Severe period pain is something that many women endure, often without realising that there might be a better way to manage it. Did you know that 92% of young Australian females experience severe period pain? For some, this pain may be linked to a condition called endometriosis, a chronic disease that can profoundly impact daily life.
What is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus. These tissue patches can be found typically inside the pelvis e.g on the ovaries, fallopian tubes, or even the bowel but can also be found outside the pelvis e.g. skin, soft tissue, diaphragm.
Like the uterine lining, this tissue responds to hormonal changes during the menstrual cycle, leading to inflammation, scarring, and pain. Symptoms can include:
- Severe period pain.
- Heavy bleeding.
- Pain during intercourse.
- Difficulty with bladder/bowel function.
- Infertility.
Despite its prevalence, endometriosis is often misunderstood and misdiagnosed, leaving many women to suffer in silence. Diagnosis of endometriosis is often delayed on average 6-8 years between onset of symptoms and diagnosis.
Why Does Severe Period Pain Happen?
Severe period pain, also known as dysmenorrhea, is more than just cramps. For those with endometriosis, pain can result from inflammation, adhesions (scar tissue), and pelvic floor muscle spasms, as well as musculoskeletal changes resulting from movement/posture changes from being exposed to chronic or ongoing pain.
Unfortunately, traditional pharmaceutical treatments like contraceptives and progesterone may not work for everyone. In fact, studies show:
- 19% of women experience no pain relief.
- 59% still have pain at the end of treatment.
- 34% have ongoing pain after treatment.
- A third of women find low-dose contraceptives and progesterone ineffective.
This is where physiotherapy can make a real difference.
How Physiotherapy Can Help Endometriosis
Physiotherapy offers a patient-centred, evidence-based approach to managing endometriosis-related pain. Women’s health physios form part of your healthcare team and work in conjunction with other members of your team including but not limited to your GP, specialists, dietician, psychologists or other health professionals.
Here are four ways we can help:
- Manual Therapy
Being in pain can alter our posture and movements as part of our protection response to pain. Over time, this can result in changes to biomechanics and impact how muscles are functioning. You may experience increased muscle tension as part of this pain which can, in turn, increase overall pain intensity. Musculoskeletal components of endometriosis management are often overlooked.
Manual therapy involves hands-on techniques that target the muscles, joints, and tissues of the pelvis and lower back, to improve muscle tension and improve restricted joint movement. Manual therapy can release tight back and pelvic floor muscles which often tighten when exposed to pain. Many women also experience pain into the muscles of their legs and abdomen which manual therapy can help with. Research shows that manual therapy can:
- Significantly reduce pain intensity.
- Improve lumbar (lower back) mobility.
- Enhance physical quality of life.
These benefits can be long-lasting, making manual therapy a valuable addition to gynecological care.
- Exercise Therapy
Exercise isn’t just good for your general health—it’s also a powerful tool for managing endometriosis pain. It can be difficult to know what type of exercise best suits you. Sometimes exercise, if inappropriate can flare symptoms which can lead to fear of moving/exercising altogether. Regular, tailored exercise can:
- Reduce pain caused by endometriosis and dysmenorrhea.
- Improve circulation and hormonal balance.
- Support overall pelvic health.
- Support mental health and help with pain management.
- Supports strength, fitness, and contributes to other direct physiological benefits
Physiotherapists design exercise plans to align with your hormonal cycle, ensuring you get the most benefit while respecting your body’s needs.
- Pain Management
Tools like heat therapy and transcutaneous electrical nerve stimulation (TENS) can be lifesavers for period and ovulation pain. These non-invasive methods work by:
- Relaxing tense muscles.
- Interrupting pain signals to the brain.
- Providing immediate, drug-free pain relief.
A Physio can prescribe these pain management techniques to you. They can help both in clinic and also give you a plan for a home program to help with the pain.
- Pelvic Floor Optimisation
The pelvic floor is a group of muscles at the base of your pelvis. These muscles support your bladder, bowel, and uterus. For women with endometriosis, as a result of pain, the pelvic floor can become overactive, leading to spasms, tightness and increased pain. Relaxing these muscles is crucial for managing period pain. Physiotherapists use techniques like:
- Internal and external manual therapy.
- Biofeedback to help you regain control over these muscles.
- Prescribe tools that can assist in managing overactive and tight pelvic floor
- Guided relaxation and breathing exercises.
Why does this matter?
An overactive pelvic floor doesn’t just contribute to pain—it can also cause issues like urinary urgency, bowel discomfort, and painful intercourse. By learning how to relax these muscles, you can break the cycle of pain and tension, improving your overall quality of life.
What does Physio for Endometriosis look like?
At our clinic, we have a team of Women’s Health Experts that can help you combat this pain.
We go above and beyond in our assessments to get to the bottom of your pain, this includes:
- Real-time ultrasound imaging to assess and guide pelvic floor function.
- Internal and external assessments to get the full picture of pelvic floor functioning.
- A comprehensive assessment of your history that helps us identify the whole picture.
Our assessments will allow us to tailor our services based on what we think will benefit you most. Often, our toolkit includes:
- Tips on lifestyle, diet and fluid to help manage symptoms.
- A variety of manual and exercise-based therapies tailored to your unique needs.
- Pain management pathways like tens and heat.
- Exercise programs to help your body beat the pain.
Take Control of Your Pain
If you or someone you know is struggling with severe period pain or endometriosis, know that you don’t have to suffer in silence. Physiotherapy offers a proven, non-invasive approach to pain management that could be the game-changer you’ve been looking for. We know, because we have seen it first hand.
Reach out today to learn how we can help you take control of your health and live life with less pain.
SquareOne, Taking you from Pain to Performance.
Feel Better. Move Better. Embrace Life.
Author: Amy Ellis.
Co-Author: Vineetha Boppana.
Date: March 2024
References:
- Armour, M., Ferfolja, T., Curry, C., Hyman, M., Parry, K., Chalmers, J., Smith, C., MacMillan, F., & Holmes, K. (2020). The prevalence and educational impact of pelvic and menstrual pain in Australia: a national online survey of 4202 young women aged 13-25.. Journal of pediatric and adolescent gynecology. Young Australian females experience sever period pain.
- Becker, C., Gattrell, W., Gude, K., & Singh, S. (2017). Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and Sterility, 108, 125 – 136. https://doi.org/10.1016/j.fertnstert.2017.05.004.
- Taylor, H., Kotlyar, A., & Flores, V. (2021). Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. The Lancet, 397, 839-852. https://doi.org/10.1016/S0140-6736(21)00389-5.
- Hunt, J. (2019) ‘Pelvic physical therapy for chronic pain and dysfunction following laparoscopic excision of endometriosis: Case report’, Internet Journal of Allied Health Sciences and Practice [Preprint]. doi:10.46743/1540-580x/2019.1684.
- K;, W.M.R. (no date) Physiotherapy management in endometriosis, International journal of environmental research and public health. Available at: https://pubmed.ncbi.nlm.nih.gov/36498220/.
- Del Forno, S. et al. (2020) ‘Transperineal ultrasound visual feedback assisted pelvic floor muscle physiotherapy in women with deep infiltrating endometriosis and Dyspareunia: A pilot study’, Journal of Sex & Marital Therapy, 46(7), pp. 603–611. doi:10.1080/0092623x.2020.1765057.
- Muñoz-Gómez, E. et al. (2023) ‘Effectiveness of a manual therapy protocol in women with pelvic pain due to endometriosis: A randomized clinical trial’, Journal of Clinical Medicine, 12(9), p. 3310. doi:10.3390/jcm12093310.
- Kannan, P. and Claydon, L.S. (2014) ‘Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: A systematic review’, Journal of Physiotherapy, 60(1), pp. 13–21. doi:10.1016/j.jphys.2013.12.003.
- Rabia Wahdah (2024) ‘Beyond painkillers: A meta-analysis of non-pharmacological approaches for managing dysmenorrhea symptoms’, Archives of The Medicine and Case Reports, 5(4), pp. 1084–1098. doi:10.37275/amcr.v5i4.648.
- Armour, M. et al. (2019) ‘Exercise for dysmenorrhoea’, Cochrane Database of Systematic Reviews, 2019(9). doi:10.1002/14651858.cd004142.pub4.
- Ekenros, L., von Rosen, P., Norrbom, J. et al. Impact of Menstrual cycle-based Periodized training on Aerobic performance, a Clinical Trial study protocol—the IMPACT study. Trials 25, 93 (2024). https://doi.org/10.1186/s13063-024-07921-4
- Del Forno, et. al., 2021. Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound in Obstetrics & Gynecology, 57.
- Del Forno, et. al., 2020. Transperineal Ultrasound Visual Feedback Assisted Pelvic Floor Muscle Physiotherapy in Women With Deep Infiltrating Endometriosis and Dyspareunia: A Pilot Study. Journal of Sex & Marital Therapy, 46, pp. 603 – 611.
- Barba, M., et al.., 2024. Changes in Pelvic Floor Ultrasonographic Features after Flat Magnetic Stimulation in Women with Chronic Pelvic Pain and Levator Ani Muscle Hypertonicity. Medicina, 60.