups will likely become less frequent and less intense. Having a tool kit of strategies to cope with pain when it does occur can be empowering and reassuring. Here are some of our favourite strategies for dealing with pain:

EH Pelvic Pain Flare Up Toolkit

Pain management

  • Apply heat – Place a wheat bag on your lower tummy or back for 15–20 minutes. A warm shower or bath can also relax your muscles. Alternatively, experiment with an ice pack (wrapped in a tea towel) over the painful area for 10 minutes.

  • Over-the-counter relief – Take paracetamol or ibuprofen (if safe for you) as directed on the packet. Speak with your GP/ specialist if stronger medication is needed.

  • Use a TENS machine – Use a wearable TENS machine. Be sure to start using it early on, ideally before the pain has intensified.

  • Gentle movement – Spend 5-10 minutes doing the stretches or exercises your osteo or physio has prescribed to ease muscle tension and calm your nervous system.

Mindset

  • Check your self-talk & reframe your pain – When you notice pain, repeat one of these mantras:

“pain does not equal tissue damage”

“I can change my pain...slowly”

“A sensitised nervous system leads to over-protective pain”

  • Breathwork – Try 4 slow breaths, in through your nose for 4 counts, out through your mouth for 6 counts.

  • Meditation – Use a short guided meditation (Apps like Smiling Mind, Calm, or Headspace can help. Spotify also has some great free tracks).

  • Journalling – Spend 2–3 minutes writing down your thoughts or feelings. Perhaps try finishing off with listing any 2 things you're grateful for today.

Care for Your Nervous System

  • Sleep – Create a 10-minute wind-down routine before bed (stretch, read, sip a warm herbal tea, or listen to calming music). Aim for consistent sleep/wake times.

  • Food & drink – Keep your bowels and bladder happy by sipping water throughout the day, and eating regular balanced meals. If cooking feels too much during a flare, have easy, nourishing options ready (soups, pre-chopped fruits/ veggies, smoothies).

  • Stress – Try a 5-minute breathing or relaxation exercise when you feel overwhelmed.

  • Joy – Do one small activity that sparks pleasure: listen to your favourite song, step outside for fresh air, call a friend, or watch a funny video.

  • Modify stressors – Notice one thing that is draining you (physical or mental). Can you delegate it, delay it, or do it differently?

Megan May
Next

Cervical Related Shoulder Pain: Why Neck Issues Can Feel Like a Shoulder Problem