Understanding Endometriosis: How It Affects Pelvic Health and Connection to Chronic Conditions

Endometriosis Awareness Week (March 3-9) is a crucial time to shed light on a condition that affects 1 in 10 people assigned female at birth. Endometriosis (or "endo") is a chronic inflammatory disease where tissue similar to the uterine lining grows outside the uterus, leading to widespread pain, systemic inflammation, and other complications. Despite its prevalence, many people face delayed diagnoses and inadequate treatment. In this post, we’ll explore what endometriosis is, how it connects to pelvic health, and its link to chronic conditions.

My Endometriosis Journey: From Patient to Pelvic Therapist

Long before I became a pelvic floor therapist, I was just trying to understand my own body. In my teens and early twenties, I experienced relentless pelvic pain and abnormal bleeding—sometimes for weeks at a time, even while on birth control. Ovarian cysts kept forming, though I never quite figured out why (a story for another day). At 23, my gynecologist recommended laparoscopic surgery to rule out endometriosis. Desperate for relief, I agreed.

In January 2013, I was officially diagnosed with endo. Finally, the years of unexplained pain made sense. A switch to a low-estrogen birth control helped, but pain persisted. I even tried pelvic floor therapy as a patient while living in Nashville. Back then, it was mostly table work, exercises, and internal treatment. It may have helped, but it wasn’t a cure-all.

Fast forward to my 30s, I had two beautiful pregnancies and babies, and for the first time in my life, am now experiencing natural cycles without birth control. Each cycle is a bit different and some are more painful than others. I believe some degree of endo has returned, but instead of hormonal suppression, I’m focusing on a holistic approach—balancing hormones naturally and following an anti-inflammatory diet.

Now, as both a clinician and someone who has walked this path, I want to shed light on the realities of endometriosis, its impact on pelvic health, and what comprehensive care should really look like.

What is Endometriosis?

Endometriosis occurs when tissue resembling the uterine lining implants and grows outside the uterus, commonly on the ovaries, fallopian tubes, intestines, and pelvic lining. Unlike normal uterine tissue, these growths do not shed during menstruation, leading to chronic inflammation, scarring, adhesions, and pain. The exact cause of endometriosis is still being studied, but theories suggest a combination of genetic, hormonal, immune system, and environmental factors play a role.

Common Symptoms of Endometriosis:

• Chronic pelvic pain (before, during, or outside of periods) that can range from mild to debilitating.

• Painful periods (dysmenorrhea) often resistant to typical pain relief methods like NSAIDs.

• Pain with intercourse (dyspareunia) due to inflammation and muscle guarding.

• Gastrointestinal symptoms (bloating, constipation, diarrhea) often misdiagnosed as IBS.

• Fatigue, brain fog, and systemic inflammation caused by chronic immune activation.

• Bladder dysfunction (painful urination, urgency, frequency) linked to adhesions affecting the bladder.

• Infertility struggles as endometriosis can impact the function of the fallopian tubes and ovaries.

The Connection Between Endometriosis & Pelvic Health

Endometriosis does not just affect the reproductive system; it impacts the entire pelvic floor and beyond. Over time, chronic pain can lead to compensatory movement patterns, restricted organ mobility, poor posture, nervous system dysregulation, and overactive pelvic muscles.

How Endometriosis Affects the Pelvic Floor:

• Chronic pain causes pelvic floor muscle tension and dysfunction, contributing to painful urination, difficulty with bowel movements, and painful intercourse.

• Adhesions from endo lesions can affect organ mobility, leading to bladder and bowel dysfunction. Adhesions can form bands of scar-like tissue that restrict movement in the pelvic organs.

• Many individuals develop levator ani syndrome, vaginismus, or non-relaxing pelvic floor dysfunction due to persistent pain signals that cause muscles to remain contracted.

• Pelvic floor therapy can be instrumental in managing pain, improving mobility, and restoring function by addressing these muscular imbalances and adhesions.

Endometriosis and Chronic Conditions: The Overlapping Puzzle

Endometriosis is more than just a reproductive health condition—it is a systemic inflammatory disease. The immune system, nervous system, and connective tissues all play a role in how the body responds to chronic inflammation. This is why many people with endometriosis also experience overlapping conditions, including:

• Ehlers-Danlos Syndrome (EDS) – Hypermobile connective tissue increases pain, adhesions, and organ instability.

• Postural Orthostatic Tachycardia Syndrome (POTS) – Blood flow issues, dizziness, and fatigue can be exacerbated by hormonal and inflammatory shifts.

• Mast Cell Activation Syndrome (MCAS) – Excessive histamine release causes widespread inflammation, pain flares, and food sensitivities.

• Irritable Bowel Syndrome (IBS) – Bloating, slow motility, and gut dysfunction are common due to endo-related inflammation.

• Interstitial Cystitis (IC) / Bladder Pain Syndrome (BPS) – Bladder urgency, frequency, and irritation often co-occur.

• Adenomyosis – Similar to endo, but tissue invades the uterine muscle, causing severe cramps and heavy bleeding.

• Autoimmune conditions – Chronic immune activation can trigger conditions like lupus, Hashimoto’s, and rheumatoid arthritis.

• Fibromyalgia & Central Sensitization – Widespread pain and nervous system dysregulation amplify symptoms.

• Migraines & Chronic Headaches – Estrogen fluctuations contribute to hormone-related migraines.

Why Do These Comorbidities Matter?

Many people with endometriosis struggle to get comprehensive treatment because their symptoms extend beyond the reproductive system. Understanding these overlaps can help guide a whole-body approach to care, including pelvic floor therapy, nervous system regulation, gut health support, and pain management strategies.

How Pelvic Floor Therapy Can Help Manage Endometriosis Symptoms

While surgery (particularly excision surgery) remains the gold standard for removing endometriosis lesions, pelvic floor therapy is an essential part of pain management and long-term recovery.

Benefits of Pelvic Floor Therapy for Endometriosis:

• Manual therapy (myofascial, visceral mobilization) to release scar tissue, adhesions, and fascial restrictions

• Pelvic floor relaxation techniques (breathwork, gentle stretching, and downtraining exercises to ease muscle tension)

• Bladder & bowel retraining to improve function and reduce urgency, frequency, and incomplete emptying

• Nervous system regulation (vagus nerve stimulation, mindfulness) to calm pain sensitivity

• Movement strategies tailored to individual needs to improve daily function and reduce symptom flares while considering joint hypermobility

Advocating for Proper Endometriosis Care

One of the biggest challenges with endometriosis is misdiagnosis and lack of awareness in the medical community. Many people are told that severe period pain is "normal" or that their symptoms are "just IBS." Many patients are dismissed for years before getting a diagnosis. If a doctor isn’t listening, find one who will. Keep pushing for the care you deserve!

It’s important to know:

• 1. Trust Your Symptoms & Speak Up

• Endometriosis pain is not just "bad period cramps"—it’s chronic, inflammatory, and can affect your entire body.

• Keep a symptom journal tracking pain, GI issues, fatigue, and how they impact daily life. Bring this to appointments to show patterns.

• If a provider dismisses your pain or suggests it's "normal," confidently say:
  👉 “I understand that some discomfort with periods is normal, but my symptoms are severely impacting my life. I need further evaluation.”

• 2. Ask for the Right Testing & Referrals

• Ultrasounds cannot rule out endometriosis. The only definitive diagnosis comes from laparoscopy with excision.

• If your provider doesn’t take your concerns seriously, ask:
  👉 “Can you refer me to an endometriosis specialist or surgeon trained in excision?”

• Request referrals for a pelvic floor therapist, functional medicine specialist, gastroenterologist, and/or autonomic specialist if you have overlapping conditions like IBS, POTS, or MCAS.

• 3. Be Prepared for Appointments

• Write down specific questions before each visit. Examples:
  ✅ What are the next steps in my diagnosis/treatment?
  ✅ Can we discuss pain management options beyond birth control?
  ✅ Do you have experience treating complex endometriosis cases?

• If you feel rushed or dismissed, don’t hesitate to say:
  👉 “I need more time to discuss my symptoms and treatment options.”

4. Find the Right Care Team

• Not all gynecologists specialize in endometriosis care—seek out an excision surgeon for proper treatment.

• Look for pelvic health specialists to help with related muscle dysfunction and pain.

• If a doctor isn’t listening to you, it’s okay to get a second opinion.

5. Know Your Treatment Options

• Excision surgery is the gold standard for removing endometriosis (not ablation, which burns tissue but doesn’t fully remove it).

• Hormonal therapies (like birth control or GnRH agonists) may mask symptoms but do not remove endometriosis.

• Pelvic floor therapy, lifestyle adjustments, and nervous system regulation can support whole-body healing.

6. Use Community & Support Groups

• Joining endometriosis advocacy groups can provide resources, referrals, and emotional support.

• Online platforms like My Endometriosis Team connect women with endometriosis and provide education on treatment options, specialists, and education on evidence-based care.

• Search the hashtag #SpeakENDO to hear other women's stories and learn how they're advocating for better care.

7. Advocate for Yourself at Work & School

• You have the right to request workplace or school accommodations for chronic pain and fatigue.

• Talk to HR about FMLA or disability accommodations if symptoms are significantly impacting your daily activities.

Final Thoughts: You Are Not Alone

If you are struggling with endometriosis-related pelvic pain, you deserve real answers and a treatment plan that addresses the full scope of your condition.

Pelvic floor therapy can be a powerful tool in your healing journey. If you’d like to explore how it can support you, reach out for a consultation—you don’t have to navigate this alone. You deserve care that helps you thrive—not just survive. 💛

*Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and guidance specific to your medical condition. The content shared here should not be used as a substitute for professional medical advice, diagnosis, or treatment.