Endometriosis & Adenomyosis Physical Therapy: You Deserve More Than “Just Live With the Pain”
By Annalise Thompson, PT, DPT | COVA Physical Therapy, Solana Beach, CA
If you have endometriosis or adenomyosis, there is a good chance you have heard some version of:
“Painful periods are normal.”
“You just have to learn to live with it.”
“Everything looks fine.”
But when pelvic pain is interfering with your workouts, work, sleep, sex life, or ability to simply get through your day, I don’t believe the conversation should end there.
I’m Dr. Annalise Thompson, a pelvic health physical therapist at COVA Physical Therapy in Solana Beach. I specialize in helping active women with pelvic pain and pelvic floor dysfunction get back to feeling strong, capable, and confident in their bodies.
One area I am especially passionate about is helping women with endometriosis and adenomyosis. I am currently developing a focused program at COVA for women living with these conditions because they deserve more options for managing their symptoms and maintaining an active life.
What are endometriosis and adenomyosis?
Endometriosis and adenomyosis are different conditions, but both can be associated with significant pelvic pain.
With endometriosis, tissue similar to the lining of the uterus grows outside the uterus. Symptoms can include painful periods, chronic pelvic pain, pain with sex, bowel or bladder symptoms, and difficulty becoming pregnant.
With adenomyosis, tissue from the uterine lining grows into the muscular wall of the uterus. Women may experience painful periods, heavy menstrual bleeding, pelvic pressure, or chronic pelvic pain.
For some women, the symptoms extend far beyond their menstrual cycle.
You may stop exercising because certain movements hurt. You may brace your abdomen or pelvic floor without realizing it. Your hips or low back may begin hurting. Sex may become painful. You may become afraid that exercise will make things worse.
Over time, your body can start adapting to pain.
And that is one of the areas where physical therapy can help.
How can pelvic floor physical therapy help endometriosis?
Physical therapy does not remove endometriosis lesions or cure adenomyosis. Medical management with your gynecologist or other healthcare provider remains an important part of care.
What physical therapy can address are many of the musculoskeletal and pelvic floor problems that may develop alongside persistent pelvic pain.
When your body experiences pain repeatedly, muscles surrounding the pelvis may become tight, guarded, weak, or poorly coordinated. The pelvic floor does not function in isolation—it works with your diaphragm, abdominal muscles, hips, back, and entire movement system.
That is why my assessment looks beyond just the pelvic floor.
Depending on what I find, treatment may address:
Pelvic floor muscle tension and coordination
Hip, abdominal and core function
Low-back and pelvic mobility
Breathing mechanics
Pain with intercourse
Pain associated with bowel or bladder function
Muscle guarding and sensitivity
Strength and movement limitations
Returning safely to exercise and activities you enjoy
For some women, the goal isn't simply “How do we make this hurt less?”
It is also “How do we help you get your life back?”
Your pelvic floor may need relaxation—not more Kegels
This is an important point because many women assume pelvic floor physical therapy means doing Kegels.
Not necessarily.
If you have lived with pelvic pain for months or years, your pelvic floor muscles may already be working overtime.
Think about what happens when you anticipate pain: your body braces.
If that happens repeatedly, your muscles can become very good at protecting you—and not very good at relaxing.
In that situation, simply strengthening the pelvic floor may not be the first priority.
Treatment may instead focus on improving your ability to relax and lengthen the pelvic floor, coordinating breathing with movement, decreasing muscle guarding, improving mobility, and gradually rebuilding strength.
The right treatment depends on your body.
“But exercise makes my symptoms worse.”
I hear this concern frequently, and it is one reason my background is particularly helpful for women with pelvic pain.
My training combines pelvic health, orthopedics, sports performance, strength training, Pilates, and hands-on treatment.
I don't want exercise to be something you become afraid of.
Instead, we can identify which movements or loads are aggravating your symptoms, determine why, modify them when necessary, and progressively build your capacity.
For one woman, that might mean returning to Pilates.
For another, it may mean lifting weights again.
For someone else, success may simply be walking, working, having sex, or getting through her period without planning her entire life around pain.
Your goals matter.
What does physical therapy for endometriosis or adenomyosis look like?
There isn't one “endometriosis exercise program” that works for everyone.
Your first visit should start with understanding your story.
I want to know when your symptoms occur, what makes them better or worse, how your menstrual cycle affects them, what happens with exercise, and whether you have bowel, bladder, sexual, hip, abdominal, or low-back symptoms.
Then I assess how your body is functioning as a whole.
Your treatment plan may include targeted exercise, Pilates-based movement, strength training, manual therapy, breathing and relaxation strategies, pelvic floor retraining, mobility work, and a gradual return to activities that currently provoke symptoms.
When appropriate and with your consent, a pelvic floor assessment can provide additional information about muscle tension, strength, coordination, and pain.
Most importantly, treatment is individualized.
You should not have to choose between protecting your pelvis and being active
This is one of the biggest reasons I am developing COVA's program specifically for women with endometriosis and adenomyosis.
I want women to have a place where we understand both sides of the equation:
Your pain is real.
And you are still allowed to want a strong, active body.
Those two things can exist at the same time.
My goal isn't to tell you to stop doing everything that hurts. It is to figure out what your body needs so we can progressively expand what it is capable of doing.
When should you consider seeing a pelvic floor physical therapist?
Consider an evaluation if endometriosis, adenomyosis, or suspected pelvic floor dysfunction is associated with pelvic pain that affects your daily life, painful intercourse, bowel or bladder symptoms, hip or low-back pain, difficulty exercising, persistent abdominal or pelvic muscle tension, or fear of movement because you are worried about triggering symptoms.
You also do not need to wait until your symptoms become severe before asking for help.
Pelvic floor physical therapy can be one component of a larger care team that may include your gynecologist, primary care physician, pain specialist, gastroenterologist, or other providers.
If you've felt dismissed, I want you to know there are more questions we can ask
One reason I care so deeply about women's health is that I know how frustrating it can be to feel like something is wrong with your body and not feel heard.
I don't want your story to end with, “I guess I just have to live with this.”
There may be parts of your symptoms that physical therapy can address.
And even when we cannot eliminate every symptom, improving strength, movement, pelvic floor function, and confidence in your body can be incredibly meaningful.
You deserve a plan built around your body, your symptoms, and the life you want to live.
Endometriosis & Adenomyosis Physical Therapy in San Diego
If you have endometriosis or adenomyosis—or persistent pelvic pain and aren't sure whether pelvic floor physical therapy could help—I would love to meet you, hear your story, and determine what we can address together.
Physical therapy is not a substitute for medical evaluation or treatment of endometriosis or adenomyosis. We work collaboratively with your healthcare team when appropriate.
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