I am in my 40’s and while the pain was unbearable, my periods only lasted a few days a month. When the pain in my left buttock started I sought out an endo surgeon. I had excision surgery 5 years ago. 30 lesions confirmed to be endo where removed. I had 3 surgeons working around my bladder, colon etc. They did an amazing job overall and I felt so good after surgery and I can’t remember when I only needed normal doses of pain killer for my period. The hip pain was gone for months, it crept back but I was managing it with stretching and hip exercises. A few years later now, my periods again come with some of the weird bladder and colon pain but not sever enough that I can’t manage. But my hip pain came back even more intensely. I feel muscle weakness and numbness along with stabbing pain in my left buttock. I just don’t know if I should see an endo surgeon now a physical therapist? I did so much research and read that endo removed with excision surgery doesn’t grow back. But clearly something is back. I can cope with the regular pain, but is the hip pain a side effect of my muscles stressed from my period or could there be endo in there? What type of doctor best to see about it? The hip pain seems to come a few days before my period and intensity a few days after my period. I usually am pain free for a couple of weeks until it begins with breast tenderness, hip pain, period, then excruciating hip pain.
Endometriosis
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December 23, 2024
Thank you for sharing your history so clearly. Based on what you describe, there are a few important points to consider.
First, it is true that when endometriosis is completely excised (not ablated), recurrence rates are lower compared to other surgical techniques. However, excision surgery does not guarantee that endometriosis can never return. Recurrence can occur due to residual microscopic disease, new lesion development, or previously undetected deep infiltrating endometriosis (DIE), particularly in complex areas such as the uterosacral ligaments, sacral plexus, or sciatic nerve.
Your pattern of symptoms is particularly important.
Cyclic buttock pain that:
* Begins a few days before menstruation
* Worsens during or immediately after the period
* Is associated with numbness, weakness, or stabbing pain
raises concern for possible nerve-related endometriosis, particularly involvement of the sacral plexus or sciatic nerve. This is sometimes referred to as “catamenial sciatica” in the literature. Deep infiltrating endometriosis in these regions can cause neuropathic symptoms such as numbness, muscle weakness, and sharp or electric-like pain.
That said, not all cyclical hip or buttock pain after surgery is recurrent endometriosis.
Other evidence-based possibilities include:
* Pelvic floor dysfunction
* Myofascial pain syndrome
* Central sensitization
* Scar-related nerve irritation
* Musculoskeletal imbalance following years of guarding and inflammation
The presence of muscle weakness and numbness, however, makes a purely muscular cause less likely and suggests possible nerve involvement.
What should you do next?
The most appropriate first step is evaluation by an endometriosis specialist experienced in deep infiltrating and nerve-related disease. Ideally, this includes:
* A detailed pelvic and neurologic examination
* High-quality pelvic MRI interpreted by a radiologist experienced in endometriosis imaging
If imaging suggests nerve involvement, referral to a multidisciplinary team (endometriosis surgeon + pelvic physical therapist + possibly a pain specialist) may be appropriate.
Pelvic physical therapy can be very helpful — especially if muscle spasm and pelvic floor dysfunction are contributing — but given your neurologic symptoms and cyclical pattern, I would not rely on physical therapy alone without proper imaging and specialist evaluation first.
In summary:
* Excision surgery reduces but does not eliminate recurrence risk.
* Cyclical buttock pain with neurologic features should raise suspicion for deep or nerve-related endometriosis.
* A specialized MRI and evaluation by an experienced endometriosis surgeon is the most appropriate next step.
* Physical therapy can be part of treatment, but not as the only initial approach in this scenario.
You are not imagining this. The cyclical pattern is clinically meaningful, and it deserves proper evaluation.
If you would like a more individualized review of your case, including imaging assessment and a structured second opinion, I would be happy to assist. Please feel free to schedule a consultation should you wish to explore this further.