Last year, when I discussed my continued struggle with polycystic ovarian syndrome with my OB-GYN during my annual checkup, I was taken aback by the question he asked in response: Have you ever considered whether some of your symptoms are related to endometriosis?
I had not. I have irregular periods, and they’re extremely painful. I also had trouble getting pregnant, which I used to chalk up to the hormonal imbalance that gives me ovarian cysts, also called PCOS. But as it turns out, some of these symptoms also describe endometriosis, a condition that occurs when uterine lining-like tissue grows outside the uterus. Symptoms include chronic pain, fatigue, organ dysfunction, and infertility.
I was already seeing a pelvic floor therapist after giving birth. I brought up my doctor’s question to my therapist, who told me that pelvic floor therapy is sometimes recommended for endometriosis, too. But getting insurance to cover this treatment, along with other care like surgery to diagnose and remove endometriosis, can be difficult.
And sometimes, changing providers can mean having to take the time to form a new relationship, which means building trust in them to help with a sensitive matter. That matters in reproductive health care, which is intimate, and perhaps more so with a pelvic floor therapist. They are, after all, to quote a patient I spoke with, “medically fingering you.”
But when it is covered, affordable, and accessible, according to endometriosis patients that I spoke with, it is well worth it
How pelvic floor therapy can help with endometriosis
About 10 percent of menstruating people have endometriosis, and that is likely an underestimate, because many health plans do not cover the diagnostic testing that is required to receive a formal diagnosis (though that may soon change because of recent scientific breakthroughs identifying less invasive ways of diagnosing endometriosis).
I, like many patients both pelvic floor therapists that Rewire News Group spoke with see, did not even attribute symptoms to endometriosis. As a result, patients are also less likely to be formally diagnosed with this painful condition.
My experience with pelvic floor PT was multifaceted. It began with an exam, where my PT inserted her fingers into my vagina at different angles and in different areas, asking me to flex or hold certain muscles to gauge their strength or locate troublesome areas.
At the following appointments, we worked my pelvic floor muscles by doing stretches, mainly where I was on my hands and knees or laying on my back, or by having her insert her fingers to massage out pressure and tension.
Dr. Emily Mason, a pelvic floor physical therapist and women’s health coach, believes pelvic floor PT can help with certain symptoms that are directly associated with endometriosis.
“Pelvic floor PT is indicated if there is any pain around the pelvis including pain with periods, abdominal pain, low back pain, tailbone pain, hip pain, pain with sexual activity, and pain anywhere in the pelvic floor,” Mason explained. “It can also be very helpful if there are any bowel or bladder issues like constipation, IBS, pain with bowel movements, pain with urination, and urinary urgency and frequency.”
Mason has been working with people struggling with menstrual cycle issues and pelvic pain for a decade. Often, she finds, these patients also have some sort of underlying medical problem—like endometriosis or PCOS.
Annabelle B., a Californian who requested to keep her last name private in order to freely speak about her health struggles, sought out a pelvic floor therapist for her pelvic pain in 2025 after learning about it on a Reddit thread.
Physical therapists, like the one Annabelle saw, often do internal exams and massage to relieve pressure and tension in the pelvic floor. Annabelle said she was also sent home with a pelvic wand to do the exercises on her own.
“I have the nicest pelvic floor PT. She makes me feel very comfortable … I wish it was something more people knew about,” Annabelle said.
Like so many endometriosis patients, Annabelle learned that the provider did not take her insurance. But the treatment improved her pelvic pain—and helped her find methods to relieve other symptoms, too.
“My quality of life is a lot better now,” she said of her pelvic floor PT experience in an early 2026 Reddit post on the endometriosis subreddit. In another post from a similar time period, Annabelle said her doctor was working on referring her to another provider to weigh additional medication options and surgery.
In my reporting and personal experience, I identified cost as a significant barrier to relief for endometriosis patients. The price of a 45-minute pelvic floor therapy session for me, even with insurance, was nearly $150 out of pocket.
Stacy Alvarez, another endometriosis patient, was referred to pelvic floor therapy by an endometriosis specialist after other treatments, like yoga and stretching, didn’t work well enough. She said yoga did help more than other treatments, but she felt that she wanted to work on more “targeted” therapy specific to endometriosis.
She did pelvic floor therapy for 12 weeks and found that with discipline, it helped her symptoms improve.
“My advice would be [to start] with yoga/pilates and see if there’s some improvement,” Alvarez said. “I was doing that and I saw that I felt better so I decided to do the therapy. … You’ll have to be open to trying things to see if they give you relief. If they don’t, then move on to the next thing.”
While Alvarez no longer sees a pelvic floor therapist, she is able to use the exercises she learned there when she needs relief.
“It will reduce and help my symptoms,” she told RNG.
The kinds of symptoms commonly associated with endometriosis include pelvic pain, back pain, constipation, hypermobility, tailbone pain, pain with sex, leaking, and urgency, said Dr. Julianne Beck, a physical therapist who in May 2025 opened a clinic specializing in reproductive health issues like endometriosis and postpartum recovery.
Beck also provides post-op care for endometriosis patients that are recovering from excision surgery, which is the procedure that is used to remove endometriosis, or a hysterectomy.
“Recovery isn’t easy,” Beck said. “At the beginning, I think of it from two lenses. One, your body is recovering from a major surgery, and that takes some rehab. … And two, starting to correct and heal the impairments that happened as a result of the endometriosis—pelvic floor dysfunction, core weakness, back pain, bowel [and] bladder dysfunction.”
What happens in a session?
While pelvic floor PT can help with endometriosis symptoms, Beck said, it is not a cure.
“Physical therapy doesn’t specifically treat endometriosis, but it looks at how we can manage symptoms and heal some of the maladaptations that happen when your body is trying to protect against the pain and trauma that endo causes within,” she said.
Beck said she speaks with patients about their medical histories and helps identify patterns, since some people may not realize symptoms they thought were normal could actually be attributed to endometriosis. They also discuss the patient’s goals, as some want surgery eventually and others would prefer to try other methods.
Typically, Beck said, with endometriosis patients, she uses a combination of movement, exercise, and manual therapy techniques—meaning massaging—to help with pain. She also provides her patients with essential information.
“We do a lot of education on modifying the current environment the person lives in—how they sleep, work, perform regular daily activities—to really make sure we’re taking a holistic approach and leaving no stone unturned,” Beck said.
Mason uses manual therapy for pain and tension, too, saying this firm pressure on the pelvic floor is “essential for the endometriosis population as there are usually tons of restrictions in the areas surrounding the pain, including the [organs] for which we do therapy, myofascial release, soft tissue mobilization, and joint mobilization.”
“We can also do lymphatic massage for any areas with inflammation or swelling which is quite common in endometriosis,” she added.
Mason also likes to do dry needling, which uses a small, thin needle to help release muscles. She noted that cupping, which involves using a massage cup on the skin to help increase blood flow and circulation, can be a helpful tool for myofascial release. She also said Kinesio taping (literally sticking tape on painful areas) may help with pain and inflammation.
She emphasized that everyone could learn more about their pelvic floor.
“Patients are often never educated about this part of the body,” Mason said. “I educate my patients on bowel and bladder basics, norms and techniques, cycle basics and strategies, and pain science and ways to relieve pain.”
How the U.S. stacks up to Europe
Katie O., in Belgium, had a noticeably similar experience to my own and the other U.S.-based women I interviewed for this story. RNG is referring to Katie by her name and first initial because she is self-employed and fears talking about her chronic illnesses could harm her job security.
When Katie saw her gynecologist for an ultrasound, there were no big cysts or deep scarring.
But during a vaginal exam, her doctor found extreme tension and “listened to [her] own description of [her] symptoms” before prescribing a progesterone pill, Slinda. The doctor also prescribed 18 sessions of pelvic floor physiotherapy for pain.
In a Reddit post discussing her experience with pelvic floor PT, Katie said that she and her physical therapist spent a lot of the first session talking and reviewing her history, including a run down of her diet and lifestyle. Her PT did a vaginal exam with her fingers to evaluate how bad her tension was and where it was located. After that, they went through hip flexor stretches and how to unclench the vaginal canal, which she said then relaxes “everything else.”
The following session was similar, with an exam and the exercises again. But this time, her therapist added a special wand—like a “small dildo with metal bits on it, maybe the size of a large tampon, which uses electric waves to measure the tension.”
Katie wrote that her doctor said if she sees no improvement in three months, she will be referred for a laparoscopy.
All of this tracks with the American patients’ experiences, but for one big difference: It wasn’t expensive.
“In Belgium, health care is partly funded by taxes and partly by insurance,” Katie said. “Insurance is pretty cheap, so I pay about €12 per month—maybe $15 USD—for my cover.”
Katie estimated that the cost for pelvic floor PT would be about €30 per session, or about $35, of which one-third is due up front.
Katie also reported new developments with her treatment that Annabelle and Alvarez did not. Her PT is using a vaginal Transcutaneous Electrical Nerve Stimulation machine—what Katie calls “the electric dildo.”
She said it feels fuzzy and tingly and helps for a couple of hours after sessions with the pain. Her PT also goes through each layer of her vagina with her fingers and tries to stretch out the muscles. This, she said, is uncomfortable, but she knows that it will help long term.
“Taxes are high in Belgium,” Katie said, “which people complain about.” But, she added, “I think I’d rather have it this way.”
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