Endometriosis & Pelvic Floor Physical Therapy: Why Period Pain Isn’t Normal and What You Can Do About It
Painful periods are common, but that doesn’t mean they’re normal. As a pelvic floor physical therapist, I see this misconception come up again and again. Too many people are told their pain is “just part of being a woman,” when in fact it’s a sign that something deeper may be going on.
If your period pain disrupts your daily life, prevents you from exercising, working, or even standing upright, you deserve to be heard. And you deserve real solutions.
One of the most common culprits? Endometriosis.
What Is Endometriosis?
Endometriosis is a chronic, inflammatory condition in which tissue similar to the uterine lining grows outside of the uterus. It can appear on the ovaries, fallopian tubes, bladder, bowel, diaphragm, and more. These lesions respond to hormonal changes each cycle, causing inflammation, bleeding, and eventually scar tissue.
Endometriosis is estimated to affect 1 in 10 individuals assigned female at birth at minimum, but diagnosis often takes 7-10 years. The condition can cause a wide range of symptoms, many of which extend beyond the reproductive system.
Common signs of endometriosis include:
Intense menstrual cramps not relieved by NSAIDs
Pain during or after intercourse
Pain with bowel movements or urination (especially during periods)
Chronic lower back, pelvic, or hip pain
Fatigue, brain fog, and poor sleep
Bloating and digestive issues (often misdiagnosed as IBS)
Infertility
Pain with periods is common—but pain that limits your life is never normal.
Why Traditional Treatments Often Fall Short
Medical treatments for endometriosis usually include hormonal suppression (e.g., birth control or GnRH agonists) or laparoscopic surgery to remove lesions. While these can provide symptom relief, many patients still experience chronic pain even after surgical excision or hormonal therapy.
That’s because endometriosis affects more than just the lesions. It creates a cascade of neuromuscular changes in the pelvic floor, core, and surrounding systems.
This is where pelvic floor physical therapy (PFPT) becomes essential.
The Link Between Endometriosis and the Pelvic Floor
Living with endometriosis often means living in a state of chronic pain. Over time, the body adapts by tightening muscles, guarding movements, and reducing mobility. The nervous system becomes hypersensitized. The pelvic floor muscles—already a highly sensitive and reactive group—can become overactive, tight, and painful to the touch.
Even after surgery, this muscle dysfunction can persist. That’s because pelvic pain isn’t only about anatomy—it’s about how your body has learned to protect itself.
How Endometriosis Affects the Pelvic Floor:
Muscle guarding in the pelvic floor and hip rotators
Myofascial trigger points in abdominal and pelvic tissues
Restricted diaphragm function impacting breath and pressure systems
Visceral tension and adhesions around the bladder, bowel, and uterus
Nerve hypersensitivity due to chronic inflammation and stress
These changes don’t resolve on their own—and they won’t show up on imaging. But they’re real, and treatable.
How Pelvic Floor Physical Therapy Helps
At Spruce Physical Therapy, our treatment plans for patients with endometriosis are always personalized and based on evidence-based protocols for chronic pelvic pain. My goal isn’t just to reduce symptoms—it’s to help you build resilience, improve function, and feel at home in your body again.
Treatment may include:
1. Manual Therapy
Internal and external myofascial release to reduce pelvic floor muscle tightness
Scar tissue mobilization (especially after surgery)
Visceral manipulation for mobility of internal organs
Trigger point therapy to address pain referral patterns
2. Nervous System Regulation
Diaphragmatic breathing techniques
Vagal nerve stimulation and grounding strategies
Pacing strategies to prevent flare-ups
Somatic awareness and body mapping
3. Movement Re-Training
Functional mobility and core coordination
Pelvic clock and motor control exercises
Hip and lower back stabilization
Stretching routines for restricted fascial planes
4. Digestive and Bladder Support
Education on bowel mechanics and perineal descent
Bladder retraining to reduce urgency/frequency
Nutritional and behavioral recommendations in collaboration with specialists
What to Expect From Your Sessions
During our first appointment, we’ll complete a detailed intake covering:
Symptom history and pain patterns
Menstrual cycle and hormonal changes
Surgical and medical history
Bowel, bladder, and sexual function
Activity limitations and emotional impact
I will perform a gentle physical assessment, which may include an external pelvic and abdominal exam. Internal exams are never required—they are always optional, consent-based, and only done when appropriate.
We’ll build a custom plan that evolves with your goals and your life. Some patients come weekly for 3 months, others come for maintenance or flare support.
Why Choose Spruce Physical Therapy?
At Spruce, I work one-on-one with every patient. There are no aides, no techs, and no “cookie-cutter” protocols. You’ll receive expert, compassionate care from a clinician with advanced training in endometriosis care and pelvic pain management.
Credentials matter—especially with complex conditions like endo.
Vetted by iCareBetter for endometriosis-informed physical therapy
Board-certified Women’s Health Clinical Specialist (WCS)
Pelvic Rehabilitation Practitioner (PRPC)
Certified Lymphedema Therapist (CLT)
PhD candidate in Women’s Health PT
Trusted by leading NYC OB/GYNs, colorectal surgeons, and endo specialists
I’ve helped hundreds of patients manage their symptoms, regain control, and build lives that aren’t dictated by pain.
You Are Not Alone—and Your Pain Is Real
For years, patients with endometriosis have been dismissed, misdiagnosed, or told to “just take Advil.” We now know better—and we can do better.
Whether you’ve just been diagnosed or are years into your journey, pelvic physical therapy can help reconnect you with your body, reduce flare-ups, and improve your quality of life.
If you're in New York City and looking for expert support grounded in compassion and science, I invite you to reach out. Together, we’ll find a path forward.
Disclaimer:
The information provided on this website is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Reading this content does not create a patient-provider relationship. Always consult with a qualified healthcare professional before beginning any treatment or if you have questions regarding your health or a medical condition. Dr. Claire Hamnett, PT, DPT and Spruce Physical Therapy do not guarantee specific results and are not liable for any outcomes associated with the use of this content.
