Lower Back Pain with Endometriosis and Adenomyosis
Lower back pain is a common but often overlooked sign of endometriosis and adenomyosis. It can be a deep ache across your beltline or a sharp, pulling pain that wraps from your pelvis into your back, and it often flares with your period.
- How common
- Common
- When
- Before and during your period
- Where
- Low back, down to the tailbone
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute · Updated Oct 2026
Where you feel it
Back view of the body. The lower spine is highlighted.
- Lower backa deep, heavy ache
- Sacrum & tailbonecan ache when sitting
- Hips & buttockspain can spread here
When it flares
It often ramps up in the days before your period, peaks during bleeding and can flare around ovulation. Back pain that's there all month still deserves a check.
Does this sound like you?
Tap any that fit. We'll turn them into a note you can bring to your visit.
None of these? If your back pain worries you, it's still worth a conversation. Speak with us
When to get help
Back pain that comes back with your period, or never fully goes away, is reason enough to see an endometriosis specialist. You don't need to wait until it stops you working or sleeping.
Keep track
For two or three cycles, note the cycle day, where it hurts, what makes it better or worse and what you've tried. It's the most useful thing to bring to your first visit.
Speak with Us
Book a visit if it:
- Comes back with your period
- Keeps coming back, or never fully goes away
- Comes with pelvic pain or painful, heavy periods
- Comes with pain during sex, bowel movements or peeing
- Gets in the way of work, school or sleep
Your first visit
We go through your history and your notes, then map out next steps together, whether that's tests, imaging or treatment.
When it needs a specialist: How to choose an endometriosis surgeon
What it feels like
How patients often describe it
- It's a deep, heavy ache I can't stretch out.
- It wraps around from my pelvis into my back.
- It aches low down, right by my tailbone.
- It stabs in waves, along with my cramps.
It can ache, press, pull, stab or burn, across your lower back or on one side, and can spread into your hips, buttocks or legs. It often ramps up in the days before your period, peaks during bleeding and can linger afterward; some people feel it around ovulation or most days. Adenomyosis pain often feels like deep cramping that radiates into the back, while endometriosis can feel more like pulling.
Why it happens
Endometriosis
Endometriosis is tissue like the uterine lining growing outside the uterus. It can inflame and scar nearby tissue and make nerves more sensitive. Disease behind the uterus, on the ligaments there or deep in the pelvis can send pain into your lower back, because the pelvis and the back share pain pathways. Scar tissue can also tether organs, so moving or having a bowel movement can pull on them.
Adenomyosis
Adenomyosis is tissue like the uterine lining growing into the uterus's muscle wall. The uterus can become inflamed, enlarged and tender and contract harder during your period, and that pressure and cramping can radiate into your back, often worst on heavy days. It often comes with endometriosis.
Muscles and nerves
Pelvic floor muscles can tighten to guard against pain and refer it to the lower back, hips and tailbone. Irritated nerves can make pain burn or shoot into the buttocks or legs, and over time the nervous system can turn the volume up, so pain continues between periods.
Learn moreEndometriosisAdenomyosis
“Back pain that follows your cycle deserves a look at the pelvis, not just the spine. A normal spine scan doesn't end the search; it tells us where to look next.”
Why it's often missed
Lower back pain is easily put down to a pulled muscle or a disc problem, and back scans can come back normal. These problems can sit alongside endometriosis or adenomyosis, so finding one doesn't rule out the others. The clues are pain that follows your cycle or comes with pelvic pain or painful, heavy periods.
How bad the pain is doesn't reliably match how much disease there is: a little endometriosis can hurt a lot.
How it's diagnosed
Track two or three cycles
Note where it hurts, when, what sets it off and any pelvic, bowel, bladder or sex pain. Pain that follows your cycle is a key clue.
Rule out other causes
Disc problems, muscle strain, kidney problems, fibroids and pelvic floor tension can cause similar pain, and more than one can be present.
A careful exam and imaging
A specialist's exam can find a tender, enlarged uterus, and an endometriosis-focused ultrasound or MRI can show deep disease and adenomyosis. Spine imaging helps when the story fits.
See an endometriosis specialist
An endometriosis-focused evaluation looks at the whole pelvis, not just your spine, and decides whether laparoscopy makes sense. Bring your notes.
Treatment options
Treatment depends on what's driving your back pain, and often combines several approaches.
- Medical
Hormonal therapy
Can ease back pain that follows your cycle, though it doesn't remove endometriosis lesions.
Hormonal Therapy - Medical
Pain relief
Anti-inflammatories and, in some cases, nerve-pain medicines, matched to your kind of pain.
Pain Management - Surgical
Excision surgery
Removes endometriosis at the root when back pain persists, worsens or medicine isn't enough.
Surgery overview - Surgical
Treating adenomyosis
Options range from medication to uterus-sparing procedures and, for some, hysterectomy.
Adenomyosis care - Support
Pelvic floor therapy
Can ease muscle guarding that adds to back pain, especially pain when sitting.
Pelvic Floor Therapy - Support
Everyday relief
Heat, TENS, gentle movement and acupuncture can help alongside other care.
Integrative Medicine
Back pain that flares with your period?
We look past the spine for endometriosis and adenomyosis, and treat the pain itself too.
Schedule a ConsultationPrefer to talk it through? Call or text us.
Questions people ask
Can endometriosis cause lower back pain?
Yes, endometriosis can cause lower back pain. Inflammation and scarring from endometriosis can irritate tissues and nerves in the back of the pelvis, or cause referred pain, where the source is pelvic but the pain is felt in your lower back.
Can adenomyosis cause back pain?
Yes, adenomyosis can cause back pain, especially low back or sacral aching that flares with your cycle. The uterus can become enlarged and tender, and deep pelvic pain can spread into the back, often alongside heavy bleeding, severe cramping or pelvic pressure.
How is adenomyosis back pain different?
Adenomyosis back pain often comes from an inflamed, sometimes enlarged uterus and can feel like deep, intense cramping that radiates into the low back. Many patients notice flares during heavier bleeding days, and it can come with pelvic heaviness or pressure.
Why does endometriosis cause tailbone pain?
Endometriosis can cause tailbone pain when pelvic inflammation and pain keep pelvic floor muscles clenched, referring pain to the coccyx. Nerve sensitization can also develop, so discomfort can persist or flare even when the original trigger seems small.
Endometriosis or herniated disc: how can I tell?
Endometriosis pain often flares with your cycle, while disc-related back or leg pain more often changes with spine movements. There’s no reliable at-home test, and both can coexist, so a symptom history, targeted exam, and appropriate imaging help distinguish them.
Will hormonal birth control relieve endometriosis back pain?
Hormonal birth control can lessen back pain when it’s driven by the menstrual cycle, by suppressing ovulation and bleeding. It doesn’t remove endometriosis lesions and may not be enough if adenomyosis or deeper disease is contributing to your symptoms.
Often happens with
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Sources & medical review
Reviewed by Dr. Steven Vasilev, MD, Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute. Last reviewed Oct 2026; next review Oct 2027.
- Soliman AM, Coyne KS, Zaiser E, Castelli-Haley J, Fuldeore MJ. The burden of endometriosis symptoms on health-related quality of life in women in the United States: a cross-sectional study. J Psychosom Obstet Gynaecol. 2017;38(4):238–248.
- Byrne D, Curnow T, Smith P, Cutner A, Saridogan E, Clark TJ; BSGE Endometriosis Centres. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open. 2018;8(4):e018924.
- Coxon L, Horne AW, Vincent K. Pathophysiology of endometriosis-associated pain: a review of pelvic and central nervous system mechanisms. Best Pract Res Clin Obstet Gynaecol. 2018;51:53–67.