Leg Pain

Leg pain isn’t “just a back issue” for many people with suspected or diagnosed endometriosis or adenomyosis. It can show up as aching, burning, heaviness, cramping, or sharp, shooting pain that starts in the pelvis, buttock, or low back and radiates into one or both legs—sometimes resembling sciatica. Some people notice it most during periods, while others feel it cyclically around ovulation or as a daily, chronic symptom.

In endometriosis, endometrial-like tissue can grow outside the uterus and trigger inflammation, scarring, and irritation in areas that “talk to” pelvic nerves. Even if endometriosis is not directly on a major nerve, deep disease, adhesions, and pelvic floor muscle guarding can create referred pain patterns—meaning the source is in the pelvis, but the pain is felt in the leg.

In adenomyosis, tissue grows into the muscular wall of the uterus. While adenomyosis is a uterine condition, it can still contribute to leg pain through intense uterine cramping, prostaglandin-driven inflammation, and secondary pelvic floor tension. When the pelvis is in a constant protective spasm (often without you realizing it), pain can radiate into the hips, thighs, and down the leg.

Leg pain from pelvic conditions can overlap with other causes like lumbar disc problems, true sciatic nerve compression, hip joint disorders, vascular issues, or peripheral neuropathy. A key clue—though not always present—is a cyclical pattern (worse with periods) and/or accompanying pelvic symptoms like Pelvic Pain, Painful Periods, bladder/bowel pain, or pain with sex.

When leg pain affects walking, sleep, exercise, work, or daily routines, it deserves a deeper look—not dismissal. A specialist evaluation can help connect the dots between pelvic disease and nerve-like pain patterns through careful history, exam, and targeted imaging when appropriate (learn more about our approach on Evaluation & Diagnosis).

People often describe endometriosis- or adenomyosis-related leg pain as radiating, deep, and hard to pinpoint. It may feel like a dull ache in the hips and thighs, a tight “pulling” sensation in the groin, or a sharp, electric, shooting pain that travels from the buttock down the back of the leg (sciatica-like). Others describe heaviness, weakness, or a sensation that the leg is “going to give out,” especially during flares.

Leg pain can be one-sided or both-sided. It may come with low back or tailbone pain, pelvic cramping, or deep pelvic pressure. Some people notice tingling or burning that suggests a neuropathic component—particularly when symptoms flare with prolonged sitting, standing, bowel movements, or during menstruation.

Patterns vary. For some, leg pain is strongly cyclical—peaking in the days before and during bleeding, then easing afterward. For others, especially with long-standing disease and nervous system sensitization, it may become more constant and flare with stress, poor sleep, or overexertion. Tracking timing alongside your cycle and other symptoms (pelvic, bladder, bowel) can provide valuable clues for your care team.

Leg pain is a recognized but under-discussed symptom in endometriosis and adenomyosis. Because it can look like orthopedic or spine-related sciatica, it’s not always captured in gynecologic symptom lists—contributing to delayed diagnosis (endometriosis commonly takes years to identify).

Research and clinical experience suggest leg and sciatic-type pain is more likely when endometriosis involves deeper pelvic structures (deep infiltrating disease) or when there is significant pelvic floor dysfunction and nerve sensitization. However, symptom intensity does not reliably match “stage,” and some people with smaller-appearing disease can have severe radiating pain.

Adenomyosis may also contribute—especially in people with heavy, painful periods and enlarged or tender uterus—often alongside endometriosis. Because these conditions frequently co-occur, evaluating both is important when leg pain is paired with menstrual and pelvic symptoms.

Leg pain in endometriosis is most often driven by a combination of inflammation, mechanical tension, and nerve pathway irritation. Endometriosis lesions can trigger inflammatory chemicals that sensitize nerves, and adhesions (scar-like bands) can restrict normal movement of pelvic organs—creating traction and referred pain into the hips and legs.

In some cases, endometriosis may involve or irritate nerves more directly (for example, near the pelvic sidewall, sacral nerve roots, or along pathways related to the sciatic nerve). Even without direct nerve invasion, chronic inflammation can amplify pain signaling, making normal sensations feel painful (a process sometimes called central sensitization).

Adenomyosis can contribute through powerful uterine contractions, increased prostaglandins, and pelvic congestion-like pressure. Over time, the body may respond by tightening pelvic floor and hip muscles as a protective reflex. Those muscles share nerve networks with the low back and legs, so persistent muscle guarding can send pain down the thigh or behind the leg.

Common factors that can worsen radiating leg pain include prolonged sitting, high-impact exercise during flares, constipation/straining, stress, poor sleep, and untreated pelvic floor dysfunction. Factors that may reduce symptoms include targeted anti-inflammatory strategies, cycle suppression for some patients, pelvic floor physical therapy, and addressing the underlying disease when present.

Treatment depends on the driver of the leg pain (active disease, nerve sensitization, pelvic floor dysfunction, or a mix). Many patients do best with a layered plan that addresses both symptom control and root causes. If you’re exploring options, start with a specialist-led roadmap through our services and an expert workup via Evaluation & Diagnosis.

Medical options may include anti-inflammatory medications, neuropathic pain agents when nerve pain is prominent, and hormone-based therapies that reduce cycling and bleeding. Hormonal suppression can lessen flares for some people with endometriosis/adenomyosis (learn more about Hormonal Therapy). For day-to-day coping and flare planning, evidence-based strategies are outlined in Pain Management.

Surgical care can be important when symptoms suggest deep endometriosis, significant adhesions, or disease affecting structures near nerve pathways. For endometriosis, excision surgery (removing disease at the root) is widely considered the gold standard approach and may offer more durable relief than burning/surface treatments in appropriately selected patients (see Surgery & Advanced Excision). At Lotus, complex cases are led by Dr. Steven Vasilev, with a focus on meticulous minimally invasive excision and whole-person recovery support.

Pelvic floor physical therapy can be a game-changer when leg pain is fueled by muscle guarding, trigger points, or altered biomechanics. A pelvic PT can work on down-training (relaxation), nerve glides, hip stabilization, breathing mechanics, and strategies to reduce flare amplification—especially when combined with integrative approaches (see Integrative Medicine & Lifestyle Care).

Self-care and lifestyle supports can help reduce day-to-day intensity: heat therapy, gentle stretching, pacing activity, anti-inflammatory nutrition patterns, sleep support, and mind–body tools that calm a sensitized nervous system. Many patients find benefit in tracking symptoms and triggers to better time exercise, travel, and demanding workdays around their cycle.

What to expect: leg pain that is largely inflammatory/cyclical may respond more quickly to cycle suppression and anti-inflammatory strategies, while nerve sensitization and pelvic floor dysfunction often improve gradually with consistent therapy. If endometriosis is a major driver, lasting improvement often requires treating the underlying disease—not just masking pain.

Seek urgent care immediately if leg pain comes with new weakness, foot drop, loss of bowel or bladder control, numbness in the groin/saddle area, severe swelling/redness of a leg, chest pain/shortness of breath, or sudden inability to bear weight. These can signal neurologic, vascular, or other emergencies that are not safe to watch at home.

Schedule a specialist appointment if your leg pain is cyclical, repeatedly flares around your period/ovulation, co-occurs with pelvic symptoms (painful periods, painful sex, bowel/bladder pain), or persists despite typical treatments for “sciatica.” Early evaluation matters because endometriosis and adenomyosis are commonly under-recognized, and targeted treatment can prevent years of uncontrolled pain and escalating nervous system sensitization.

When you meet with a clinician, describe: where the pain starts, the exact pathway it travels, whether it’s one- or two-sided, what it feels like (burning/shooting vs aching), cycle timing, and associated symptoms like Lower Back Pain or Pelvic Pain. If you’re ready for a comprehensive assessment, you can schedule a consultation with Lotus.