Home›Hematology› PFMT plus hormonal therapy cuts dysmenorrhea recurrence risk in endometriosis
PFMT plus hormonal therapy cuts dysmenorrhea recurrence risk in endometriosisPelvic Floor Training May Reduce Endometriosis Pain Recurrence
Frontiers in MedicinePublished September 1, 2026Study authors: Jie Song, Hui Dong, Zhen ChenDOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider PFMT as an adjunct to hormonal therapy for endometriosis, but await randomized trials.
This retrospective cohort study included 446 women with surgically confirmed endometriosis. The intervention was pelvic floor muscle training (PFMT) combined with hormonal therapy (progestogen or oral contraceptives), compared with hormonal therapy alone. The primary outcomes were 12-month pain recurrence, health-related quality of life (EHP-30), and recurrence-free survival. Secondary outcomes included dysmenorrhea recurrence, chronic pelvic pain, and dyspareunia. Follow-up was 12 months.
For dysmenorrhea recurrence at 12 months, the combination of PFMT with progestogen (LAP) showed a recurrence rate of 36.5% versus 75.0% in the progestogen-only group (OR=0.192, p=0.0002). Similarly, PFMT combined with oral contraceptives (COC) had a recurrence rate of 38.3% versus 68.1% in the COC-only group (OR=0.291, p=0.0072). PFMT was identified as an independent protective factor against recurrence for dysmenorrhea, chronic pelvic pain, and dyspareunia (all p<0.05).
Safety outcomes, including adverse events, serious adverse events, and discontinuations, were not reported. The study is limited by its retrospective, non-randomized design, which precludes causal conclusions. The authors note that confirmation in prospective randomized controlled trials is warranted.
For clinical practice, these findings suggest that PFMT may offer a clinically meaningful adjunctive benefit when added to hormonal therapy for endometriosis-related pain, but the low certainty of the evidence means clinicians should interpret these results cautiously and await higher-quality data.
How this fits prior evidence
This retrospective cohort study extends prior coverage on hormonal therapies for endometriosis by suggesting that adding PFMT to hormonal therapy may further reduce dysmenorrhea recurrence, building on the finding that hormonal therapies significantly reduce overall pelvic pain. It also complements dietary and genetic insights by addressing a non-pharmacological adjunct. However, the non-randomized design contrasts with the stronger evidence base for hormonal therapy alone, and the lack of safety data highlights gaps. The results should be interpreted with caution given the low certainty.
Researchers looked at 446 women with surgically confirmed endometriosis to see how different treatments affected their symptoms over 12 months. They compared women who used only hormonal therapy, such as progestogens or oral contraceptives, against those who combined hormonal therapy with pelvic floor muscle training (PFMT).
The study found that women who practiced pelvic floor muscle training alongside their hormones had much lower rates of recurring pain. Specifically, the recurrence of painful periods (dysmenorrhea) was significantly lower in both groups that included pelvic floor training. The results also suggested that these exercises could be a protective factor against chronic pelvic pain and pain during intercourse.
Because this was a retrospective study and not a randomized trial, the results are not definitive. The study shows a link between the training and better outcomes, but more high-quality trials are needed to confirm these findings. Patients should speak with their doctor to see if adding pelvic floor exercises to their current treatment plan is a suitable option.
What this means for you:
Pelvic floor training combined with hormones may lower pain recurrence in women with endometriosis.
Common questions
Does pelvic floor training help with endometriosis pain?
The study found that pelvic floor muscle training (PFMT) acted as an independent protective factor against the recurrence of dysmenorrhea, chronic pelvic pain, and dyspareunia. When combined with hormonal therapy, it was associated with lower rates of pain returning over a 12-month period.
How does it compare to taking hormones alone?
Women who used only hormonal therapy had higher rates of pain recurrence. For example, the recurrence of dysmenorrhea was 75.0% for those on progestogen alone, compared to 36.5% for those who also did pelvic floor training. A similar trend was seen with oral contraceptives.
Is this a proven treatment for endometriosis?
The study shows a link between pelvic floor training and lower pain, but it was a retrospective study rather than a randomized trial. Because the evidence is not from a randomized trial, it is not yet a confirmed standard of care, and you should consult your doctor.
Endometriosis (EMS) causes debilitating pain and reduces quality of life. Whether pelvic floor muscle training (PFMT) provides independent, additive benefits beyond standard postoperative hormonal suppression remains unknown.
A retrospective cohort study was conducted on 446 women with surgically confirmed EMS between June 2022 and May 2024. Patients were categorized into five groups: PFMT-only (n = 98), PFMT+long-term adjuvant progestogen (PFMT+LAP; n = 91), PFMT+combined oral contraceptives (PFMT+COC; n = 87), LAP-only (n = 85), and COC-only (n = 85). Propensity score matching (PSM) with 28 baseline covariates was applied to isolate the effects of PFMT. Primary outcomes included 12-month pain recurrence, health-related quality of life (EHP-30), and recurrence-free survival.
After PSM, 12-month dysmenorrhea recurrence was significantly lower in combination groups compared to hormonal therapy alone: PFMT+LAP vs. LAP-only (36.5% vs. 75.0%; OR = 0.192; p = 0.0002) and PFMT+COC vs. COC-only (38.3% vs. 68.1%; OR = 0.291; p = 0.0072). Multivariable logistic regression confirmed PFMT as an independent protective factor against recurrence for dysmenorrhea, chronic pelvic pain, and dyspareunia (all p
Pelvic floor muscle training combined with hormonal therapy significantly reduces pain recurrence and quality-of-life burden while extending recurrence-free survival compared to hormonal therapy alone. These findings suggest that PFMT may confer a clinically meaningful adjunctive benefit. However, given the retrospective, non-randomized design of this study, confirmation in prospective randomized controlled trials is warranted before routine integration into postoperative endometriosis management protocols can be recommended.
