Endometriosis has a reputation for causing brutal periods, but the pain doesn’t necessarily stop when the bleeding does. It can show up during sex, when you use the bathroom, or on an otherwise ordinary day when your hips or lower back just ache.
The good news is pelvic floor physical therapy may help. It won’t remove endometriosis lesions, but it may reduce the pain that’s built up around them. It’s growing in popularity, so we reached out to experts to find out exactly how PT helps, what happens during treatment sessions, and who might benefit from it the most.
First, what is endometriosis?
Endometriosis occurs when cells that are similar to the ones that line the uterus grow outside the uterus. This can cause painful inflammation and scar tissue. The condition affects an estimated 1 in 10 women of reproductive age, though many people who have it may not know it.
Part of what makes endometriosis so hard to diagnose is that painful cramps are common in people who don’t have it, too, says Dan Martin, M.D., the executive and medical director of the Endometriosis Foundation of America. On top of that, small endometriosis lesions may not show up on an ultrasound or MRI, explains Mary Jane Minkin, M.D., a clinical professor of ob/gyn at Yale University.
A laparoscopy can allow a surgeon to see endometriosis and take a tissue sample to confirm it. But a gynecologist can still diagnose suspected endometriosis without surgery and help you manage the condition. Depending on your situation, that might mean medication, further evaluation, or both, according to Dr. Minkin.
How can pelvic floor PT help endometriosis?
“The lesions aren’t necessarily the only thing contributing to pain,” explains Heather Jeffcoat, P.T., D.P.T., the owner of Femina Physical Therapy in Los Angeles. “Your pelvic floor muscles can tense up in response to pain, even when the lesions aren’t in those muscles.” If they stay tense over months or years, the muscles themselves may become another source of discomfort—one that PT may be able to help with.
One 2026 review published in the Brazilian Journal of Physical Therapy found that people who tried various types of physical therapy reported less pelvic pain and pain during sex, as well as better quality of life. Another study in the Journal of Clinical Medicine found that women with endometriosis who received eight weeks of hands-on manual physical therapy experienced less pelvic pain than those who only received light touch—with improvements still seen six months later.
A lot depends on where the pain is coming from. In some cases, tight or sensitive pelvic floor muscles can make sex or putting in a tampon hurt, but it can also lead to pain when you pee, have a bowel movement, or go about your day. The hips, lower back, and abdominal muscles may need some TLC, too.
Pelvic floor physical therapy is also helpful in reducing bloating, in the absence of SIBO (small intestine bacterial overgrowth) and with a well-controlled diet, notes Jeffcoat. “Sometimes the symptoms of bloating are actually due to an incoordination that has developed between the diaphragm and pelvic floor muscles, often combined with postural dysfunction,” she adds.
“Some PTs, like myself, also take a whole-body approach to their pain, including addressing cervical and TMJ dysfunction—both of which are commonly found in patients with endometriosis and chronic pelvic pain,” says Jeffcoat. That’s why a physical therapist should always ask about all your symptoms instead of assuming every pain has the same cause.
What happens during pelvic floor PT?
At your first appointment, expect to answer questions about when your pain happens, whether it changes with your cycle and how it affects sex, bathroom trips, sleep, and everyday life, explains Jeffcoat. Your PT may then look at how your hips and back move, how you breathe and whether your abdominal muscles or any surgical scars are tender.
An internal pelvic floor exam may also be offered. If you agree to it, a therapist can check how well your pelvic floor muscles contract and relax, and whether any areas are tight or tender, Jeffcoat explains. She says an internal exam can provide useful information, but it isn’t necessary. She’s worked with young patients who didn’t have one and still improved.
Your treatment mostly depends on what your PT finds during the exam and which symptoms are bothering you most. If your hips and lower back have been aching, your PT may spend time working on those areas. If you tend to clench your stomach whenever pain hits, they might help you notice when that’s happening and practice breathing in a way that lets your pelvic floor relax. It may sound almost too simple, but when you’ve been bracing against pain for a long time, letting go isn’t always something you can do on command.
Along those same lines, if sex hurts, your body may have gotten used to tensing up because it expects the pain, says Gina Cunningham, PT, DPT, WCS, the director of Pelvic Floor Physical Therapy at Axia Women’s Health says. PT can help the muscles around the vaginal opening relax and, over time, make touch feel less painful.
If you opt for internal treatment, a therapist might use a gloved finger to gently work with muscles that feel tight or tender. They may also suggest biofeedback, Jeffcoat explains, which helps you see when those muscles are tensing and relaxing, or vaginal dilators if insertion has become painful.
You’ll probably have a little homework, though it shouldn’t be a whole second job. Your PT might give you a stretch that helps when your hips ache or a breathing exercise to try when you feel a flare coming on. Once you find movements that ease pain, they can become part of your routine between visits.
Remember, you can always ask what your PT is recommending and why. You can also ask to slow down or stop at any point. If a treatment doesn’t feel manageable or makes you feel worse, tell your PT. The plan is supposed to fit you, not the other way around.
How long does it take to feel better?
There isn’t a set number of sessions that works for everyone. Some people start with more frequent appointments and space them out as they learn what helps. “Depending on the type of practice most patients see their pelvic floor PT anywhere from two times per week to two times per month,” says Jenny Archer, PT, DPT, a pelvic floor therapist based in Nashville. “If you are able to see your therapist for longer visits that typically decreases how often you need to be seen, as is if you’re able to stick with your home program of stretches and self-release work.”
Keep in mind, improvement can be easy to miss if you’re only asking, “Do I still have pain?” Maybe sex is less painful, the burning you feel when you pee happens less often, or a flare no longer wipes out your entire day. Those are all wins!
What can’t pelvic floor PT do?
As helpful as pelvic floor therapy can be, it can’t remove endometriosis lesions, stop the disease itself, or treat heavy bleeding or infertility. Pelvic floor PT is just one tool that may be helpful to use while you and your gynecologist address the condition itself.
It’s also worth noting that period pain can be trickier to treat with PT, especially if you have adenomyosis, a condition in which tissue that’s similar to the uterine lining starts growing into the muscle of the uterus. And if endometriosis lesions are affecting the bowel, PT may not be enough to resolve painful bowel movements.
At the end of the day, research is still catching up with the interest in PT. A 2022 guideline from the European Society of Human Reproduction and Embryology found that the evidence available at the time wasn’t strong enough to recommend any particular physical therapy approach for endometriosis pain. That means that what works for someone else may not be the best approach for you, but another aspect of PT could still be effective.
Who should consider PT for endometriosis?
If sex or putting in a tampon hurts, or you’re having pelvic pain even when you’re nowhere near your period, bring up pelvic floor PT with your gynecologist. The same goes if you’ve been dealing with bathroom pain or an achy lower back and hips. A PT who works with pelvic pain can check whether your muscles might be adding to the problem and talk you through what they’d actually do about it.
You can see a PT while you’re still figuring out whether you have endometriosis, too. Just keep your gynecologist in the picture, especially if you’re also having heavy bleeding or pain with bowel movements. Feeling better after PT doesn’t necessarily mean everything else has been addressed.
