Is It Normal? Painful Periods, Endometriosis, and Pelvic Physiotherapy
March is Endometriosis Awareness Month, a time to open up the conversation about one of the most common yet misunderstood conditions affecting women and people with uteruses. If you experience painful periods, you may have been told it's "just part of being a woman" or something to push through. But when is it not normal?
This article explores the link between painful periods, endometriosis, and how pelvic physiotherapy can play a role in supporting your health, comfort, and quality of life.
What is Endometriosis?
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus, often on pelvic organs like the ovaries, bowel, and bladder. These lesions can bleed and inflame surrounding tissue, causing pain, scarring, and adhesions.
It’s estimated that 1 in 9 people assigned female at birth in Australia will be diagnosed with endometriosis by age 44, but many remain undiagnosed for years.
Symptoms That May Signal Endometriosis
Pain is the most common symptom, but it can show up in different ways:
Severe period pain (dysmenorrhoea) that interferes with daily life
Pain with intercourse (dyspareunia)
Pain with bowel movements or urination, especially around menstruation
Chronic pelvic pain
Abdominal bloating and fatigue
Fertility challenges
If your period pain can’t be managed with over-the-counter medications, or you dread your cycle each month, it’s time to seek help. Painful periods are common, but they are not necessarily normal.
Why It Often Goes Undiagnosed
Many people with endometriosis wait 7–10 years for a formal diagnosis. This delay can be due to:
Normalisation of pain from a young age
Lack of awareness by healthcare professionals
Symptoms overlap with other conditions, like IBS or bladder pain syndrome
The gold standard diagnosis (laparoscopy) is surgical
Early intervention and support can significantly improve quality of life, and that’s where physiotherapy comes in.
How Pelvic Health Physiotherapy Can Help
Pelvic physiotherapists are trained to assess and treat the musculoskeletal and neuromuscular systems of the pelvis. While physiotherapy cannot remove endometriosis lesions, it can play a vital role in managing pain, improving pelvic floor function, and reducing symptoms related to the condition.
Here’s how:
1. Pelvic Floor Muscle Assessment and Treatment
Many people with endometriosis may develop tight or overactive pelvic floor muscles in response to chronic pain. This can lead to further discomfort during sex, tampon use, bowel movements, or prolonged sitting.
Pelvic physios assess the muscles internally (with consent) and provide manual therapy, relaxation strategies, and guided exercises to reduce tension and restore muscle coordination.
2. Scar and Abdominal Massage
After laparoscopic surgery or abdominal procedures (like C-section), scar tissue and adhesions can cause discomfort. Physiotherapy can include soft tissue techniques to help soften scar tissue, reduce restrictions and improve movement through the abdomen and pelvis.
3. Pain Education and Management Strategies
Understanding the science of chronic pain helps reduce fear and anxiety around symptoms. Pelvic physios use pain neuroscience education to explain what’s happening in your body and teach tools like:
Relaxation techniques
Breathwork and body scanning
Bladder and bowel re-training
Movement strategies and gentle stretches to reduce flare-ups
4. Tailored Exercise Programs
Gentle movement can reduce pain, improve circulation, and ease stress — all helpful in managing endometriosis. Your physiotherapist will develop a safe, individualised exercise plan that considers fatigue, flare-ups, and any pain triggers.
When to See a Pelvic Health Physiotherapist
You don’t need a diagnosis of endometriosis to see a pelvic physio. If you experience any of the following, consider booking an appointment:
Pain that interferes with work, relationships, or daily life
Pain during sex or pelvic exams
Difficulty using tampons or menstrual cups
Urgency, frequency, or pain with urination
Constipation or straining with bowel movements
Chronic lower back, hip, or abdominal pain
Even if you're already under the care of a gynaecologist or pain specialist, pelvic physio is a complementary approach that can improve outcomes.
Empowering Yourself Through Education and Support
Endometriosis can be isolating - especially if your symptoms are dismissed or misunderstood. Seeking care from providers who listen, validate your experience, and offer evidence-based solutions can change your quality of life.
Pelvic physiotherapy is not just about doing kegels or exercises - it’s about supporting your entire body, nervous system, and emotional well-being.
You Deserve Pain-Free Periods
Painful periods should not be your norm. If you're struggling with pain, bloating, or pelvic discomfort, especially around your menstrual cycle, it’s time to explore support options.
Pelvic physiotherapy offers gentle, holistic tools to help you move, function, and live with more comfort and less fear. As we honour Endometriosis Awareness Month this March, let’s keep advocating for better care, education, and outcomes for people with pelvic pain.