Endometriosis affects many women, yet it remains a condition that is often misunderstood or overlooked. Despite being common, it can take years for people to receive a diagnosis, leaving many living with ongoing pain and uncertainty.
At FitRight HQ, we are seeing more people seeking support to better manage endo and its impact on daily life. The good news is that awareness is growing, research is expanding, and there are a range of approaches—medical, physical, and holistic—that can make a real difference.
In this blog, FitRight Physiotherapists Emma Brown and Eliza Laycock share their knowledge and experience about endometriosis.
What is endometriosis and how many people does it affect?
Endometriosis is where tissue similar to that of the uterus lining is found on other parts of the body. Symptoms include: pelvic pain, painful periods, bladder and or bowel issues, fertility issues, abdominal bloating and fatigue.
Endometriosis is more common in women than Diabetes, 1 in 7 females are diagnosed with the condition. Endometriosis costs Australia $9.7 Billion dollars annually.
Who is most at risk of endometriosis?
If a close relative has a diagnosis of Endometriosis, one is 7 times more likely to also be diagnosed with Endometriosis.
Endometriosis can be hormone related as it is Oestrogen dependent. It is known that females are experiencing their first period at younger ages, due to multiple factors, resulting in females experiencing more periods in their lifetime. More periods and shorter menstrual cycles actually increase one’s risk of Endometriosis.
Why does endometriosis cause pain?
The pain experience is SO varied for each person with endometriosis. This is because pain is so complex, and the local lesions or area of endometriosis are not the only source of pain. In a lot of cases, the lesion severity does not match the symptom severity.
There are often 3 different layers of pain mechanism at play. The first is called nociceptive pain, which is pain response from local tissue injury.
There is then neuropathic pain, which represents nerve pain, this is more common following surgical injury or if there is nerve involvement.
Nociplastic pain is the last type, and is often the most complex. This type of pain occurs because of altered pain modulation in the brain, we also refer to it as central sensitisation.
Other than pain, what other symptoms might one experience with Endometriosis?
Common comorbidities can exist with endometriosis and these all have their own symptoms:
- Gastrointestinal problems: IBS, coeliac, IBD
- Bladder: interstitial cystitis
- Migraine
- POTS
- Musculoskeletal: lower back pain, EDS
- Psychological: anxiety
- Neurodiversity: ADHD
Management therefore needs to involve holistic care which addresses the physical, mental, emotional, spiritual and social components of health.
The team who manages someone with endometriosis could include:
- Physiotherapist
- Gynaecologist
- General Practitioner
- Exercise Physiologist
- Naturopath
- Osteopath
- Psychologist
- Pain specialist
- Fertility specialist
What is my role, as a Pelvic Health Physiotherapist, in the management of Endometriosis?
- Educating my clients about the condition
- Assessing and adjusting movement patterns
- Assessing and optimising movement of the pelvic floor
- The facilitation of return to gradual exercise and movement
- Education regarding pain management strategies that can be self managed
- Optimising bladder and bowelb management, sexual function and the pacing of activities
How is the pelvic floor involved in endometriosis?
Many women with chronic pelvic and abdominal pain secondarily develop a “high tone” or “overactive” pelvic floor. The pelvic floor muscle group tends to go into 'protection mode' in response to pain and stress, and if it remains wound up like this it can cause secondary issues like pelvic pain, painful sex and bladder urgency and frequency.
Pelvic floor physiotherapy aims to make sure your pelvic floor can fully contract, but can also fully relax - trying to achieve a full range of motion in your pelvic floor contraction.
At the same time, we want to improve the pelvic floor function by reducing tension in other areas – relaxed stomach, relaxed glute muscles, relaxed lower limbs - and by reducing overall stress.
Some management strategies and pacing analogies from Jo's presentation:
1. Pacing of activities, using The Spoon Theory
The Spoon theory- this I loved! I think that this can apply to many areas of life, in relation to the pacing of daily life activities, demands and stressors. We all have different amounts of spoons and activities that “use” a spoon.
To put it simply, everyone has so many spoons of energy in a day, in this case lets imagine that we have 10 spoons. Some may use 1 spoon to get a child out the door to school in the morning, a working day may take 4 spoons, a stressful work meeting may take another.
At the end of the day, how many spoons do you have left? Are you in a surplus or are you in a deficit? You may need one more spoon to battle the bedtime routine, to clean the house or do the grocery shopping.
The theory is that we should try to ensure that we pace ourselves, to ensure that we have enough “spoons” or energy to sustain us throughout the day. This is particularly important when living with Endometriosis as fatigue management is very important.
2. Movement
The importance of movement every day plays a crucial role in the management of fatigue. The great thing is, is that any movement is better than no movement. Try to find something that you enjoy!
Examples include:
- Yoga
- Clinical exercise
- Pilates
- Walking
- Dancing
Doing a Physiotherapist-led exercise class could be a great way to integrate exercise back into your routine. Our clinical pilates classes could be a great way to start as they are self-paced and very individualised to your care.
There is no evidence for avoidance of running or doing HIIT style workouts with endometriosis. However, you may need to gradually build to this style of exercise. It would also be worth self-reflecting on if you hold tension in your lower limbs and abdominal region with these exercises as this could translate to your pelvic floor.
We run clinical exercise and pilates-style group exercise classes at FitRight - click here to see more.
3. The Toolbox
This is like someone with an anaphylactic allergy carrying their EpiPen - keep this toolbox (full of strategies used to manage or ease your symptoms) near you so you can manage a flare wherever it happens:
This can include:
- TENS machine
- Heat packs, these can be worn and can be rechargeable
- Natural creams or medications
- Journaling, mindfulness
- Wand or dilator for self release of tense pelvic floor muscles
4. Nutrition
There is a lot of research being done into this area, and consultation with a dietitian would be highly recommended.
In many cases, a diet such as The Mediterranean diet which is low in processed foods can be helpful with symptom management.
This could include:
- Lean meats
- Fish
- Fruit and vegetables,
- Legumes
- Dairy
- Nuts
- Seafood
What is the Matilda app?
The Matilda app is a fantastic resource for those living with Endometriosis. Joanna Morris has developed this innovative app, alongside a number of other experts in this area, which is being used to assist women in the lead up to and following endometriosis surgery.
