Endometriosis, Hip Flexor Pain, and Other Symptoms

Hello, I'm Dr. Pooja
I am a former pharmacist turned licensed dietitian-nutritionist, Institute for Functional Medicine Certified Practitioner, and the founder of Pooja Mahtani Wellness, a virtual functional nutrition practice specializing in
PCOS, Thyroid, and Fertility.
Now Trending:
Have Food Sensitivities? Your Hormones May Be Playing A Role
5 Underlying Causes Of Adult Acne: A Functional Medicine Approach To Breakouts
Looking To Transition Off The Pill? Here’s What You Need To Know Before Making The Change
Endometriosis Hip Flexor Pain

Endometriosis is a complex immune condition characterized by inflammation and pain. In fact, at least half of all women with endometriosis experience pain. 

This article will discuss the common symptoms of endometriosis, explore the potential root causes of this disease, and explain why a functional medicine approach may be the best method for addressing endometriosis hip flexor pain and related symptoms.

What is Endometriosis? 

Endometriosis is a disease that affects one in nine women in the United States. It is a condition where the endometrial tissue that lines the inside of the uterus grows outside of the uterus. These growths, or lesions, are most commonly found in the abdominal cavity, such as the pelvic region and bowels.

During a normal menstrual cycle, endometrial tissue grows in response to fluctuating hormones to prepare the uterus for the potential implantation of an embryo. This tissue is shed during menstruation if implantation does not occur that month. 

In women with endometriosis, on the other hand, endometrial tissue will grow outside the uterus as well and respond similarly to the fluctuating hormones during a menstrual cycle. Wherever excess endometrial tissue is found, such as on the ovaries, fallopian tubes, bladder, or other regions of the body, it will continue to grow and proliferate.

However, instead of “shedding,” these lesions become trapped because they cannot pass through the uterus. In turn, these lesions can lead to inflammation, possible swelling, significant pain, scarring, infertility, and a whole host of other symptoms. 

How is Endometriosis Diagnosed? 

Endometriosis is challenging to diagnose. In fact, endometriosis can be easily misdiagnosed because the varied symptoms of this disease often reflect other inflammatory conditions. 

Typically, an extensive medical history is needed to make the connection between endometriosis, hip flexor pain, heavy menstrual periods, and extreme fatigue. Though it is important to point out that a subset of women presenting with endometriosis may be asymptomatic. 

In these “silent” cases, women do not present with any of the usual symptoms of endometriosis. Instead, the disease is only suspected or considered when the woman struggles with infertility. In this case, other tools like biomarker diagnostics (bloodwork), imaging studies such as ultrasounds, MRIs, and CT scans, as well as pelvic exams, can be helpful.

However, despite all the advanced testing that is now available, the gold standard for confirming endometriosis is still a laparoscopy (a surgical procedure) and a biopsy of the visualized tissue. Ideally, this procedure is performed by a skilled surgeon who specializes in endometriosis.

Signs and Symptoms of Endometriosis 

The signs and symptoms of endometriosis vary by individual. At first glance, many of these symptoms may appear unrelated, but they all have a common root cause: endometriosis. Again, due to the varying nature of this disease, it can take years to receive a formal diagnosis. 

While symptoms can differ from person to person, a hallmark sign of endometriosis is severe pain. This pain is generally experienced around the time of menstruation and is significantly worse than standard “period cramps.” This pain can be experienced as follows:

  • Endometriosis hip flexor pain
  • Lower back and abdominal pain
  • Pain during or after intercourse
  • Pain with urination and/or bowel movements

Other symptoms of endometriosis can also include: 

  • Heavy and prolonged menstrual periods 
  • Spotting between menstrual periods
  • Digestive symptoms like diarrhea, constipation, bloating, nausea, or slowed motility during a menstrual period
  • Increased risk for allergies and autoimmune diseases
  • Depression, anxiety, and other mood disorders
  • Extreme fatigue
  • Infertility

Furthermore, the peritoneal fluid of women with endometriosis was found to have high levels of inflammatory mediators. This inflammation can lead to further symptoms such as headaches, low-grade fevers, increased susceptibility to infections, and hypoglycemia (low blood sugar).

Endometriosis Hip Flexor Pain 

What is the connection between endometriosis, hip flexor pain, and lower back pain? Depending on the location of the endometrial lesions, they can mimic common musculoskeletal problems, especially in young women who are menstruating. 

This hip pain occurs because the pelvic region contains a complex set of nerves. As endometrial tissue grows in the pelvic region, it can directly affect these nerves or create scar tissue that presses against the nerves. When endometrial tissue builds around the nerves, it can radiate pain.

The location of the pain is often determined by which nerves are affected, but hip flexor pain is one of the more common symptoms. In some cases, this hip pain may travel to the back and further down the backside as well.

Root Causes of Endometriosis 

Several popular (and unconfirmed) theories describe the pathogenesis of endometriosis.

The most popular is the concept of retrograde menstruation, a phenomenon where a small number of endometrial tissue cells travel through the fallopian tubes and leak into the pelvic cavity rather than flow out through the uterus.

However, newer studies indicate that retrograde menstruation occurs in the majority of women regardless of endometriosis status, which brings this popular theory into question.

At present, the exact cause of endometriosis is unknown, but science is beginning to unravel this complex web of root causes.

Here is a list of probable factors that contribute to the disease:


Endometriosis tends to run in families, suggesting this disease may be hereditary in nature. Studies show that first-degree relatives of affected women are 5 to 7 times more likely to have this disease surgically confirmed.

Recently, genome-wide association studies (GWAS) have shed light on the genetic variants involved in the development of endometriosis. Among them, two main cellular pathways appear to play a role in the pathogenesis of this disease: the MAPK pathway and the WNT pathway. 

What’s important to know about these two pathways is that they explain some aspects of endometriosis onset and progression. As research is evolving, scientists may be able to design novel therapeutic interventions that target these pathways.

Immune Activation

Inflammation is one of the main mechanisms that can lead to the development of endometriosis. In fact, one study tested the peritoneal fluid (fluid found in the pelvic cavity) of women with endometriosis. The results found high levels of inflammatory cytokines in the peritoneal fluid after retrograde menstruation.

Additionally, more studies are discovering that increased secretion of inflammatory cytokines leads to the growth of endometrial lesions.

New research is also showing that there is cross-talk between sensory nerves, which surround and innervate endometriotic lesions, and the immune system. This cross-talk not only triggers chronic and debilitating pain but also further contributes to the growth of endometriotic tissue.

While the origin of endometriosis is still uncertain, it is becoming increasingly clear that the immune system plays a central role in both the onset and progression of the disease.

Gut Microbiome 

Researchers have discovered that there is a significant difference between the gut microbiome of women with endometriosis and women without the condition. 

In fact, an imbalance of the gut microbiome due to an increase in bad bacteria and other pathogenic species, also known as gut dysbiosis, is found to contribute to the onset and progression of endometriosis. 

It is believed that gut dysbiosis disrupts normal immune function, increases inflammatory mediator secretion, and weakens immune system surveillance, all of which may contribute to the pathogenesis of the disease.

Other studies also demonstrate the ability of probiotics and antibiotics to reduce the symptoms of endometriosis, indicating the pivotal role of the gut microbiome.


Research is beginning to reveal estrogen as a key biologic driver of endometriosis. 

Not only is estrogen dominance a common root cause of endometriosis, but science is also beginning to uncover progesterone resistance, or the inability of endometrial tissue to respond favorably to progesterone, as another underlying factor. In many cases, this imbalance in estrogen and progesterone signaling can lead to devastating endometriosis symptoms, such as infertility.

While many physicians recommend oral contraceptives as a treatment option for endometriosis, the concept of progesterone resistance may explain the poor efficacy of progestins, a progesterone-like ingredient found in oral contraceptives, in at least a third of women with endometriosis.

Related Post: Estrogen Dominance Part 1: When One Hormone Gets the Upper Hand

Related Post: Estrogen Dominance Part 2: Achieving Hormone Balance

Environmental Toxins

Your body has several detoxification pathways, including those in the liver, kidneys, skin, digestive tract, and respiratory system.

When these detoxification pathways become inundated with environmental toxins, they cannot support the body as needed. When this goes on for long enough, there is a turning point at which disease processes begin to escalate.

The research has found several environmental toxins, such as bisphenol A and phthalates, to contribute to the development of endometriosis. These chemicals are also known as “endocrine disrupting chemicals,” which are substances that can directly interfere with the actions of our endogenous hormones.

In fact, more and more research is beginning to identify endocrine disrupting chemicals as an emerging threat to female health and fertility.

Functional Medicine Approach to Endometriosis 

Endometriosis is a complex and debilitating disease, and much of the pathology is still unknown. 

However, based on what we do know about the condition, certain diet and lifestyle interventions can go a long way towards helping ease symptoms and reducing further disease progression.

Consume Anti-Inflammatory Whole Foods

Because endometriosis is an inflammatory disease, eating an anti-inflammatory whole foods diet is critical for symptom relief.

Prioritize high-quality, organic, and grass-fed proteins such as beef, poultry, eggs, and tofu. A variety of vegetable fibers, such as leafy greens and cruciferous vegetables, are also critical for hormone health. Lastly, healthy fats such as avocados, olive oil, coconut oil, and full-fat organic butter or ghee are crucial as well.

It is also vital to decrease, and in some cases eliminate, the intake of red meat, gluten, dairy, sugar, and alcohol due to their inflammatory properties.

Eat Organic Foods

Choosing organic foods is integral to reducing the intake of pesticides and herbicides, especially since there is a strong connection between endometriosis and environmental toxins.

Increase Intake of Gut-Boosting Foods

Another dietary intervention includes supporting your gut microbiome by adding fiber-rich foods and probiotics. Regularly consume more fruits and vegetables and prioritize fermented foods like kefir, pickled vegetables, kimchi, and sauerkraut.

Reduce Exposure to Environmental Toxins

Here are a few tips to help reduce exposure to endocrine disrupting chemicals:

  • Minimize canned foods and choose BPA-free items (when possible).
  • Avoid heating plastic tupperware (as heating causes more toxins to leach into the food).
  • Use glass and stainless steel containers instead of plastic.
  • Use essential oils instead of perfumes.
  • Swap standard personal care products for natural alternatives.
  • Swap standard cleaning products for non-toxic alternatives.

Work with a Functional Medicine Nutritionist 

My one-on-one consultation program can help you manage and reverse the symptoms of endometriosis using a functional medicine approach.

This six-month program helps you discover that endometriosis, hip flexor pain, painful menstruation, fatigue, and all the other debilitating symptoms do not need to be part of your everyday life.

During this program, we will get to the root of your health concerns by undergoing a detailed health history review and comprehensive functional lab testing. 

Rest assured, you will receive an action plan that outlines personalized diet, supplement, and lifestyle recommendations to help you finally heal from endometriosis.

Apply to work with me
Hi there

I’m Dr. Pooja!

I am a pharmacist turned functional medicine clinical nutritionist. After years of struggling with PCOS, I finally uncovered the root cause of my hormone symptoms and found a solution that actually works long-term. Now I'm on a fierce mission to help other women achieve hormone healing!

more about ME

Pooja Mahani wellness ⓒ 2023 | Terms | Privacy | disclaimer