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Endometriosis Awareness: Q&A with a Pelvic Health Physical Therapist

  • Writer: Madison Hasley, PT, DPT
    Madison Hasley, PT, DPT
  • Mar 19
  • 5 min read

Endometriosis is a common condition affecting an estimated 1 in 10 women. Despite its prevalence, there are many misconceptions about what it is and how it affects people. As a pelvic health physical therapist, I'm here to answer some common questions and explain the lesser-known treatment options that are available. 


a woman in pain due to endometriosis sits in bed


What is Endometriosis?  

Endometriosis is a condition where tissue similar to the lining of the uterus (known as endometrium) grows in places it doesn’t belong, such as the ovaries, fallopian tubes, and pelvic lining. This leads to internal inflammation, adhesions (scar tissue), and disruptive symptoms, including: 


  • Significant pelvic and abdominal pain 

  • Chronic fatigue 

  • Pain with intercourse (dyspareunia) 

  • Painful periods (dysmenorrhea) 

  • Reduced Fertility (subfertility) 



How is Endometriosis Diagnosed? 

Diagnosis of endometriosis is usually made after a patient has had their first menstrual cycle, as most patients with this diagnosis experience significant bleeding, large clots, and pelvic, abdominal, and back pain.9 Although all these symptoms can be indicative of endometriosis, a true diagnosis can currently only be made through a laparoscopic exploratory abdominal surgery to check for endometrial adhesions outside of the uterus. These adhesions are typically removed if found during the procedure; however, this does not “cure” the condition. 



Common Questions About Endometriosis 

As a pelvic health physical therapist, patients often come to me with misconceptions and concerns about their condition. Here are some of the most commonly asked questions we receive about endometriosis: 


Is Endometriosis Just Bad Period Cramps? 

No. Endometriosis is so much more than “bad cramps” — it's a chronic, systemic inflammatory disease that can have a huge impact on one’s health and quality of life. Extremely painful cramps are not a “given” of menstruation; the common advice to “tough it out” is misguided and medically ill-advised. Only you can truly know how painful and impactful your symptoms are; if it feels significant to you, talk to your primary care provider or OBGYN about it.

Does Endometriosis Only Affect the Uterus? 

No. Beyond the reproductive organs, endometriosis can also impact the nearby internal organs, muscles, ligaments, and, in some cases, the diaphragm and lungs.9 This disease affects the adipose tissue and metabolism in the liver as well, leading to systemic inflammation and fluid retention.5,6,7 

Does Endometriosis Only Happen After You Get Your First Period? 

No. Endometrial tissue growth can begin before the menstrual cycle occurs. Most diagnosing occurs after menstruation simply because that is when symptoms like painful periods become most noticeable to the patient.  

Does Endometriosis Cause Infertility? 

Endometriosis is medically classified as a subfertility diagnosis. This means that it can cause reduced fertility, but it isn’t correlated with infertility. Individuals with endometriosis can often still conceive children naturally.9 

Can Endometriosis Be Cured? 

No, this is sadly not the case. Even after surgery to remove adhesions or the uterus, those cells remain active in the body and can create new adhesions.9 

Is Surgery the Only Treatment for Endometriosis? 

No. There are many avenues to address the symptoms of endometriosis beyond surgical interventions. These include hormonal therapies, pain management strategies, lifestyle adjustments, and pelvic floor physical therapy. 

 


When Should I Seek Medical Treatment for Endometriosis? 

If you have ever wondered if your symptoms warrant medical treatment, our position is that it never hurts to ask. If you experience any of the following, we highly recommend speaking to a healthcare provider: 


  • Pain That Interferes with Daily Life: If you often have to miss work, school, or social events due to pain, or if you often stay in bed for a day or longer each month due to pain.

  • Pain Relievers Don’t Work for Cramps: If standard doses of over-the-counter pain relievers (like ibuprofen, Tylenol, or Advil) don’t alleviate your pain. 

  • Progressive Pain: If your periods are getting more painful over time. 

  • Painful Sexual Intercourse: If you feel deep pain in the pelvic area during or after sexual intercourse. 

  • Bowel or Bladder Issues: If you experience constipation, diarrhea, bloating, and/or frequent urination, especially if correlated with your menstrual cycle.

  • Family History: If your family member has been diagnosed with endometriosis, your likelihood of having it is significantly higher. 


Even if you don’t experience these specific endometriosis red flags, your pain and discomfort are something to take seriously. If you feel concerned about your pelvic health, we always recommend discussing it with your healthcare provider. 

 


What is Pelvic Floor Physical Therapy for Endometriosis? 

Pelvic floor physical therapists can play a key role in your care team, along with other healthcare providers such as your OBGYN or primary care physician. Physical therapists (PTs) can help manage the symptoms associated with endometriosis through multiple methods: 


  • Manual Treatment focuses on decreasing muscle restrictions to improve overall mobility and reduce stress through the nervous system.1 These hands-on therapeutic techniques are typically done in a private room and only with the patient's consent. 

  • Nervous System Down-Regulation Techniques involve teaching the patient how to reduce over-activation of the nervous system and pain signals to help reduce the severity of pain, especially during a flare-up.1 

  • Exercise Therapy can be very beneficial for endometriosis management. Physical activity is known to improve inflammation, reduce pelvic pain, improve joint stability, and release natural endorphins to improve mood and cognitive function.2 A qualified pelvic floor physical therapist can help design an exercise program that will help to reduce pain for your specific condition and postural factors. Overall, physical activity is shown to have a significant impact on improving the quality of life in those with endometriosis.8,10  


Pelvic health physical therapy can be incredibly beneficial for those with endometriosis. I highly recommend that if you resonate with the information in this article, you connect with your healthcare team and ask about starting pelvic floor physical therapy. Remember, pain is not something you just have to deal with on your own; we’re here to help. 



About the Author: Madison Hasley, PT, DPT - Madison graduated from the University of Wisconsin-River Falls with a bachelor's degree in Exercise and Sports Science and earned her Doctorate of Physical Therapy from Regis University in Denver, Colorado, in 2025. During her DPT program, she worked with mentors who guided her toward her specialty in Pelvic Health. She is now a Pelvic Health specialist at Rehab United of San Diego, specializing in women's health, including pregnancy and postpartum care.


This Article was Medically Reviewed by: Brynn Frauenhoff, PT, DPT - Brynn is the Pelvic Health Department Lead at Rehab United of San Diego. Brynn earned her Doctorate of Physical Therapy from Baylor University. She has since taken continuing education courses to hone her knowledge in Pelvic Health, including Herman and Wallace 1 and 2A, Female Chain Reaction, and ICE Pelvic Live. With this training, she is able to better understand and treat the pelvic floor in conjunction with the rest of the body.



Sources Cited: 

  1. Can, G., das Virgens, I. P., Fehér, B., Orbán, E. P., Fehérvári, P., Bánhidy, F., Hegyi, P., Mayer, Á. A., & Ács, N. (2025). Physiotherapy for endometriosis-associated pelvic pain: A systematic review and meta-analysis. Pain Medicine, 27(1), 95–103. https://doi.org/10.1093/pm/pnaf083  

  2. Chen, L.-H., Lo, W.-C., Huang, H.-Y., & Wu, H.-M. (2023). A lifelong impact on endometriosis: Pathophysiology and pharmacological treatment. International Journal of Molecular Sciences, 24(8), 7503. https://doi.org/10.3390/ijms24087503  

  3. Endometriosis and infertility: A committee opinion (2012). ASRM. (2012). https://www.asrm.org/practice-guidance/practice-committee-documents/endometriosis-and-infertility-a-committee-opinion-2012 

  4. Exercise & endometriosis. The Endometriosis Network Canada. (n.d.). https://endometriosisnetwork.com/endo-hub/exercise-endometriosis/  

  5. Galvez-Sánchez, C. M., Camacho-Ruiz, J. A., Contreras-Merino, A. M., & Limiñana-Gras, R. M. (2026). Women with endometriosis: A narrative review of adiposity and metabolic function from a biopsychosocial and intersectional perspective. Women, 6(1), 12. https://doi.org/10.3390/women6010012  

  6. Horne, A. W., & Missmer, S. A. (2022a). Pathophysiology, diagnosis, and management of endometriosis. BMJ, 379. https://doi.org/10.1136/bmj-2022-070750  

  7. Tsamantioti, E. S. (2023, January 23). Endometriosis. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK567777/  

  8. What is endometriosis?. Cleveland Clinic. (2025, November 26). https://my.clevelandclinic.org/health/diseases/10857-endometriosis  

  9. World Health Organization. (n.d.). Endometriosis. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis?  

  10. Xie, M., Qing, X., Huang, H., Zhang, L., Tu, Q., Guo, H., & Zhang, J. (2025). The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis. PLOS ONE, 20(2). https://doi.org/10.1371/journal.pone.0317820 

 

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