Endometriosis-Related Leg Pain

Reviewed by: HU Medical Review Board | Last reviewed: June 2018

Many individuals will experience leg pain at some point during their life, and this pain can be incredibly varied. For some, leg pain may be the result of a fall, fracture, or other injury, while for others, there may be no obvious cause of discomfort. Leg pain may vary in its location and intensity. Some may report that their leg pain is dull or causes a widespread ache, while others may have stabbing, sharp pain that can be pinpointed to one specific spot. Common sites of leg pain include the knees, outside of the legs, back of the thighs or calves, and the hips. In some cases, leg pain may go away on its own after a few days and not need medical attention, and in others, it may require serious treatment.1,2 It has been estimated that 40% or more of all women with endometriosis experience leg pain.3,4

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What causes endometriosis-related leg pain?

A variety of different conditions can cause leg pain, including conditions not directly related to the leg. Some of these issues include, but are not limited to:

  • Direct leg injury such as a muscle or ligament tear, bone fracture or break, or a sprain
  • Tendinitis
  • Blood clot
  • Spinal injury such as a herniated disk or the narrowing of the spine (spinal stenosis)
  • Arthritis (including psoriatic arthritis, rheumatoid arthritis, or osteoarthritis)
  • Nerve disorder (such as peripheral neuropathy)
  • Endometriosis
  • Sciatica (pain along the sciatic nerve)
  • Cramping of one or more muscles in the leg
  • Overuse or overexertion
  • Infection of the skin
  • Infection within a bone (also called osteomyelitis)1,2

In relation to endometriosis, the mechanism by which leg pain occurs is not well understood. Leg pain related to endometriosis may be due to inflammation, or endometriosis lesions that invade nerves related to leg pain perception, such as the sciatic nerve.3-6 In some cases, it has been hypothesized that endometriosis-related leg pain is referred pain, meaning pain that is perceived at a different site in the body than where the underlying issue is. For example, a woman may have an ovarian cyst that is painful, however, instead of perceiving this pain in her pelvis, she might perceive it in her legs.3 The mechanism by which referred pain occurs is also not well understood. Some women with endometriosis-related leg pain experience pain fluctuations that coincide with their menstrual cycle, while others' pain does not have a pattern.5,6 More research is needed to fully determine how endometriosis relates to leg pain.

How is leg pain evaluated?

If your leg pain is the result of a hard fall or trauma, it is important to seek medical attention as soon as possible. Additionally, if your leg pain is persistent and lasts for several days, it may be beneficial to consult a healthcare provider as well. However, if you cannot walk, have a fever, or notice that your leg is changing color (such as red and swollen, pale, or blue) or changing in temperature relative to the rest of your body, seek medical attention immediately.1,2

Once you consult your provider, they will try to figure out what's leading to your pain. Determining a cause can be quite challenging, as many conditions can affect leg pain, including some that are not directly related to the legs. Because of this, your provider will weigh the possibility of many different conditions against one another, based on your personal medical history and any other symptoms you're experiencing, to try to rule potential causes out. This is called a differential diagnosis. Your provider may recommend imaging exams, such as an x-ray, CT scan, or MRI to better view your leg muscles, bones, ligaments, and tendons, as well as other surrounding structures to look for an obvious cause. If your provider suspects that endometriosis may be the cause of your pain, they may recommend a laparoscopy to diagnose the condition.

How is leg pain treated?

Treating leg pain often requires treating the underlying issue contributing to the pain. For those experiencing leg pain related to their endometriosis, endometriosis treatment options such as hormonal therapy or laparoscopic excision of endometriosis lesions may lead to pain relief.4,6 In other cases, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to alleviate pain.2 Medications used to treat other underlying conditions, such as antibiotics for infection or arthritis treatments may help relieve pain if these issues were the source of the discomfort. Your provider will work with you to create the most efficient treatment regimen for your specific situation.

How can I manage leg pain?

Outside of the medical interventions that your healthcare provider might recommend, there are other strategies for managing leg pain. Some of these include, but are not limited to, elevating and icing your legs, resting, stretching the legs, and massage.2 Before trying a new method of managing your leg pain, consult your healthcare provider to ensure that it is safe for your situation, and that it doesn't interfere with any other treatments that you're using.

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