As endometrial lesions (implants) from endometriosis (endo) grow and bleed, they cause inflammation and pain. The nerves around the implant can get entrapped, inflamed, or irritated. When endo affects nerves in the pelvis (between the hips), it can cause discomfort and hip pain.
This article reviews how endometriosis affects the nerves and causes hip pain, the timing of hip pain throughout the menstrual cycle, and tips for pain relief from endometriosis.
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Endometriosis, Nerves, and Hip Pain
Endometriosis frequently causes chronic pelvic pain and increased menstrual cramps. It can also affect the nerves in the pelvis and cause leg or hip pain.
The pelvis contains complex nerves, including the following:
- Sciatic (largest nerve in the body; runs from the lower spine and down the back of each leg)
- Obturator (a major peripheral nerve in your thigh; responsible for some leg movements and sensation)
- Femoral (one of the largest leg nerves; runs from your pelvis down the front of your leg)
- Pudendal (the main nerve in the area between the anus and genitalia)
When these nerves become inflamed, damaged, or irritated, they can cause neuropathic pain. This pain can feel sharp or stabbing and radiate (move or spread). Nerve damage or irritation can also cause neuropathy, resulting in numbness or tingling, muscle spasms, and weakness.
Hip pain from endometriosis can start in your back or pelvis and radiate to your hip, buttocks, or legs. You may feel pain, tingling (pins and needles), or numbness. The location of the pain depends on which nerves are affected.
Upregulated Nervous System Function
Upregulation of the nervous system is when something creates a pain signal that travels up the branch of the nervous system. This means it travels from the nerve to the spine and brain.
Endometriosis lesions entrap, inflame, or irritate the nerves in the pelvis, sending pain signals to the brain. Endo also triggers nerve growth where they do not typically grow.
These factors cause the nervous system, including the brain and spinal cord, to become hypersensitive.
Cytokines and Prostaglandins
Cytokines and prostaglandins are substances that are naturally produced in the body as described below:
- Cytokines are part of the immune system that cause inflammation when trying to kill a bacterium or virus.
- Prostaglandins are fatty acids that have hormone-like effects. They are responsible for triggering muscles in the uterus to contract during your period. High levels of prostaglandins cause severe cramps.
When a condition such as endometriosis causes increased production of cytokines or prostaglandins, it negatively affects the nervous system. Increased levels activate nerve fibers and trigger nearby cells to release inflammatory molecules.
Related Gynecologic Causes
Some people with endometriosis never experience pelvic or menstrual cramping. Hip pain may be their first and only symptom. In this case, it’s easy to dismiss it and assume it’s a non-gynecologic cause, such as an injury, arthritis, or bursitis. This is especially true when you have not received an endo diagnosis.
Endometriosis vs. Bursitis
Bursitis is inflammation of the bursae (small sacs that cushion the joints) that causes intense joint pain. It occurs due to overuse, repetitive motion, injury, spine conditions, and bone spurs. The pain often gets worse at night and radiates down the thigh. It is intense or sharp at first but dulls or goes away over time.
Endometriosis hip pain may be constant or come and go based on your menstrual cycle. However, it doesn’t usually dull or go away with time.
Several gynecologic conditions, including endometriosis, can cause hip pain. These conditions inflame, entrap, press against, or irritate the nerves, joints, or tissues in the pelvis area. Examples include:
Adenomyosis
Adenomyosis is a gynecologic condition similar to endometriosis. However, the misplaced endometrial tissue stays within the uterus as it spreads to the myometrium (uterus muscles). It also causes heavy menstrual bleeding, painful periods, and hip pain.
Timing of Hip Pain From Endometriosis
Due to changing estrogen levels throughout your menstrual cycle, hip pain from endometriosis may vary throughout the month. The changing levels stimulate the endometrial implants causing them to bleed, resulting in inflammation, irritation, and pain.
Ovulation
Ovulation is the release of an egg from an ovary. It usually occurs mid-cycle, about two weeks before starting your period. It is common to have mild discomfort during ovulation, but it usually goes away after a couple of days. Ovulation pain is generally on one side.
Endometriosis pain during ovulation can spread to the hips or legs. It usually lasts longer than 48 hours and can cause nausea, vomiting, or diarrhea.
Before and During Period
Endometriosis hip pain often starts a few days before starting your period, gets worse during your period, and stops once the bleeding is over.
Chronic Issues
Chronic symptoms are those that last longer than six months. Chronic pelvic pain is one of the most common problems of endometriosis.
Research has linked other chronic health concerns to endometriosis. While the exact reasons for these connections are still unclear, they include the following:
After Hysterectomy
A hysterectomy is the surgical removal of the uterus and sometimes the ovaries. It is the last resort when treating endometriosis, especially for those who want to conceive more children.
Endometriosis symptoms can still occur after a hysterectomy. Most likely because of lesions that were overlooked or left behind. Sometimes lesions do not look like a typical endometriosis lesion or are not located within the surgical area explored.
Tips for Endometriosis Hip Pain Relief
For mild endometriosis hip pain, you can try the following options at home:
- Change positions: Sometimes, changing positions can help take pressure off the nerve.
- Exercise: Movement reduces inflammation, relaxes the muscles, and circulates more oxygen. Exercise also stimulates serotonin and endorphins (mood-elevating chemicals and natural pain relievers). Good options include swimming, walking, stretching, yoga, and pilates.
- Cold therapy: Cold packs or a cool cloth can help decrease inflammation. You can apply them to the inflamed area or lower back for 15 minutes several times per day.
- Topical medications: You can place topical (on the skin) patches, gels, or creams over sore or inflamed areas and the lower back. They help decrease inflammation, and some also include lidocaine which helps numb the area. Examples include Aspercreme (trolamine salicylate), Bengay (menthol, camphor, or methyl salicylate), Icy Hot (methyl salicylate-menthol), and more.
- Over-the-counter (OTC) pain relievers: If approved by your healthcare provider, you can try a pain relievers such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drug (NSAID) such as Advil or Motrin (ibuprofen) or Aleve (naproxen).
- TENS machine: Transcutaneous electrical nerve stimulation (TENS) machines are devices that use mild electrical impulses to relieve pain and can be purchased over the counter.
Talk with your healthcare provider before using heat therapy. While it helps with endometriosis cramping, it could inflame the nerves, leading to increased hip pain.
If the pain is moderate, severe, or progressing, your healthcare provider may suggest the following:
- Prescription anti-inflammatory or pain medications
- Hormonal therapy
- Physical therapy
- Nerve blocks
- Muscle relaxers
- Vaginal Valium (diazepam)
- Injections, such as Chirocaine (levobupivacaine) or Botox, BTXA, Dysport (onabotulinumtoxin-A)
- Surgery
Summary
While it’s common to assume that hip pain comes from an injury, arthritis, or bursitis, it can also result from multiple gynecologic conditions, including endometriosis. When endometrial lesions entrap, irritate, or inflame pelvic nerves, pain can radiate to the hip, buttocks, and legs.
Hip pain due to endometriosis can vary based on your menstrual cycle. Many note it gets worse before their period but starts to ease up after the bleeding is over.
In addition to chronic pelvic pain, endometriosis has been connected to fibromyalgia, anxiety, autoimmune disorders, asthma, some cancers, and more. Treatment for endometriosis depends on the severity of your symptoms.
