Adenomyosis is a condition that can cause painful periods, heavy menstrual bleeding, pelvic pressure, and ongoing pelvic pain. These symptoms can affect daily activities, exercise, sleep, relationships, and overall quality of life. While medical treatments are often the first step in managing adenomyosis, pelvic floor physical therapy (PFPT) may offer extra support for people who experience pelvic muscle pain, pain during sex, or ongoing discomfort. It is important to understand that pelvic floor physical therapy does not treat adenomyosis itself. Instead, it can help manage some of the muscle-related symptoms that may develop alongside the condition. When used with appropriate medical care, PFPT may be a helpful part of a complete treatment plan.
Adenomyosis occurs when tissue similar to the lining of the uterus grows into the muscular wall of the uterus. This tissue responds to hormonal changes during the menstrual cycle, which can lead to inflammation, swelling, and pain. The uterus may also become enlarged and tender. Although adenomyosis is a benign condition, meaning it is not cancer, its symptoms can be severe and may interfere with everyday life.
Common symptoms include heavy or prolonged menstrual bleeding, painful periods, pelvic cramping, lower abdominal discomfort, and a feeling of pressure in the pelvis. Some people also experience pain during sexual activity or chronic pelvic pain that continues outside their menstrual period. Adenomyosis can occur alongside other conditions, such as endometriosis or uterine fibroids, which can make symptoms more complex.
The pelvic floor is a group of muscles and connective tissues that support the bladder, bowel, and reproductive organs. These muscles help control urination and bowel movements, support sexual function, and contribute to core stability. Like other muscles in the body, they need to contract and relax at the right times to work well.
When someone experiences pelvic pain over a long period, the pelvic floor muscles may begin to tighten as a protective response. This can happen without the person being aware of it. Over time, the muscles may become overly tense, tender, or difficult to relax. This is sometimes called pelvic floor muscle overactivity or a hypertonic pelvic floor.
For someone with adenomyosis, ongoing uterine pain may contribute to this pattern of muscle tension. Tight pelvic floor muscles can then add another layer of discomfort, including pain with movement, pressure in the pelvis, difficulty relaxing during bowel movements, or pain during sexual activity. The result can be a cycle in which uterine pain contributes to muscle tension, and muscle tension adds to the overall pain experience.
However, not everyone with adenomyosis has pelvic floor dysfunction. A pelvic floor assessment can help determine whether muscle tension, tenderness, or movement problems are contributing to a person’s symptoms.
Pelvic floor physical therapy is a specialized form of rehabilitation that focuses on the muscles, joints, connective tissues, and movement patterns of the pelvis. A physical therapist with pelvic health training can assess how these areas work together and develop a treatment plan based on the person’s symptoms and goals.
Treatment may include gentle manual therapy to reduce muscle tension and tenderness. This can involve work on the lower abdomen, hips, lower back, and other areas connected to pelvic movement. When appropriate and with the patient’s informed consent, the therapist may also offer internal vaginal muscle assessment or treatment. Internal techniques are not required for every patient, and external treatment may be a suitable starting point.
Other treatment methods may include diaphragmatic breathing, gentle stretching, relaxation exercises, movement training, and real time ultrasound imaging (RUSI). RUSI shows muscle activity to help a person understand when their pelvic floor muscles are tightening or relaxing. A home exercise program helps people practice these skills between appointments.
The treatment plan should match the person’s needs. For example, someone with painful, tight pelvic floor muscles may benefit most from relaxation and gentle movement. Someone with weakness or poor muscle coordination may need a different approach.
Pelvic floor physical therapy may help reduce the muscle-related part of chronic pelvic pain. By improving the ability of the pelvic floor muscles to relax and move comfortably, therapy may reduce tenderness, pressure, and pain caused by muscle tension. It may also help people who experience pain during sexual activity when pelvic floor dysfunction contributes to their discomfort.
PFPT may also help with menstrual pain. Gentle hip and abdominal stretching, breathing exercises, and pelvic floor relaxation can support better movement and reduce muscle guarding during painful periods. Some research on dysmenorrhea, or painful menstruation, has found that physical therapy approaches can reduce pain intensity. However, these findings do not mean that PFPT has been proven to treat adenomyosis directly.
Research published in 2025 reviewed rehabilitation approaches for endometriosis and adenomyosis. The findings suggested improvements in pain and quality of life among people receiving rehabilitation interventions. Pelvic floor PT is supported by evidence from chronic pelvic pain, painful menstruation, and related pelvic health conditions. This makes PFPT a reasonable option for selected patients, rather than a proven treatment for the underlying uterine disease.
Kegel exercises are often recommended to strengthen the pelvic floor muscles. They involve tightening and lifting the muscles used to control urine and gas. While strengthening may help some people, it is not the right starting point for everyone.
If the pelvic floor muscles are already tight or overactive, repeated contractions may increase tension and worsen pain. People with adenomyosis and pelvic floor muscle tenderness may need to learn how to release and relax these muscles before considering strengthening exercises.
A pelvic health physical therapist can help determine whether the muscles need relaxation, strengthening, coordination training, or a combination of approaches. This is one reason a personalized treatment plan is important. People should not assume that more muscle contraction will always improve pelvic floor function.
The most effective approach to adenomyosis often involves more than one type of care. Hormonal treatments and other medical options address the uterine disease and help manage symptoms such as heavy menstrual bleeding and painful periods. PFPT focuses on the muscles and movement patterns that may contribute to pain.
For example, a person may use medication to control menstrual symptoms while attending physical therapy to address pelvic floor tension and pain during sex. This combination may improve comfort and daily function more effectively than relying on one approach alone. However, results vary, and treatment should be adjusted based on symptom changes and individual needs.
It is important to remember that PFPT does not stop the growth of adenomyosis-related tissue, change the course of the disease, or directly reduce heavy menstrual bleeding. If bleeding is heavy, prolonged, or associated with fatigue, dizziness, or weakness, medical evaluation is important because blood loss can lead to iron deficiency or anemia.
If you have adenomyosis and ongoing pelvic pain, a consult with a physical therapist with specific training in pelvic health and myofascial pain may be helpful, especially if you have pelvic muscle tenderness, pain during sex, or discomfort that continues even when menstrual symptoms are better controlled.
Adenomyosis can affect many parts of a person’s life, but care does not have to focus on the uterus alone. Medical treatment addresses the underlying condition, while pelvic floor physical therapy may help reduce the added burden of muscle pain and tension. Although more research is needed, PFPT can be a useful part of a broader, individualized care plan for people whose adenomyosis symptoms include pelvic floor dysfunction. The goal is not simply to reduce pain, but to help people move more comfortably, improve daily function, and regain confidence in their bodies.
