Chronic pelvic pain, which is pain in the lower abdomen or pelvis that lasts greater than 3 months, accounts for 5% of gynecologist visits for adolescent girls¹.

Did you know that endometriosis is one of the most common causes of pelvic pain in girls ages 8-24¹?
In fact, endometriosis is the main cause of chronic pelvic pain in 25-49% of cases in this population¹.

Unfortunately, endometriosis is often missed in these patients.

Endometriosis is a chronic disease where cells that are normally inside of the uterus (endometrial cells), are found in the pelvic and/or abdominal cavity. Because these cells don’t belong outside of the uterus, the body produces an inflammatory response that can cause pelvic and lower abdominal pain. Endometriosis is often difficult to diagnose, and most patients will see around 5 providers and go up to 6 years before a diagnosis is made.

What to Look For

There are a few signs to look for that may point us towards endometriosis being a main cause of pelvic pain¹.

These include:

1. Pelvic pain that is worse before and during menstruation
2. Girls ages 8-24 with chronic pelvic pain (pain lasting greater than 3 months)
3. Multiple physician visits with no clear diagnosis
4. Family history of endometriosis
5. Earlier onset of first period (younger than age 11)

If you have a young female in your life with any of the signs listed above, it is probably time for her to see a gynecologist. The earlier that treatment for endometriosis can be given, the better the long-term results are.

Common treatments for endometriosis include:

1. Over the counter pain medication/anti-inflammatories
2. Hormonal birth control
3. Laparoscopic surgery if the pain is severe
4. Physical therapy
5. Working with a mental health counselor

You maybe saw the last one on that list – YES physical therapy can help reduce pain from endometriosis! Often with chronic pain, even if the pain originates in the abdomen, we will see musculoskeletal involvement. Specifically, with endometriosis, we often find tight spots in the muscles of the pelvic floor, abdomen, and hips. These tight spots in the muscle can cause ongoing pain, even when other medical treatments for endometriosis are working.

Physical therapy is an integral part in treating endometriosis. Because there is often musculoskeletal involvement in chronic pelvic pain from endometriosis, working with a pelvic health physical therapist can help greatly reduce pain and help these young females get back to the life they want to live.

There are a variety of treatment methods pelvic health physical therapists use to help reduce musculoskeletal pain associated with endometriosis.

These include:

• Soft tissue releases to the tight muscles
• Exercises, usually stretching, to lengthen the tight and painful muscles
• Relaxation techniques to calm down the body to reduce pain
• Biofeedback to learn to relax the pelvic floor
• Education on posturing, daily activities to reduce strain on the tight muscles

If your young female is seeing improvement with medical management of endometriosis but is still experiencing pain, it may be a good time to look into physical therapy!

Because musculoskeletal changes are common with pain, this may be the reason why she is still experiencing pain. A pelvic health physical therapist can be a great member of her treatment team to return to the activities she loves doing!

Mansfield, Chrissy. (Host). (2019, April 4). Pelvic Pain and Endometriosis in Adolescent Girls. [Audio Podcast]. In Choose PT. American Physical Therapy Association. https://www.choosept.com/radio/detail/pelvic-pain-endometriosis-in-adolescent-girls