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Can Endometriosis cause Back Pain?
UPDATED ON 26 Sept. 2024
Endometriosis is a disease which predominantly spreads in the pelvis outside the Endometrial lining due to abnormal immunology, leading to an altered endometrium which becomes active
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Dr Jay Mehta
Scientific Director & IVF Specialist with 10+ years of experience
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What to Expect After Endometriosis Surgery?
As explained, this disease is characterized by adhesions occurring in the pelvis, causing the normal anatomy of the uterus to be altered.
- Retroverted Uterus and Kissing Ovaries: This leads to a retroverted uterus with bilateral ovaries getting adherent to each other and the posterior uterus, leading to the formation of “kissing ovaries.”
- Hematosalpinx and Tubo-Ovarian Mass: Blood in the fallopian tubes, called hematosalpinx, can also form a tubo-ovarian mass.
- Association with Adenomyosis and Rectal Adhesions: A majority of the disease is associated with adenomyosis and adhesions involving the rectum and sigmoid.
- Severe Pelvic Fibrosis and the Negative Sliding Sign: The result is severe fibrosis in the pelvis, causing organs to adhere to each other (Negative Sliding Sign). It is important to note that normally, organs glide freely over one another.
Back Pain in Endometriosis
Understanding why back pain occurs in Endometriosis becomes easier with the anatomy in mind:
- Nerve Involvement: Nerves exiting the spine and entering the pelvis are densely packed to maintain supply to organs like the bladder, vagina, and rectum.
- Fibrosis and Nerve Stretching: Due to fibrosis caused by Endometriosis, these nerves are stretched, leading to persistent back pain unrelated to menstruation.
Also Read : How Is Endometriosis Different From Fibroids?
- Characteristics of Back Pain: Lower back pain associated with Endometriosis is usually difficult to relieve with standard painkillers or hot fomentation. It is a distressing symptom and affects quality of life.
Adenomyosis and Its Contribution to Back Pain
Adenomyosis causes severe pelvic congestion, adding to the intensity of back pain in women with Endometriosis.
Post-Surgical Back Pain Recovery
- Recovery Timeline: Back pain related to Endometriosis takes about 4-6 weeks to fully subside after surgery.
- Nerve Sheath Involvement and Medication: Some women with involvement of the nerve sheath may require medications to relax the nerves and promote healing post-surgery.
- Specific Nerve Symptoms: Symptoms of specific nerve involvement, like the obturator nerve in the lateral pelvic wall or the sciatic nerve in the deep pelvis, have different sets of symptoms discussed separately.
Back Pain in Young Women with Endometriosis
- Severe Involvement in Younger Patients: From personal experience treating patients across India, young women with back pain often have severe involvement of Endometriosis.
- Limited Expertise and Misuse of GnRH Agonists: Many women do not have access to proper expertise in treating Endometriosis and are often placed on GnRH Agonist injections, such as leupride or decapeptyl depots, without proper surgical intervention.
- Side Effects of GnRH Agonists: A significant side effect of these injections is osteoporosis, which leads to back pain in young women, due to induced menopausal changes.
AUTHOR
Dr Jay Mehta
Scientific Director & IVF Specialist with 10+ years of experience
TREATMENT
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Depo Provera Usage and Back Pain in Eastern India
- Depo Provera Administration: The use of Depo Provera is common in eastern India (especially Odisha and West Bengal), where limited expertise is available for treating Endometriosis.
- Prolonged Amenorrhoea and Back Pain: The use of this drug leads to prolonged amenorrhoea, contributing to back pain in these young women.
Surgical Expertise in Endometriosis Treatment
At our Clinic, Dr. Jay Mehta, India’s leading endometriosis surgeon, personally operates on patients across India, ensuring that back pain is addressed comprehensively, unlike other clinics/hospitals where consultations and surgery are handled by different doctors.
Additional Evaluation for Back Pain in Endometriosis
- Kidney and Orthopedic Evaluation: Back pain requires evaluation of the kidneys and consultation with an orthopedic surgeon in certain cases.
- Disc Prolapse Consideration in Older Women: Women over the age of 35 with back pain and Endometriosis may also have associated disc prolapse, which requires additional evaluation.
Post-Surgical Menopause and Back Pain
- Hormonal Support Loss after Ovariectomy: Women who lose both ovaries due to Endometriosis may experience back pain as a fresh symptom post-surgery, due to surgical menopause.
- Importance of Hormone Replacement Therapy: Post-surgical hormone replacement therapy is crucial and should be discussed during counselling to ensure proper management of these symptoms.
Conclusion
Back pain is a significant and often overlooked symptom of Endometriosis, especially in young women. It is not only caused by nerve stretching due to pelvic adhesions but also by other associated factors like adenomyosis, hormonal changes, and the side effects of medical treatments such as GnRH Agonists or Depo Provera.
Effective treatment and management of Endometriosis require a specialized surgical approach and multidisciplinary care, as well as a detailed evaluation of other potential causes of back pain such as disc prolapse.
Post-surgical care, including the consideration of hormone replacement therapy, plays an essential role in long-term recovery and improving the quality of life for women suffering from this condition.
Proper awareness, expertise, and a personalized treatment plan can significantly alleviate the pain and improve outcomes for patients with Endometriosis across various locations.
Recommended Reading
Can Endometriosis Cause Cancer?
Untreated endometriosis can sometimes lead to a rare type of ovarian cancer called clear cell ovarian cancer. If you have endometriosis and your CA 125 levels are high, you may feel more anxious
Where does Endometriosis Occur?
Endometriosis affects both pelvic and extra pelvic areas, commonly involving the bowel, appendix, caecum, small intestine, uterosacral ligaments, bladder, and ureters
Difference Between Adenomyosis and Endometriosis
Adenomyosis involves the invasion of endometrial tissue into the uterine wall, while endometriosis is the presence of endometrial tissue outside the uterus.
