Pain Medicines for Endometriosis

Endometriosis happens when tissue similar to the lining of the uterus grows outside the uterus. This can cause pain in the pelvis, lower back, and other areas. The pain can be sharp, dull, or cramping. It can also be constant or come and go.^1,2

Endometriosis can cause a lot of pain. Many medicines can help.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are a common first-line treatment for pain associated with endometriosis. These medicines are available over the counter. They help reduce inflammation and help with mild to moderate pain. These medicines are available over the counter and do not require a prescription.^1,2

Examples of NSAIDs include:¹

• Ibuprofen (Advil®, Motrin®)
• Naproxen (Aleve®)

Side effects of NSAIDs include stomach upset. NSAIDs should not be used long-term without talking to a doctor. People who cannot take NSAIDs can take acetaminophen (Tylenol®).^1,2

Opioids

Opioids are strong pain medicines. Doctors prescribe them for severe pain. Doctors usually prescribe opioids for endometriosis only when other medicines do not work and after surgery for endometriosis.^1,3

Examples of opioids include:⁴

• Codeine
• Oxycodone
• Hydrocodone

Opioids can have side effects including:⁴

• Constipation
• Nausea
• Drowsiness

Opioids are powerful but can be addictive. If you are concerned about your opioid use for pain management, talk to your doctor.⁴

Muscle relaxants

Muscle relaxants help relax tight muscles. This can reduce pain caused by muscle spasms. They can be useful when endometriosis causes cramping and pelvic pain.⁵

Examples include:^5,6

• Baclofen (Lioresal®)
• Cyclobenzaprine (Flexeril®, Amrix®)
• Tizanidine (Zanaflex®)

Side effects of muscle relaxants include:⁶

• Dizziness
• Drowsiness and fatigue
• Dry mouth
• Nausea

These medicines should not be mixed with alcohol. Muscle relaxants also have the potential to be misused. Talk to your doctor about whether these kinds of drugs are right for your symptoms.⁶

GnRH agonists and antagonists

GnRH agonists and antagonists are newer medicines specifically for endometriosis pain. They work by lowering estrogen levels and other hormones in the body. This can reduce the growth of endometriosis tissue and lessen pain.^1,7

Examples of GnRH agonists include:^1,7

• Leuprolide (Eligard®, Lupron Depot®)
• Nafarelin (Synarel®)

Examples of GnRH antagonists include:^1,7

• Elagolix (Orilissa®)
• Relugolix, estradiol, and norethindrone acetate (Myfembree®)

Side effects of GnRH agonists and antagonists include:^1,7

• Low levels of estrogen
• Bone loss
• Mood changes
• Headaches
• Trouble sleeping

Anti-anxiety medicines and antidepressants

Chronic pain caused by endometriosis can lead to anxiety and depression. Anti-anxiety medicines like benzodiazepines can help with short-term anxiety, but they can be addictive.^1,5

Some antidepressants that are used in small doses to help with chronic pain include:⁵

• Desipramine (Norpramin®)
• Amitriptyline (Elavil®)

Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can help with long-term anxiety and depression that is associated with endometriosis. Examples of these include:^1,5

• Duloxetine (Cymbalta®)
• Fluoxetine (Prozac®)
• Sertraline (Zoloft®)

Talk to your doctor about whether antidepressants are right for you.^1,5

Anticonvulsants

Anticonvulsants are medicines typically used to treat seizures. But they can also help with nerve pain. They can be helpful for pain that feels like burning or tingling.^5,8

Examples of anticonvulsants include:^5,8

• Gabapentin (Neurontin®)
• Pregabalin (Lyrica®)
• Topiramate (Topamax®)

Anticonvulsants can cause side effects such as:⁸

• Dizziness
• Drowsiness

Other things to know

Managing endometriosis pain often requires a combination of treatments. This can include medicines, lifestyle changes, and sometimes surgery. A doctor can help create a plan that works best for each person.

These are not all the possible side effects of these pain medicines. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with these drugs.

Before beginning treatment for endometriosis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.