Lower Back Pain

Lower back pain is a common but often overlooked symptom of both endometriosis and adenomyosis. For some people it feels like a deep ache across the beltline; for others it’s sharp, pulling, or burning pain that starts in the pelvis and “wraps” into the lower back. Many notice a cyclical pattern—worse before or during bleeding—but it can also become persistent over time.

With endometriosis, endometrial-like tissue grows outside the uterus and can trigger inflammation, scarring (adhesions), and irritation of nearby nerves and muscles. Disease behind the uterus (often in the back of the pelvis), on the uterosacral ligaments, or deeper in the pelvis can refer pain into the low back because pelvic nerves and back structures share interconnected pain pathways.

With adenomyosis, tissue similar to endometrium grows into the muscular wall of the uterus. The uterus may become inflamed, enlarged, and more tender—especially during the menstrual cycle. That increased uterine pressure and cramping can radiate into the lower back and pelvis, and some patients describe it as “labor-like” pain that also hits the back.

Lower back pain can also come from other conditions (disc disease, muscle strain, kidney issues, fibroids, pelvic floor dysfunction, or bladder/bowel disorders), which is why symptom pattern matters. A clue that points toward endometriosis/adenomyosis is pain that’s cyclical, linked with pelvic symptoms, or not explained by spine imaging. A thorough workup through a specialist-focused process like Evaluation & Diagnosis can help clarify the cause.

When back pain is driven by pelvic disease, it can affect work, sleep, exercise, sitting tolerance, and intimacy—often leading to avoidance, deconditioning, and frustration after being told “everything looks normal.” If this is your experience, you deserve a deeper look and a plan that addresses root causes, not only temporary suppression.

People often describe endometriosis/adenomyosis-related lower back pain as deep, heavy, and hard to “stretch out.” It may feel like a constant ache near the sacrum/tailbone area, pressure across the low back, or stabbing pain that comes in waves—sometimes alongside pelvic cramping. Some notice pain after standing for long periods, after bowel movements, or after intercourse, when pelvic muscles and inflamed tissues are more reactive.

A common pattern is cyclical flares: back pain ramps up in the days before bleeding, peaks during menstruation, and improves afterward. Others feel it around ovulation or have near-daily pain with periodic “spikes.” Adenomyosis-related pain is often described as intense uterine cramping with back radiation, while endometriosis may feel more “tethering” or pulling—especially if adhesions restrict normal organ movement.

Variability is normal. Some people feel back pain on one side; others feel it centrally. It can coexist with leg pain, hip pain, or buttock pain, especially when nerves are sensitized. Over time, repeated inflammation can contribute to central sensitization (the nervous system becomes more reactive), meaning pain may persist even outside the period window and can be triggered by stress, lack of sleep, or physical strain.

Lower back pain is widely reported in people with endometriosis and adenomyosis, although exact rates vary depending on how studies define “back pain” and which populations are surveyed (general community vs. specialty clinics). In clinical practice, it’s common to see back pain listed alongside classic symptoms like painful periods and pelvic pain—especially when symptoms worsen around menstruation.

Importantly, symptom severity does not always match “stage” of endometriosis. Some patients with minimal-appearing disease can have significant back pain, while others with extensive disease have less pain. Location can matter: disease in the posterior pelvis or deep infiltrating areas may be more likely to produce referred back pain, but there’s no single rule.

For adenomyosis, back pain often travels with heavy bleeding and strong cramping. Because adenomyosis and endometriosis frequently co-occur, overlapping mechanisms can make back pain more persistent and harder to control unless both conditions are considered during evaluation.

In endometriosis, lesions can provoke chronic inflammation, releasing chemicals that irritate pain fibers and make nerves more sensitive. Over time, inflammation can lead to scarring and adhesions that restrict how pelvic organs glide, creating a pulling sensation that’s often felt in the lower back—especially with movement, bowel function, or during the menstrual cycle.

In adenomyosis, the uterine muscle becomes infiltrated and inflamed. The uterus may contract more forcefully and irregularly, and the uterine wall can thicken—both of which can increase pelvic pressure and trigger pain that radiates to the back. Many patients notice the back pain is most intense during heavy bleeding days.

Nerve and muscle involvement can amplify the symptom. Pelvic floor muscles may tighten protectively in response to chronic pelvic pain, which can create secondary low back pain and hip tension. If nerves are irritated or sensitized, pain may feel burning, electric, or may radiate into the buttocks or legs.

Flares are commonly worsened by factors such as prolonged sitting, constipation/straining, poor sleep, high stress, and high inflammation states. Tracking patterns—what improves it (heat, rest, anti-inflammatory meds, gentle movement) and what worsens it—can provide important clues for your clinician and help tailor treatment.

Treatment depends on whether your back pain is primarily driven by endometriosis, adenomyosis, pelvic floor dysfunction, another condition—or a combination. Many patients benefit from a layered approach: symptom relief now plus a plan to address root causes through expert evaluation (see Evaluation & Diagnosis).

Medical management may include nonsteroidal anti-inflammatory drugs (NSAIDs) when appropriate, neuropathic pain medications in select cases, and targeted strategies from our Pain Management approach. If symptoms are clearly cyclical, hormonal suppression (such as continuous combined hormonal contraception, progestin therapy, or other options) may reduce bleeding-related inflammation and cramping; learn more at Hormonal Therapy. These options can be helpful for symptom control, but they don’t remove endometriosis lesions.

When endometriosis is suspected or confirmed and symptoms are persistent, excision surgery is considered the gold standard because it aims to remove disease at the root rather than simply burning the surface. Advanced, minimally invasive approaches—especially for deep or complex disease—can be explored through Surgery & Advanced Excision and our broader our services. If adenomyosis is a major contributor, treatment may range from medication to uterus-sparing procedures in select situations, and for some people hysterectomy is considered; decisions are individualized and should account for fertility goals.

Pelvic floor physical therapy can be a game-changer when muscle guarding contributes to back pain—especially if you have pain with sitting, intercourse, bowel movements, or urinary symptoms. See related education in our Pelvic Floor PT and Pelvic Floor Dysfunction resources. Integrative options like heat, TENS, gentle mobility, acupuncture, and anti-inflammatory nutrition can complement medical/surgical care; explore Integrative Medicine & Lifestyle Care and At-Home Remedies.

What to expect: some people improve significantly with hormonal and supportive care, especially when symptoms are strongly cycle-linked. Others need a surgical plan—particularly if pain is progressive, disabling, or associated with deep disease. If you’re looking for expert guidance, you can learn about Dr. Steven Vasilev and how our team approaches complex pelvic pain with precision and compassion.

Seek urgent care right away if lower back pain comes with fever, chills, fainting, severe one-sided flank pain, vomiting that won’t stop, new weakness/numbness, loss of bowel/bladder control, or if you might be pregnant and have severe pain or heavy bleeding. These can signal conditions that require immediate evaluation.

Schedule a specialist appointment if your back pain is cyclical, lasts more than a few months, interferes with work/school/sleep, or occurs with symptoms like pelvic pain, painful periods, heavy bleeding, bowel/bladder pain, pain with intercourse, or infertility. Because endometriosis and adenomyosis are frequently missed for years, early, expert evaluation matters—especially if you’ve been told imaging is “normal” but your pain continues.

To make your visit more productive, bring a brief symptom timeline: when it started, cycle timing, what makes it better/worse, any GI/urinary/sex pain symptoms, and treatments you’ve tried. If you’re ready for a deeper assessment and an individualized plan, schedule a consultation or contact us.