What Is an Endometriosis flare up?

Let’s talk about pain. Not the kind that goes away after a hot bath or a quick nap, but the kind that grips your pelvis, radiates down your legs, bloats your belly, and makes a regular Tuesday feel like a battle. For millions of women worldwide, that’s what an endometriosis flare up feels like.

In this guide, we’re diving deep into what causes endometriosis flares, how to recognize one, and what actually helps (hint: it’s not just curling up with a heating pad—though we won’t knock it). Whether you’ve been newly diagnosed or have been navigating the endo rollercoaster for years, this is your evidence-backed, compassion-filled roadmap.

What is Endometriosis?

Endometriosis is a chronic, estrogen-dependent condition where tissue resembling the endometrium grows outside the uterine cavity. These ectopic implants are commonly found on the ovaries, fallopian tubes, pelvic peritoneum, and sometimes beyond—leading to chronic inflammation, fibrosis, and pain.

It affects approximately 10% of women of reproductive age globally, significantly impacting quality of life, fertility, and pelvic health (1)

What Is a Pelvic Health Flare Up?

In endometriosis, a flare up refers to a spike in symptom severity - usually pain, bloating, fatigue, and gastrointestinal upset—that can persist for hours or days. These are often tied to inflammatory cascades, hormonal changes, or external triggers, and are commonly described by patients as "flare days" or "pain flares" (2).

What Triggers an Endometriosis Flare Up?

Endometriosis flare ups don’t follow polite schedules—but some triggers are especially common.

1. Hormonal Fluctuations During menstruation or ovulation, estrogen levels rise, which stimulates growth and bleeding in ectopic tissue—fueling inflammation and pain (3).
2. Stress Chronic stress increases cortisol, which can disrupt immune function and exacerbate pain sensitivity, gut dysfunction, and hormonal imbalance—known contributors to flare-ups (4).
3. Pro-Inflammatory Diet High intake of red meat, trans fats, caffeine, and processed foods has been associated with an increased risk of endometriosis and symptom worsening due to elevated systemic inflammation (5).
4. Physical Activity & Intercourse Deep pelvic involvement or adhesions can make certain exercises or penetrative sex a trigger for pain flares due to mechanical irritation (6.
5. Gut Dysfunction Women with endometriosis often present with IBS-like symptoms. Dysbiosis, constipation, or “endo belly” may intensify during flares (7).

What Are the Symptoms of an Endometriosis Flare Up?

• Deep or cramping pelvic pain
• Pain radiating to back or thighs
• Bloating and abdominal distension (“endo belly”)
• Gastrointestinal distress (diarrhea, constipation, nausea)
• Painful bowel movements
• Dysuria or urinary urgency
• Painful sex (dyspareunia)
• Fatigue, anxiety, or brain fog

These symptoms are often cyclical, but some people with endo report daily or constant pain, especially in advanced stages (8).

What Are the Common Causes of Pelvic Pain?

Pelvic pain isn’t always endometriosis. Other causes include:

• Interstitial cystitis/bladder pain syndrome
• Irritable bowel syndrome (IBS)
• Pelvic floor myofascial pain
• Adenomyosis
• Uterine fibroids
• Pelvic inflammatory disease (PID)

One major underdiagnosed contributor is pelvic floor dysfunction (PFD) - hypertonicity or muscular imbalance that mimics or worsens endo pain (9).

How to Calm an Endometriosis Flare Up

1. Apply Heat Heat increases blood flow and relaxes tense pelvic floor muscles. A randomized trial showed topical heat to be as effective as NSAIDs in reducing menstrual-related pain (10).
2. Anti-Inflammatory Nutrition A Mediterranean-style diet rich in leafy greens, fatty fish, fiber, and turmeric may help reduce systemic inflammation associated with endo flares (11).
3. Gentle Movement Light physical activity like walking, yoga, or stretching can enhance lymphatic flow and ease muscle tension without triggering pain (12).
4. Pelvic Floor Physical Therapy Targeted therapy can relax overactive pelvic muscles, reduce nerve sensitivity, and improve sexual function in people with endometriosis and PFD (13).
5. Supplements

• Omega-3 fatty acids: anti-inflammatory (14)
• Magnesium: smooth muscle relaxant
• Vitamin D: may modulate inflammation and estrogen

Always consult your provider before beginning any supplement regimen.

Can Pelvic Floor Therapy Help Endometriosis?

Yes, and it’s often life-changing.

One clinical study found that pelvic floor physical therapy significantly reduced pain intensity and improved quality of life in women with deep infiltrating endometriosis(12). It can also help address:

• Painful sex
• Urinary urgency
• Constipation or rectal pain
• Poor core stability

Menopause and Endometriosis: Does It Go Away?

Some experience relief post-menopause, but endometriosis doesn’t always vanish. In fact, continued estrogen exposure (via hormone therapy or adipose tissue) can keep lesions active. A small but real number of postmenopausal women report recurrence (15).

How to Prevent Endometriosis Flare Ups

Prevention isn’t guaranteed, but these evidence-backed strategies can reduce severity and frequency:

• Follow an anti-inflammatory diet
• Prioritize gut health (probiotics, fiber)
• Reduce chronic stress
• Maintain a symptom journal
• Treat co-occurring conditions (e.g., PFD, IBS, IC)
• Use hormonal suppression under medical guidance

Can Kegel Exercises Help with Endometriosis?

It depends. If your pelvic floor is hypertonic (tight and overactive), Kegels can worsen symptoms by increasing muscle tension. Many people with endo benefit more from down-training exercises focused on release and relaxation.

How to Do Kegels (if appropriate)

• Contract pelvic muscles gently for 5 seconds.
• Relax completely for 5 seconds.
• Breathe through the movement.
• Avoid clenching abs or glutes.

Always consult a pelvic floor therapist first.

Pelvic Health FAQs: Your Questions Answered

How long does an endo flare last? It varies—typically from 6 hours to 3 days, depending on hormonal cycles and inflammation.

Does pelvic floor dysfunction worsen endometriosis pain? Yes. Overactive pelvic floor muscles can amplify pain from endo lesions and make sex or bowel movements painful.

Are flares worse after surgery? Sometimes. While excision surgery can reduce long-term pain, post-operative inflammation or scar tissue can cause temporary flares.

Final Thoughts

You don’t have to white-knuckle your way through a flare. Endometriosis is real. The pain is real. And the good news? Relief is possible with the right blend of clinical care, pelvic floor support, and compassionate self-advocacy.

Blossom is here for all of it - your healing, your breakdowns, your breakthroughs, and your big exhale.