Sciatic Endometriosis

Medically reviewed by Chioma Ndubisi, MD

Endometriosis is a medical condition that causes endometrial tissue—tissue similar to that which lines the uterus—to grow elsewhere in the body. This can cause pain, irregular periods, and infertility.

Sometimes, these areas of endometrial tissue (also called lesions or implants) put pressure on the sciatic nerve, which runs from the lower back all the way down the back of each thigh. This is a condition called sciatic endometriosis. People with sciatic endometriosis often experience leg pain and weakness around the time of their menstrual cycle.

Learn more about sciatic endometriosis, including symptoms, diagnosis, treatment options, and when to see a healthcare provider.

How Does Endometriosis Affect the Sciatic Nerve?

Usually, endometrial implants grow in and adhere to the ovaries, fallopian tubes, bladder, intestines, rectum, or peritoneum (the lining of the abdominal cavity). This abnormal growth may be due to higher-than-normal levels of estrogen. Some researchers believe that endometriosis is related to retrograde menstruation, which causes menstrual blood to flow backwards into the pelvis instead of out through the vagina.

Rarely, endometrial tissue can grow in different parts of the body. Sometimes, the cells grow in the area of the pelvis just above the sciatic nerve. The sciatic nerve is the longest nerve in the body, running down the back of each leg.

When endometrial lesions put pressure on the sciatic nerve, they can cause irritation and inflammation. Like other types of endometriosis, sciatic endometriosis can lead to severe pelvic pain and make it harder to conceive.

Sciatica, or lumbar radiculopathy, refers to leg pain and weakness caused by pressure on the sciatic nerve. The pain is often one-sided. It may involve tingling, numbness, or a burning sensation.

Symptoms of Sciatic Endometriosis

Some people with endometriosis experience no symptoms or mistake their symptoms for typical signs of premenstrual syndrome (PMS).

The most common signs and symptoms of sciatic endometriosis include:

• Painful, heavy, and/or irregular periods

• Pain during sex, urination, and bowel movements

• Pain in the pelvis, stomach, lower back, hips, and buttocks

• Weakness, numbness, tingling, burning, or a dull aching sensation in the back of one or both legs

• Difficulty walking or standing

• Limping

• Lack of balance

• Infertility

• Bleeding between periods

• Constipation or diarrhea just before or after your period

• Fatigue

• Foot drop (trouble lifting the front of the foot)

Up to 50% of people with endometriosis experience leg pain at some point. However, sciatic endometriosis itself—in which endometrial implants grow around the sciatic nerve—is relatively rare.

Diagnosing Endometriosis-Related Sciatica

Endometriosis, including sciatic endometriosis, typically can’t be diagnosed with a pelvic examination or ultrasound alone.

In addition to discussing your menstrual cycles, symptoms, and medical history, your healthcare provider may need to perform a biopsy using laparoscopy. This surgical procedure involves making small incisions in the skin and removing a tissue sample with tools attached to a thin tube with a camera.

Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, can also provide essential information about the location and size of any endometrial implants.

How to Treat Sciatic Endometriosis

Pain caused by sciatic endometriosis can sometimes be relieved temporarily with over-the-counter (OTC) pain relievers, such as Advil or Motrin (ibuprofen). Gentle exercise, physical therapy, and applying heat or cold to the affected area may also help.

Your healthcare provider may prescribe hormonal treatment to prevent new endometrial implants from growing. Options include:

• Progestin (a synthetic form of progesterone)

• Hormonal birth control (the pill)

• Gonadotropin-releasing hormone (GnRH) agonists

If your pain persists or gets worse, you may need to undergo surgery to remove the endometrial tissue. In rare, severe cases, a hysterectomy (surgical removal of the uterus) may be necessary.

When to Seek Medical Care

Many people with endometriosis don’t seek out help, but treatment is available. Talk to your healthcare provider if you have any signs of sciatic endometriosis, such as irregular periods, spotting, or pain around the time of your menstrual cycle. Over time, sciatic endometriosis may cause nerve damage. Therefore, it’s important to seek treatment as soon as possible.

If you have sciatic endometriosis and wisht to get pregnant, fertility treatment such as in vitro fertilization (IVF) may help. Reach out to an ob-gyn (a medical doctor specializing in obstetrics and gynecology) for an infertility evaluation. This is important if you’ve been having unprotected sex for a year or more without conceiving or for at least six months if you’re 35 years old or over.

Summary

Sciatic endometriosis refers to a condition in which endometrial cells grow outside of the uterine lining and compress the sciatic nerve that runs up and down each leg. This leads to leg pain, especially before and during each menstrual cycle. Like all forms of endometriosis, sciatic endometriosis can also cause pain during sex, bowel movements, and urination, as well as painful periods, fatigue, irregular vaginal bleeding, and infertility.

Treatment for sciatic endometriosis typically involves taking medication or undergoing physical therapy for pain relief. For severe and/or persistent pain, you may require surgery, including laparoscopic surgery to remove endometrial implants or a complete hysterectomy.