Endometrium & Endometriosis Explained

If your period feels like a monthly horror show-complete with bloating, pain that hijacks your plans, and a heating pad that's become your best friend-this article is for you. Endometriosis affects around 10% of women of reproductive age globally, and yet, for many, it remains misunderstood, misdiagnosed, and mysterious.

We’re going to break it all down: what endometriosis actually is, why it wreaks havoc on your pelvic health, how to tell if it's behind your symptoms, and what you can do about it.

What Is Endometriosis?

Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus-on ovaries, fallopian tubes, bladder, bowel, and sometimes even beyond. These rogue cells act like uterine lining: they build up, break down, and bleed each month. The problem? They have nowhere to go. This leads to inflammation, pain, and scar tissue. It’s not just “bad cramps” - endometriosis can impact fertility, digestion, urination, energy levels, and mental health. [1][2][3]

What Is Pelvic Health and Why Should You Care About It?

Pelvic health includes the muscles, ligaments, and tissues that support your bladder, uterus, bowel, and vagina. Endometriosis can impair these systems, especially when inflammation spreads or lesions press on nerves and organs. The result? Painful sex, digestive problems, and even issues like bladder leakage or constipation.

It’s all connected-and when your pelvic floor is tight or inflamed from chronic pain, the effects ripple outward. [4][5]

What Are the Symptoms of Endometriosis?

Endometriosis symptoms include severe period pain, painful sex, infertility, bloating, fatigue, painful bowel movements, and urinary issues. Symptoms vary and often mimic IBS or UTIs.

In more detail, the most common symptoms include:

• Painful periods (dysmenorrhea)
• Chronic pelvic pain
• Pain during sex (dyspareunia)
• Pain with bowel movements or urination
• Heavy or irregular bleeding
• Infertility
• Fatigue and bloating (“endo belly”)

These symptoms often worsen during menstruation. Unfortunately, many women wait 7–10 years on average before receiving an accurate diagnosis. [6]

Common Causes of Pelvic Pain in Women

Endometriosis is one of the most common causes of pelvic pain-but not the only one. Here’s how endometriosis contributes:

• Inflammation from lesions irritates surrounding organs
• Adhesions form, which can cause organs to stick together
• Lesions may affect pelvic nerves, causing radiating or cyclical pain

Other conditions that may present similarly include pelvic inflammatory disease, IBS, fibroids, and interstitial cystitis. This overlap makes diagnosis tricky and often delayed. [4][5]

How to Recognize Pelvic Floor Dysfunction

When the pelvic floor reacts to chronic pain (like from endometriosis), it often tightens defensively. Over time, this can lead to:

• Hypertonic pelvic floor (too tight)
• Pain during intercourse
• Bowel and urinary dysfunction
• Difficulty relaxing during urination or bowel movements

Nearly three-quarters of people with endometriosis show signs of pelvic floor dysfunction. It’s part of a vicious cycle: pain causes muscle guarding, which causes more pain. [7]

Pelvic Health During Pregnancy: What to Expect

Some women find pregnancy eases endometriosis symptoms (thanks to progesterone). Others continue to struggle. Pregnancy with endometriosis may increase the risk of:

• Miscarriage or preterm birth
• Placenta previa
• Severe pelvic pain or uterine irritability

A large study found that women with endometriosis had higher rates of complications during pregnancy, including hypertension and cesarean delivery. [8]

Effective Exercises to Support Pelvic Health with Endometriosis

Here’s what works (and what doesn’t):

• Pelvic floor therapy
• Deep core breathing
• Gentle yoga and mobility work
• Targeted stretching
• Avoid high-impact workouts during flares
• Avoid crunches or abdominal gripping

A clinical trial found pelvic floor rehab led to significant improvements in pain and function among women with endometriosis-related pelvic pain. [9]

What Are the Symptoms of Postpartum Pelvic Health Issues?

Whether you gave birth vaginally or via C-section, your pelvic floor takes a hit. Add endometriosis to the mix, and you may notice:

• Painful intercourse
• Bladder leakage
• Pelvic organ prolapse
• Flare-ups of endometriosis pain due to hormonal shifts
• Emotional distress and fatigue

Pelvic rehab should be part of your postpartum plan. It’s not just about "bouncing back”-it's about healing from the inside out. [10]

Can Pelvic Floor Therapy Help After Birth?

Yes. And if you’re navigating both postpartum recovery and endometriosis, it’s essential. Physical therapy can:

• Reduce pain and adhesions
• Normalize bladder and bowel function
• Help retrain overly tight or weak muscles

A study found postpartum physical therapy significantly improves pelvic pain and functional outcomes. [10]

Menopause and Pelvic Health: What Every Woman Should Know

Once you hit menopause, estrogen levels drop. Since endometriosis is fueled by estrogen, some women see a reduction in symptoms. But not all. Endometriosis can persist or even develop after menopause, especially with hormone replacement therapy.

Symptoms might shift to:

• Vaginal dryness
• Urinary frequency
• Pelvic muscle weakness
• Chronic discomfort

You might feel better hormonally, but pelvic pain may still linger if scar tissue or adhesions remain. [11]

How to Manage Pelvic Pain During Menopause

Try a combination of:

• Pelvic floor physical therapy
• Localized estrogen therapy (if appropriate)
• Anti-inflammatory nutrition and movement

Always consult a menopause-informed provider when managing both endometriosis and aging pelvic tissues. [11]

How to Prevent Pelvic Health Problems in the Future

Here’s your toolkit:

• Advocate for early diagnosis
• Practice pelvic floor awareness
• Manage inflammation with lifestyle and nutrition
• See a physical therapist regularly
• Get support (emotionally and medically)

There’s no magic pill, but ongoing care makes a massive difference in symptom severity and life quality. [7]

Can Kegel Exercises Improve Pelvic Health?

Yes-but only if your pelvic floor isn’t already too tight. In women with hypertonic muscles (common in endometriosis), Kegels can make pain worse.

Instead, prioritize:

• Reverse Kegels
• Muscle lengthening
• Mind-body relaxation

A review recommends individualized assessment before prescribing Kegel exercises. [12]

How to Do Kegels Properly

• Contract the pelvic floor for 5 seconds
• Fully release for 5 seconds
• Don’t clench your glutes or thighs
• Breathe!

If this feels confusing or makes symptoms worse, it’s a sign to see a pelvic floor therapist. [12]

Pelvic Health FAQs: Your Questions Answered

Q: Is endometriosis curable? A: Not yet. But with proper treatment-including hormonal support, surgery, and pelvic therapy-it can be managed. [1][13]

Q: Does endometriosis cause infertility? A: Yes. Around 30–50% of people with endometriosis experience infertility. [13]

Q: Should I get surgery? A: Laparoscopic excision can be helpful but isn’t always the first step. Talk to your specialist about risks and benefits. [1]

Q: Can diet help with endometriosis? A: Emerging evidence supports an anti-inflammatory diet (low gluten, high omega-3, rich in plants) for symptom reduction. [14]