What is endometriosis and adenomyosis — and why pelvic pain matters
Q: What are these conditions?
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus - often on the ovaries, pelvic lining, bowel or bladder.
Adenomyosis is closely related - where uterine-lining tissue grows into the muscular wall of the uterus. This can cause similar symptoms including heavy bleeding, pelvic pain, and pressure. (While research is more abundant for endometriosis, many principles of pelvic physiotherapy apply to adenomyosis as well.)
Q: How common are these conditions?
Globally, about 5–10% of women of reproductive age are estimated to have endometriosis.
That means an estimated 190 million women worldwide.
Because adenomyosis often co-exists with or is misdiagnosed as endometriosis / other pelvic-floor issues, actual pelvic-pain symptoms related to these conditions are thought to be under-recognised.
Q: Why does it lead to pelvic pain?
Ectopic uterine-like tissue can bleed, inflame and irritate neighbouring organs, nerves, and pelvic floor muscles - leading to chronic pelvic pain, painful periods, pain during intercourse, bowel/bladder discomfort, and pelvic floor tension.
Over time, pelvic floor muscles may become overactive, tense, or poorly coordinated (“hypertonic”), contributing further to pain, discomfort, and dysfunction.
Can physiotherapy really help? What does evidence show?
Q: Is physiotherapy effective for pelvic pain in endometriosis/adenomyosis?
Yes - growing research supports physiotherapy (manual therapy, exercise, pelvic floor therapy) as a key component of conservative management. A 2025 meta-analysis found physiotherapy significantly reduced pelvic pain versus no physiotherapy (mean pain reduction −1.97 on pain scales). PubMed+1
Locally applied techniques (e.g., internal pelvic floor therapy, myofascial release, visceral therapy) tended to offer greater benefit than generalised treatments. PubMed+1
Q: What types of physiotherapy are used?
A multifaceted, tailored approach is common but will always depend on the symptoms of each patient that are specific to them. Common physio management approaches to pelvic pain include a combination of the following modalities,
Pelvic floor muscle training: assessment and retraining of pelvic floor muscle tone, coordination and relaxation. Helps address poorly relaxing muscles, pelvic floor coordination, and pain during intercourse or daily activities.
Manual therapy & myofascial release: gentle manual techniques to address pain or tension of pelvic floor muscles and nearby muscles groups
Therapeutic exercise & posture correction: individually prescribed exercise including breathing control, core/pelvic stability, mobility work & relaxation - to improve alignment, mobility and reduce strain.
Self-management & education: breathing, relaxation techniques, home pelvic floor exercises, posture awareness, lifestyle and movement advice to support long-term management.
Q: Is there evidence for long-term benefit?
A recent RCT combining supervised pelvic floor training and exercise for women with confirmed endometriosis found a significant reduction in current pelvic/genital pain after intervention - benefits sustained at 12-month follow-up. ScienceDirect
Moreover, a 2025 systematic review of multimodal physical therapy for chronic pelvic pain showed high-certainty evidence for pain reduction compared with inactive or non-conservative treatment. ScienceDirect+1
How we approach pelvic pain at Melbourne Pregnancy and Pelvic Physio
Q: While there is no one size fits all approach, the following gives an insight into what a typical treatment plan might look look like as we know the more our clients know the less apprehensive they feel about seeking care.
Comprehensive assessment
Clinical history (symptoms, cycle, previous treatments, surgeries)
Pelvic floor muscle assessment (tone, control, coordination, relaxation)
Biomechanical and postural assessment (spine, hips, pelvis, gait)
Pain triggers and aggravating factors (work, posture, bowel/bladder habits)
Tailored physiotherapy plan
Gentle manual therapy and soft-tissue work to release tension around pelvic organs, hips and lower back
Pelvic floor retraining - restoring balance in tone and control rather than just strengthening (many with endometriosis have hypertonic or poorly coordinating pelvic floor)
Movement and posture work — correcting alignment, strengthening core and pelvic stability, improving mobility
Home programme — self-massage, breathing, relaxation, stretches, posture/ergonomics advice
Pain education, pacing and lifestyle guidance (stress, sleep, activity modification, pain self-management)
Ongoing review and adjustment
Regular re-assessment of pain, function, pelvic floor status and quality of life
Collaboration with gynaecologists, pain specialists or GPs when needed for hormonal, medical or surgical management
Long-term maintenance and self-management support
Q: What if I already had surgery or other treatment?
Physiotherapy is complementary - many find benefit even post-surgery or alongside hormonal management. Manual therapy, scar tissue work, pelvic floor re-education and movement therapy can support recovery, reduce adhesions, improve mobility and manage chronic pain.
What you should know — limitations & when to seek other care
Physio support and pelvic floor work must be individualised - for someone with hypertonic pelvic floor, strengthening is not the goal; rather, relaxation and coordination are key.
Pelvic physio should complement - not replace - gynaecological care, medical, surgical, psycholofical and other interventions when indicated.
Pain management for endometriosis/adenomyosis is often most effective within a multimodal, biopsychosocial approach (medical, physio, lifestyle, pain education)
Why choose Melbourne Pregnancy and Pelvic Physio
At MPPP, we take a whole-person, patient-centred approach. Our physiotherapists specialise in pelvic health and women’s health - with experience in chronic pelvic pain, endometriosis, pelvic floor dysfunction, prenatal and postnatal care. We offer:
Individualised assessment and treatment plans
Internal pelvic floor therapy, manual therapy, myofascial release and movement-based rehab
Integration with your medical/gynaecological care and referral support if needed
Home-based self-management and education —-to support long-term pelvic health and quality of life
Summary
Pelvic pain related to endometriosis or adenomyosis can deeply affect daily life, relationships and well-being. While hormonal and surgical treatments may be needed, evidence supports physiotherapy as a valuable, non-invasive, conservative component - especially when it includes pelvic floor therapy, manual therapy and tailored exercise. At MPPP we aim to support women holistically - helping you move more comfortably, restore function, and reclaim quality of life.
Author: Tahlia Hunter, Senior Women’s Health Physiotherapist, Melbourne Pregnancy and Pelvic Physio
Make an appointment to see Tahlia