Endometriosis Leg Pain: Before, During, and After Periods

Endometriosis (endo) occurs when endometrial-type tissue is present outside the uterus or womb. This tissue (lesion or implant) grows and bleeds with hormone changes, just like the lining of the uterus during a menstrual cycle or period.

The tissues and nerves around the implant can get entrapped, inflamed, or irritated. When it affects nerves in the pelvis (between the hips), it can cause radiating leg pain, muscle spasms, and possibly neuropathy (numbness, tingling, weakness).

This article reviews endometriosis leg pain, the link between inflammation, nerves, and endometriosis, and options for pain relief. 

What Is Endometriosis Leg Pain?

When endometrial implants irritate, inflame, or place pressure on the nerves in the pelvis, leg pain can occur.

Sensation

Leg pain associated with endometriosis differs from the soreness you may feel after a hard workout. It feels more like a stabbing, sharp, or throbbing pain. 

Associated Symptoms 

In addition to leg pain, symptoms may include: 

• Trouble walking
• Loss of muscle mass in the buttocks or legs
• Restless legs syndrome (RLS)
• Problems sleeping
• Difficulty sitting for long periods
  

Endometriosis can also cause:

• Heavy menstrual bleeding or cramping 
• Pain with sex
• Painful urination
• Painful bowel movements
• Infertility (not able to get pregnant)
• Stomach upset

Location

Leg pain can start in your back or pelvis and radiate down both legs. You may feel pain, tingling (pins and needles), or numbness in your buttocks, thighs, calves, feet, or toes. The location depends on the nerves affected. 

During Your Monthly Cycle

Some people note that endometriosis leg pain starts a few days before they start menstrual bleeding (period), gets worse during their period, and stops once the bleeding is over.

Changing estrogen levels are responsible for this cycle. They stimulate your period and cause the endometrial implants to bleed (just like the lining of the uterus). This results in inflammation, irritation, scar tissue, and pain. 

Before and After Surgery

Leg pain can also occur if you've had surgery to treat endometriosis. There is a wide range of pain relief patterns after surgery; the pain may go away right after surgery or take a few days or weeks.

Your healthcare provider may prescribe hormone treatment before or after surgery. The goal of hormonal therapy is to keep new implants from growing.

The Link Between Inflammation, Nerves, and Endometriosis 

Endometriosis can irritate the nerves through inflammation, nerve entrapment, or pressure from the implants. The following are nerves that endometriosis can affect: 

• Sciatic nerve: Sciatic pain (sciatica) may start in your lower back and radiate to your buttocks and down one or both legs. 
• Obturator nerve: This nerve works with the muscle of the thigh. Irritation may cause pain in the groin, inner, or front thigh. It may also cause thigh weakness, making it difficult to walk. 
• Femoral nerve: The femoral nerve is the major nerve in your thigh that starts near the groin. Inflammation and irritation can cause discomfort on the front and side of the thigh.
• Pudendal nerve: This major nerve runs through the buttocks and perineum, sending information to the genital area. It can cause vaginal, urethra, and rectal pain. 

The following are also links between endometriosis and pain:

• Nerve irritation from endometrial implants sends signals of pain to the brain.
• There are multiple nerves in the pelvis that can be affected.
• Endometriosis increases nerve growth where they don’t usually grow.
• Endometrial tissue increases cytokines, which cause inflammation, and prostaglandins, which cause cramping (when there are too many).

Relief Options

For mild symptoms, you can try the following options at home:

• Heat: Apply heat using a patch, heating pad, warm bath, or hot water bottle.
• Cold: Use an ice pack or cool cloth (apply to the painful or inflamed area for 15 minutes several times per day).
• Topical medications: Pain relieving patches, gels, or creams can be placed directly on the skin.
• Movement or position change: Try changing positions or doing some light exercise and stretching to see if it takes the pressure off the nerve.

If approved by your healthcare provider, you can also try the following over-the-counter (OTC) pain relievers:

• Tylenol (acetaminophen)
• Advil or Motrin (ibuprofen), a type of nonsteroidal anti-inflammatory drug (NSAID)
• Aleve (naproxen), an NSAID

If the pain is moderate, severe, or progressing, your healthcare provider may suggest the following:

• Prescription anti-inflammatory or pain medications
• Hormonal therapy
• Nerve blocks
• Muscle relaxers
• Vaginal Valium (diazepam)
• Injections, such as Chirocaine (levobupivacaine) or Botox, BTXA, Dysport (onabotulinum toxin A)
• Anticonvulsants, such as Neurontin (gabapentin) or Lyrica (pregabalin)
• Surgery

Complementary and alternative medicine (CAM) treatments that may provide relief include:

• Acupuncture 
• Chiropractic care
• Supplements including vitamin B1, magnesium, omega-3 fatty acids, cinnamon twig, or licorice root
• Isoflavones
• Boiron, Naturopathica (arnica) cream or pellets

Movement

Movement helps reduce inflammation and relax the muscles, which helps break the pain cycle. An increased heart rate pumps or circulates more oxygen and increases energy. It also stimulates serotonin and endorphins, mood-elevating chemicals and natural pain relievers.

Walking and swimming are good options as they have greater effects on serotonin, toning muscles throughout the body, and improving circulation. Stretching exercises, yoga, and Pilates are also helpful in strengthening and relaxing muscles. 

Physical Therapy

Endometriosis treatment often requires a multidisciplinary approach, which involves physical therapy specialists. Physical therapy may include: 

• Stretching techniques
• Breathing exercises
• Pelvic floor therapy
• Deep tissue massage
• Trigger point injections
• Tissue mobilization
• Biofeedback 
• Nerve stimulation

Anti-Inflammatory Diet

Certain foods can trigger inflammation in the body. An anti-inflammatory diet is a well-balanced diet that helps you avoid those foods. It is a good option for those with endometriosis as it can help reduce chronic inflammation. 

This diet includes lots of:

• Vegetables
• Fruits and berries
• Healthy fats (fish, almonds, olive oil, avocado)
• Green tea

It discourages foods that cause inflammation, including:

• Red meat
• Saturated fats
• Refined sugar
• Caffeine
• Large amounts of alcohol

Dark chocolate is OK if it has at least 70% cocoa. It’s also important to drink plenty of water as hydration reduces inflammation.

Excision Surgery

Excision surgery removes implants or scarring, which can help alleviate pain and improve fertility. The goal is to completely remove all of the endometriosis. However, this becomes more difficult for those with stage 4 endometriosis.

If you think you need this surgery, look for a gynecologist specializing in minimally invasive surgery techniques and endometriosis. They may also put together a team of specialists because the tissue may be outside the typical gynecological area and involve delicate areas and nerves. 

Summary 

Endometriosis occurs when endometrial tissue is present outside the uterus or womb. The tissue grows and bleeds with hormone changes, like the lining of the uterus. This can irritate, inflame, or place pressure on the nerves in the pelvis, causing leg pain. 

Relief options vary based on the severity of endometriosis and its symptoms. For immediate relief, try a topical medication, heat or ice pack, change positions (lie on your side), take OTC pain medications, and perform light exercises, such as swimming or walking.

Treatment may require prescription medications, hormone therapy, physical therapy, or surgery for persistent symptoms or leg pain that affects your daily activity.