your period should not be stopping your life.

I could not be more excited to see all the research and treatment options that are available for period pain including endometriosis over the last few years. I recently watched a workshop from Dr. Sinervo from Center for Endometriosis Care in Atlanta, GA. Dr. Sinervo is an incredible advocate for individuals with endometriosis and has spearheaded excision surgery with incredible results.

Which is incredible, but lets look at the facts.

Endometriosis credited to have been first visualized and identified under microscope in 1860 by Kar von Rokitansky is defined as “endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with associated inflammatory process; a spectrum disease with variety of subtypes and clinical presentations” (International Endometriosis Working Group, 2021). “Characterized at surgery” is at the start of that quote and I removed it as in 2024 the clinical guidelines for diagnosing endo changed to provide a non-invasive diagnostic protocol.

Unfortunately, for those of us in the United States we are on a slower track. February 2026 is where the American College of Obstetricians and Gynecologists (ACOG) updated its clinical guidance for diagnosing endometriosis; although, while other countries started using bio-markers the ACOG explicitly recommends against using blood, urine, endometrial, or other biomarkers to diagnose endometriosis in clinical practice. The first line of diagnostic support relies on traditional imaging like transvaginal ultrasound or pelvic MRI rather than biomarkers and uses what they call presumptive clinical diagnosis based on patient history, symptoms, and physical exams, which they deem sufficient to initiate medical treatment.

Also known as, “listening to what the patient is saying” and using clinical knowledge. Novel concept *insert sarcasm*. In actuality, it is a great stride for the ACOG and the gynocologists in our country as this can help shorten the time expected for a individual to get a diagnosis and started on a treatment plan.

The USA has grated fast track designation for the FDA on Molecular Imaging; although, has not been FDA approved for clinical use as of now. The strides made in other countries are providing hope on diagnostic procedures that are less invasive for patients are paving the way for us here in America. There is hope!

As of 2020 the World Health Organization (WHO) found that 190 million + affected with endometriosis and Soliman et al, 2018 stated an annual direct and indirect costs to the USA alone to be $69.4 BILLION. Making this a more costly public health problem above migraines and on par with Type II Diabetes, Crohn’s & Rheumatoid Arthritis (Fourquet et al., 2010; Zondervan et al., 2020).

Yet, I believe the general public’s understanding of endometriosis was limited to “painful menses/periods” until recently (if at all depending on where their focus is and how their algorithms feed them information). Due to this expectation by the masses in our society it has normalized the condition and created an invisible disease that predominately affects women (Dr. Cara Jones; 2016). In actuality, the menstrual pain/problems can be among the symptoms but the symptoms are not only confined to menstruation as endometriosis can diminish or negatively affect physical, sexual, reproductive, emotional, psychological, and financial health while also impacting relationships of all kinds potentially isolating the individual (Krsmanovic et al., 2022).

Unfortunately, the previous go-to treatment for endometriosis was ablation and often this would require repeated procedures and failed interventions. Potentially a contributing factor to the failed interventions could be due to the fact that the effects of disease is not contained to the pelvis. Dr. Sinervo shared stories of how one of his patients had severely limited neck rotation and had been referred to him by her PT for concerns of diaphragm involvement. With the use of Dr. Sinervo’s skill and his medical team they removed adhesions to this patient’s diaphragm and post-operatively she had fully neck rotation.

The biggest thing to take away from this story is that the body is so incredibly interconnected and when we focus on “the problem” we can often miss pieces that can improve the condition significantly.

There is an extensive list of co-morbidities that can lead to endometriosis and patterns have been found that can aid in a diagnosis; such as what is called Evil Septuplets and the Evil Quadruplets.

Evil Septuplets stated by Perry, 2005 identified endometriosis, Interstitial Cystitis (painful bladder syndrome), vulvovestibulitis, pelvic floor tension myalgia (pain), irritable bowel syndrome, and fibromyalgia contribute to generating pain.

Evil Quadruplets stated by Amy Stien 2024, a pelvic floor PT since before anyone knew what it was 👀, found that there is a strong correlation with autoimmune and connective tissue disorders as well. Autoimmune, mast cell activation syndrome, POTS, connective tissue disorders make up the evil quadruplets added to the previously stated evil septuplets.

One more thing before we move into how pelvic floor physical therapy (PFPT) can help with endometriosis. For years, and likely currently, the first course of action when an individual has painful periods is to prescribe birth control. This drug masks symptoms for the duration of the birth control use and when they stop use - typically when ready to get pregnant - they learn that their symptoms are exponentially worse. Why you may ask?

The mask was just that - a way to not feel the progression of the disease. Just another negative to the use of this drug and a massive reason that we should be demanding better options. A soapbox for another day. If you want to hear it…

This blog is starting to get long..

How PF PT can help with endo

As much as I would love to say that PF PT can resolve problems it is not possible to stop or reverse disease processes. What we can do is still incredible and beneficial.

Throughout our schooling we learned about trigger points and fascia adhesions and how to treat them - easy! Through training and being mentored in PF PT we learn this about the pelvic floor musculature and literally what got me to start working on pelvic floors to begin with.

Due to adhesions from endo within the pelvic bowl there are referral patterns to the low back and hips. Yes, your pelvic floor can be the reason for your back and/or hip pain - especially if it is not responding to PT.

We have a strong understanding and passion for nerve distrubutions and how adhesions can create problems in this area, which narrows down where to treat for the adhesions through soft tissue restrictions and improve joint and viscera (organ) mobility.

Another modality that is coming more used for this as well as period pains is dry needling. I actually got certified in May to dry needle the pelvic floor. As the pelvic floor and abodminal musculature is often affected by endo adhesions dry needling can be helpful to help lengthen these muscles to reduce pain.

Our main goal is pain management and the biggest pain management option found in research is movement.

This does not mean that I expect you to do a full HIIT workout every day. That is irrational when symptoms vary so much day-to-day. The goal is to create a tool box of options that can be utilized at any time with the main goal to create movement every day.

We are learning how to persist throughout life every day and article published. If you have any questions or would like to read the referenced articles yourself please reach out!