Could endometriosis be causing my back pain?
Back pain is a hugely common condition, but due to the wide variety of things that may cause it, it can sometimes be difficult to deduce whether your back pain is due to a specific condition. Reproductive issues can sometimes cause back pain, which is unsurprising given the location of the reproductive organs within the pelvis.
Back pain related to reproductive health tends to be around the lower back and/or gluteal region and is often described as intermittent or episodic. Therefore, it can come and go at certain times of the month, and can even simply settle with no intervention. However, back pain may also radiate down the legs, and it can cause problems with bowel movements or passing urine.
Endometriosis is one such condition that can cause back pain. It is a common condition in which the tissue that forms the lining of the womb, also known as the endometrium, is found growing in other parts of the body. This condition is estimated to affect around 1 in 10 women in the UK.1
What causes endometriosis?
It is usually found in the ovaries, tubes and other parts of the pelvis, but has also been reported in other regions including the lungs, brain, and external genitals. 2 The cause of endometriosis is unknown and various theories exist as to why it occurs. It does appear to have a genetic component as it tends to run in families. Theories include retrograde menstruation (where menstrual blood flows the wrong way back through the tubes), the spread of endometrial tissue through the bloodstream or immune system (the lymphatic system), and tissues changing to become like the tissue in the endometrium due to exposure to oestrogen.3
The cause of endometriosis is unknown but it does appear to have a genetic component as it tends to run in families.
While a fifth of women with endometriosis will have no symptoms,4 features of endometriosis include chronic pain in the pelvic region, menstrual cycle related pain, deep pelvic pain during sex which can persist even after intercourse, heavy and painful periods (also known as secondary dysmenorrhoea), low energy, period related or cyclical bowel or urine problems, and infertility.5 Of course, quality of life can be hugely affected by these symptoms, and the mental health impact can be devastating, with depression also being an associated symptom of endometriosis.
What is the link between endometriosis and back pain?
Endometriosis is associated with lower back pain as the endometrial tissue can grow in any internal places within this area. The pelvis consists of four bones: the right and left hip bones, and the sacrum and the coccyx, which are posterior, and therefore part of the lower back. As such, it is logical that any problems in these areas are felt in the lower back. With endometriosis being period related, pain in the posterior pelvis region tends to occur during menstruation. This may be worse if the endometrial tissues are found within the bowel, bladder, kidney, or the ligaments and nerves within the lower back.6 If back pain is caused by endometriosis it is likely to be felt deep within the lower back, and changing posture or carrying out exercises prescribed by a chiropractor are unlikely to relieve it.
If endometriosis is the cause of your back pain, it is likely to be associated with heavy painful periods.
The flare up during menstruation occurs because the endometrial tissues react the same way as they do in the womb: the build up, break down, and bleed monthly. Yet in other parts of the body, the blood as no means of leaving that area, which results in pain. If endometriosis is the cause of your back pain, it is likely to be associated with heavy painful periods, and other symptoms of endometriosis as described above. For a definite diagnosis to be made, you will need a laparoscopy, in which a camera is inserted to look for scar tissue and patches of endometriosis. If you have any of the above symptoms, and back pain, then it is important you go to your doctor for investigation.
How can I relieve my symptoms?
While there is no cure for endometriosis, symptoms can be relieved. In terms of pain, a hot water bottle on the lower back, or a hot bath can provide some relief, as can over the counter anti-inflammatory medications and painkillers. Other pain modulating medications exist too, such as those which work on nerve signalling. To keep endometriosis under control, medication involves hormonal suppression, such as using a Mirena IUD to stop the build up of cells. While these things won’t cure the condition, they can help keep it at a level where symptoms don’t affect your day to day life, and both pain medication and hormonal suppression should work to relieve any associated back pain.
If you don’t have any endometriosis symptoms, but are experiencing back pain, it is important to go to your doctor for thorough examination nonetheless, as, as stated, back pain can be caused by a whole host of conditions, as well as minor injuries. If you have already received a diagnosis for endometriosis and experience menstrual cycle related back pain, it may well be that endometriosis is the cause. As such, discuss this with your specialist or doctor, who will be able to conduct further examination, or prescribe appropriate pain medication.
- P. A. Rogers et al., ’Priorities for endometriosis research: recommendations from an international consensus workshop’, Reprod Sci, vol. 16, no. 4, 2009, pp. 335-46, [accessed 18 January 2019].
- S. Amer, ‘Endometriosis’, Obstetrics, Gynaecology and Reproductive Medicine, vol. 18, no. 5, 2008, pp. 126-133, [accessed 18 January 2019].
- NICE, ‘Endometriosis: diagnosis and management’, NICE Guideline NG73, September 2017, [accessed 18 January 2019].
- John R. Floyd 2nd et al., ‘Cyclic sciatica from extrapelvic endometriosis affecting the sciatic nerve’, J Neurosurg Spine, vol. 14, no. 2, 2011, pp. 281-289, [accessed 18 January 2019].