When you hear “endometriosis,” what comes to mind? If you said painful periods, you’re not wrong—but that’s not even the full picture. As a physical therapist, I see firsthand how this condition impacts the whole body, not just the reproductive system. So, let’s break it down and talk about what’s really going on, why it’s more than just a “bad period,” and how physical therapy can help.
What Is Endometriosis?
Endometriosis (or “endo” for short) happens when tissue similar to the uterine lining grows outside the uterus. This tissue can show up on the ovaries, fallopian tubes, bladder, intestines, and even the diaphragm. It most commonly appears within the abdominal region; however, we have scientific evidence that shows that endo lesions can occur throughout the body. Unlike the uterine lining, which sheds during menstruation, this rogue tissue has nowhere to go, leading to inflammation, scarring, and adhesions that stick organs together. Ouch!
Endometriosis is an estrogen-driven condition, meaning that estrogen can fuel the growth of these lesions. Endo lesions have also been shown to produce estrogen as well. This is why symptoms often worsen during times of high estrogen, such as in the late follicular phase of the menstrual cycle or with certain hormonal imbalances. Managing estrogen levels—through lifestyle changes, nutrition, and medical interventions—can be an important part of symptom relief.
More Than Just Pelvic Pain
While painful periods (dysmenorrhea) are a hallmark symptom, endo can cause a whole range of symptoms. These symptoms can include:
🔹 Chronic pelvic pain – Not just during your cycle, but all month long.
🔹 Pain with sex (dyspareunia) – Often due to tight, irritated pelvic floor muscles.
🔹 Bowel and bladder issues – Think IBS-like symptoms, constipation, urinary urgency, and painful urination.
🔹 Low back, hip, and leg pain – Thanks to nerve irritation and fascial restrictions.
🔹 Fatigue – Chronic inflammation and hormone imbalances can leave you feeling drained.
🔹 Fertility challenges – Endo is one of the leading causes of infertility.
Why Does It Affect So Much?
Endo isn’t just about where the tissue is growing—it’s about how the body responds. Chronic inflammation and adhesions can pull on muscles and fascia, leading to movement restrictions and pain in areas far beyond the pelvis. Nerve sensitization makes pain signals go into overdrive, meaning even normal movements can feel unbearable. And when you’re in pain, muscles tend to tighten as a protective response, which can further contribute to discomfort. If not managed, it can become a vicious cycle.
Fertility and Endometriosis
For those trying to conceive, endometriosis can add another layer of frustration. Inflammation, scar tissue, and adhesions can interfere with ovulation, egg transport, and implantation. Endo can also disrupt hormone regulation, affecting cycle regularity. However, treatment options—including physical therapy—can help by improving blood flow, reducing adhesions, and addressing pelvic muscle imbalances that may impact reproductive health.
The Gut-Endo Connection
Digestive issues are incredibly common with endometriosis. Many people experience symptoms like bloating (often called “endo belly”), constipation, diarrhea, and nausea. Here’s why:
- Inflammation from endo lesions can irritate the gut and cause scarring.
- Scar tissue and adhesions can cause mechanical restrictions, affecting digestion and motility.
- The gut and pelvic floor are closely connected, meaning tight or dysfunctional pelvic muscles can contribute to constipation or difficulty emptying the bowels.
- Endo and IBS often overlap, making it tricky to separate symptoms.
How Can Physical Therapy Help?
You might not think of PT as a go-to treatment for endometriosis, but it should be! This is where a pelvic health physical therapist can be a game-changer. By improving pelvic mobility, addressing muscle imbalances, and using visceral mobilization techniques, PT can help support digestion and relieve and manage common endo symptoms..
Here’s how physical therapy can help:
1. Pelvic Floor Therapy
Many people with endo develop tight, overactive pelvic floor muscles from years of guarding against pain. A pelvic health PT can help release this tension through various forms of manual therapy, biofeedback, and exercises to improve coordination.
2. Myofascial and Visceral Mobilization
Because adhesions can restrict movement, gentle hands-on techniques can help free up fascial restrictions and improve organ mobility. This can relieve pressure on the bladder, intestines, and surrounding muscles.
3. Pain Neuroscience Education
Chronic pain rewires the nervous system, making it more sensitive. Learning about how pain works and using techniques like graded exposure and relaxation can help dial down the nervous system’s overreaction. This process can take time and is important to work on regardless of other decided on interventions to help manage this disease process.
Medical Interventions for Endometriosis
Because endometriosis is driven by estrogen and inflammation, many medical treatments focus on hormone regulation and symptom management. Before speaking on these options, I feel that it is important to emphasize that we currently do not have a cure for endometriosis and that medical interventions are used to help manage symptoms. Here are some common options:
1. Hormonal Therapy
- Birth Control Pills, Patches, or Rings – These can help regulate hormones and suppress ovulation, reducing pain and bleeding.
- Progestin Therapy – Options like progestin-only pills, IUDs (such as Mirena), or injections (like Depo-Provera) may help thin endometrial tissue and reduce inflammation.
- GnRH Agonists and Antagonists – These medications (such as Lupron or Orilissa) suppress estrogen production to put the body into a temporary menopausal state, often reducing pain but with potential side effects like bone loss.
2. Pain Management
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) – Medications like ibuprofen and naproxen can help reduce inflammation and pain.
- Neuromodulators – Some providers prescribe medications like gabapentin or amitriptyline to help calm nerve-related pain.
3. Surgery
- Laparoscopy (Excision Surgery) – Considered the gold standard for diagnosing and treating endo, this surgery removes lesions and adhesions to relieve pain and improve fertility outcomes. Excision is preferred over ablation, as it fully removes endometrial-like tissue rather than just burning the surface.
- Hysterectomy – This surgical intervention does not treat endometriosis; however, it does treat for something called adenomyosis. Adenomyosis directly involves the uterine lining and it is closely associated with endometriosis, although it is a separate diagnosis. Historically, some providers were offering hysterectomies to women with endometriosis in an attempt to cure the disease, and this has since identified as ineffective for endometriosis.
4. Multidisciplinary Care
Because endometriosis is a whole-body condition, medical treatment is most effective when combined with pelvic physical therapy, nutrition, mental health support, and lifestyle modifications. A team-based approach offers the best chance for long-term relief.
You’re Not Alone
If you’re struggling with endometriosis, know this: Your pain is real, and you deserve care that looks at the whole picture—not just your reproductive system. A multidisciplinary approach that includes pelvic floor PT, medical management, nutrition, and mental health support can make a world of difference.
Endometriosis is more than period pain, and treating it requires more than painkillers and surgery. If this resonates with you, consider seeking out a pelvic health physical therapist who understands the complexities of endo. You don’t have to push through the pain—help is out there!
Have you worked with a PT for endometriosis? I’d love to hear about your experience in the comments!