Endometriosis

When hormones, surgery, or “normal imaging” do not explain why pelvic pain keeps returning, spreads, or never fully turns off.

The Clinical Reality

With endometriosis, medical pathology is managed by your gynecologist and may include hormonal and surgical strategies. What often remains is functional pelvic pain: protective muscle guarding, irritated or mechanically sensitive nerves, and a nervous system that learns to anticipate threat around the pelvis. This can show up as pelvic floor “holding,” altered breathing and abdominal bracing, and hypersensitive trigger points in deep hip and pelvic muscles. Over time, the pattern can become partly cyclical and partly persistent, where symptoms flare around the cycle but never fully return to baseline.

Our role is to assess and treat the musculoskeletal and neuro-myofascial contributors that amplify pain, limit tolerance for sitting, sex, exercise, and bowel or bladder function, and prolong recovery after medical or surgical care.

Why Standard Care Fails

Standard care can be essential, but it often leaves a gap: medications and surgery target hormonal signaling and lesions, while persistent symptoms may be driven by soft tissue and nerve sensitivity that imaging does not capture. Even after appropriate medical management, pelvic floor hypertonicity, myofascial trigger points, hip and abdominal wall tension, and nerve mechanosensitivity can keep the system reactive. If these drivers are not directly palpated, mapped, and treated, patients may be told everything looks fine while they continue to limit sitting, training, intimacy, or travel. Our approach focuses on the functional layer that is frequently missed, while staying aligned with your OB-GYN and pelvic specialists.

Signs & Symptoms

Do any of these sound familiar?

Cyclical pelvic pain with a “shadow” baseline

Flares predictable around ovulation or menses, but a lower-level ache, pressure, or burning persists between cycles and reduces tolerance for sitting, meetings, or commuting.

Deep dyspareunia or post-intercourse pain

Not just discomfort during penetration, but delayed cramping, pelvic heaviness, or deep hip pain for hours to days, often linked to pelvic floor guarding and trigger points.

Bowel-related pelvic pain

Pain with bowel movements, straining sensitivity, or rectal pressure that spikes during flares, sometimes with a sensation of incomplete emptying driven by pelvic floor overactivity.

Bladder urgency and urethral sensitivity during flares

Frequency, urgency, or burning without a clear infection pattern, often paired with suprapubic tightness and pelvic floor tone that increases with stress and cycle changes.

Hip, low back, and groin referral pain

Pain that migrates between deep hip rotators, adductors, low back, and lower abdomen, especially with standing, running, lifting, or prolonged sitting.

Root Cause Contributors

The mechanical drivers behind your symptoms

Pelvic Floor Myofascial Hypertonicity

Protective guarding can become the default. Elevated tone and trigger points can refer pain to the vagina, rectum, bladder, tailbone, and deep hip.

Pudendal and Posterior Femoral Cutaneous Nerve Mechanosensitivity

Nerves can become sensitive to load, stretch, and compression, contributing to burning, sitting intolerance, genital or perineal pain, and flare persistence.

Obturator Internus and Deep Hip Rotator Trigger Point Referral

Deep hip musculature can mimic pelvic organ pain and contribute to dyspareunia, buttock pain, and pelvic asymmetry patterns.

Abdominal Wall and Iliopsoas Guarding

Lower abdominal bracing and hip flexor tone can amplify anterior pelvic pain, restrict diaphragmatic breathing, and increase pelvic floor co-contraction.

What to Expect

Your roadmap to recovery
Weeks 1-3
Clearer mapping of drivers and triggers. Many patients notice reduced guarding, improved sitting or sleep tolerance, and less intense rebounds after activity or intercourse, even if cycle flares still occur.
Weeks 4-8
More predictable flare behavior across the month with improved capacity for workdays, commuting, and training modifications. Decreased sensitivity in key trigger points and improved pelvic floor coordination under load.
Weeks 9-12
Consolidation of gains with a focus on return to function: longer sitting windows, steadier exercise tolerance, and better recovery after unavoidable stressors. Ongoing work is based on flare frequency, medical timeline, and performance goals.

Frequently Asked Questions

Get answers to common questions

We do not treat or diagnose endometriosis as a medical disease. Your OB-GYN or endometriosis specialist manages medical and surgical decision-making. We treat the functional drivers that frequently coexist with endometriosis, such as pelvic floor guarding, myofascial trigger points, and nerve sensitivity that can keep symptoms active even when imaging is inconclusive or after surgery.

Surgery can be essential for lesion management, but it does not automatically normalize pelvic floor tone, deep hip trigger points, scar and tissue sensitivity, or nervous system threat responses. Post-surgical pain can also be influenced by altered mechanics and protective patterns. Our assessment identifies what remains modifiable in the soft tissue and neural layers, and we coordinate timing with your surgeon’s guidance.

We often work well alongside pelvic floor PT. Our clinical emphasis is assessment-driven acupuncture and dry needling to specific myofascial and neuromuscular structures, including deep hip and pelvic floor targets when appropriate. Many patients choose us when they want a more direct needling-based approach to tone reduction, trigger point referral, and nerve mechanosensitivity, with a plan tailored to high-demand schedules.

It depends on chronicity, cycle reactivity, and how many functional drivers are present. Many patients start with weekly sessions for several weeks to build momentum, then taper as capacity stabilizes. We set milestones around sitting tolerance, training tolerance, and cycle predictability rather than chasing a single pain score.

Some tenderness is common because we are working with sensitized tissue. The goal is a controlled input, not an aggressive one. We dose carefully and track your 24 to 72 hour response, especially around your cycle. If you are highly reactive, we start with external and proximal drivers first and progress only as tolerated.

We recommend medical evaluation for severe or rapidly worsening symptoms, heavy bleeding, fever, suspected infection, pregnancy-related pain, fainting, unexplained weight loss, new neurologic deficits, or any red-flag pattern. If you do not have an established OB-GYN or endometriosis specialist, we will encourage referral so your medical and functional care run in parallel.

Ready to Find Real Answers?

Schedule a free 15-minute discovery call to discuss your case and determine if our approach is right for you.

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118 W. 72nd, Rear Lobby, Upper West Side, NY 10023 Evidence-based acupuncture and dry needling on the Upper West Side, NYC. From chronic pain, headaches, and pelvic floor dysfunction, Dr. Jordan Barber integrates the highest level of training with compassionate care to help you thrive. Disclaimer: This site does not provide medical advice. Always consult a qualified healthcare professional before making changes to your health. Read our full disclaimer

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