Women's health physiotherapy for endometriosis, PCOS and pelvic floor dysfunction
Written by Luiza, Women's Health Physiotherapist (POGP-registered) · Medically reviewed by Tommaso Luccarini, Osteopath & Physiotherapist (GOsC, HCPC, CSP) · Last reviewed: 4 August 2026
Physiotherapy for endometriosis does not treat or cure the disease, but it can meaningfully ease the pelvic floor tension, pain and restricted movement that build up around it, usually without adding to your medication or surgery. It works alongside your gynaecology care, not instead of it. At Complement in Islington, our women's health physiotherapy service supports women with endometriosis, pelvic floor dysfunction and related gynaecological pain.
The reason it helps is largely mechanical. Endometriosis, where tissue similar to the lining of the womb grows elsewhere and which affects around 1 in 10 women, can irritate the tissues around the pelvis and leave the pelvic floor muscles overactive and tight. That tension then refers pain into the lower back, hips and abdomen, and often keeps hurting long after a flare has settled.
Start by getting a clear diagnosis from your GP or gynaecologist, then consider a women's health physiotherapy assessment. A first visit is a detailed conversation and a physical assessment, with any internal pelvic floor assessment offered only with your consent.
This guide explains how endometriosis affects the pelvic floor, what physiotherapy can and cannot do (including for PCOS), what treatment involves, and how to keep exercising without flaring your pain.
How endometriosis affects the pelvic floor
Endometriosis often leaves the pelvic floor overactive and tight, which refers pain into the back, hips and abdomen and keeps symptoms going between flares.
The pattern we see most often is a pelvic floor that has learned to guard. In response to ongoing irritation and pain, the muscles around the pelvis tighten and stop relaxing fully, a state sometimes described as an overactive or hypertonic pelvic floor. Research into pelvic floor tenderness in endometriosis supports this link between the disease and raised muscle tension. That tension can make intercourse painful, disturb bladder and bowel habits, and set up trigger points that refer pain well away from the pelvis itself.
Crucially, this muscular layer behaves like any other overloaded muscle group: it responds to assessment and treatment. That is the part physiotherapy targets, and it is frequently the piece that has never been looked at. Many of the same principles apply to the wider picture of pelvic pain, which we cover in our post on physiotherapy for pelvic pain.
What physiotherapy for endometriosis can and cannot do (and where PCOS differs)
Physiotherapy manages the muscular and pelvic floor symptoms around these conditions. It does not treat or cure endometriosis or PCOS themselves.
For endometriosis, that distinction still leaves a lot physiotherapy can help with. Work on the pelvic floor, teaching it to relax rather than clench, alongside manual therapy, breathing and pressure management and graded movement, can reduce pain and improve bladder, bowel and sexual function. This is recognised by the POGP, the UK professional body for pelvic, obstetric and gynaecological physiotherapy, whose guidance our service follows.
PCOS is a different case, and it is worth being honest about it. Polycystic ovary syndrome is a hormonal and metabolic condition, not a pelvic floor problem, and physiotherapy does not treat PCOS itself. Pain in PCOS is real but under-recognised, and it is not driven by the pelvic floor in the way endometriosis pain often is. Where PCOS comes with an associated musculoskeletal or pelvic floor component, an assessment can identify whether physiotherapy would help those specific symptoms. Where it would not, we will say so rather than stretch the point.
What treatment looks like at our Islington clinic
Treatment is individualised: pelvic floor rehabilitation, manual therapy, breathing and pressure management, and Pilates-based strength, delivered by a specialist.
Our women's health physiotherapy service is led by Luiza, who is registered with the POGP. A first appointment begins with a detailed history, then a physical assessment that may include posture, breathing, core function and movement. A pelvic floor assessment is carried out only where it is clinically appropriate and only with your full consent, explained in detail beforehand, and it never has to happen at the first visit.
From there, the plan is built around your findings and goals. It might combine hands-on treatment, pelvic floor rehabilitation, breathing and pressure work, scar management and pain-management strategies, with one-to-one Pilates to build the strength that holds the work in place. Because the clinic is integrated, osteopathy can address the lower back and hip restrictions that add to the load, all coordinated by clinicians who share your case rather than treating in isolation.
Exercising and living with endometriosis without flaring your pain
You can usually keep exercising with endometriosis, but pacing, load management and pelvic-floor-friendly movement help you stay active without triggering a flare.
One of the most common worries we hear is that exercise, and lifting in particular, sets pain off. It is a fair concern, and the answer is rarely to stop. More often it is to change how you load. That means building intensity gradually rather than in jumps, keeping some genuinely easy days, and avoiding the breath-holding and hard straining that spike pressure through an already-sensitive pelvic floor. Learning to breathe through effort, rather than bracing against it, protects the pelvic floor while you train.
It also helps to work with your cycle rather than against it, easing back in the days a flare tends to hit and pushing on when symptoms are quieter. A physiotherapist can help you adapt lifting, core work and higher-impact exercise to your symptoms, so movement becomes part of managing endometriosis rather than something to fear.
Common questions
Can physiotherapy cure endometriosis?
No. Physiotherapy does not treat or cure endometriosis, which is a gynaecological condition managed by your GP and gynaecologist. What physiotherapy does is ease the pelvic floor tension, pain and movement problems that build up around endometriosis, so it works alongside your medical care rather than replacing it. Many women find it reduces day-to-day pain and improves function.
Does physiotherapy help PCOS-related pain?
Sometimes, but indirectly. PCOS is a hormonal and metabolic condition, not a pelvic floor problem, so physiotherapy does not treat PCOS itself. Where PCOS comes with a musculoskeletal or pelvic floor component, such as associated pelvic pain or bladder symptoms, an assessment can identify whether physiotherapy would help those specific symptoms. If it would not, we will tell you honestly.
Will I need an internal examination?
Not necessarily. An internal pelvic floor assessment can give useful information, but it is always optional, explained fully beforehand, and only carried out with your consent. It does not have to happen at your first appointment, and there are other ways to assess the pelvic floor if you would prefer not to. You are in control throughout.
Is it safe to exercise with endometriosis?
Usually yes. Most women with endometriosis can and should stay active, but how you exercise matters. Pacing, gradual loading and avoiding breath-holding or straining help you keep moving without triggering a flare. A physiotherapist can help you adapt lifting, core work and higher-impact exercise around your symptoms and your cycle.
Do I need a diagnosis before starting physiotherapy?
It helps to have one. You should always see your GP or gynaecologist first for any new or unexplained pelvic pain, so that anything needing medical investigation is checked. Once endometriosis is suspected or diagnosed, physiotherapy can begin alongside your medical care to manage the muscular and pelvic floor side of your symptoms.
About the author
Luiza is a women's health physiotherapist at Complement Osteo & Physio in Islington, registered with the POGP (Pelvic, Obstetric and Gynaecological Physiotherapy), the UK professional body for pelvic health. She assesses and treats endometriosis-related pain, pelvic floor dysfunction, and pregnancy and postnatal concerns, following POGP guidelines and a consent-first approach. Read more about Luiza and the team.
Book your session at our Islington clinic
If endometriosis or pelvic pain is affecting your daily life, book an assessment with our women's health team. Our clinic is at Highbury Grove in N5, a short walk from Highbury & Islington station and easily reached from Angel, Canonbury and Barnsbury. A first session includes a full history, an assessment tailored to your symptoms and delivered with your consent, and a clear plan to work with between visits. We accept most major insurance providers and offer multi-session packages.
