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endometriosis and sleep
Endometriosis & Sleep: Improving Melatonin through PFPT and Lifestyle Changes | Image Courtesy of Lux Graves via Unsplash

What Are The Connections Between Endometriosis and Sleep?

March is Endometriosis Awareness Month.

The endometrium is the lining of the uterus. When there is tissue similar to the endometrial lining that is growing outside of the uterus, it is called endometriosis. Endometrial lesions can be on the ovaries, vaginal walls, bladder, colon, and more. Endometriosis affects up to 10% of the general population and can be quite debilitating as common symptoms include dysmenorrhea, dyspareunia (pain with sex), infertility, bloating, gastrointestinal symptoms, and chronic pelvic pain.

Unfortunately, with chronic pain conditions, such as endometriosis, sleep quality can be impaired. Sleep is essential for cognitive function, immune function, and overall health. The relationship between pain and sleep is a vicious cycle as pain can lead to poor sleep, but at the same time, poor sleep can increase sensitivity to pain and worsen depressive thoughts and thus experience a poorer quality of life. In fact, sleep disorders and changes in your melatonin level can have an effect on the reproductive system, not making it any easier to conceive. 


Melatonin is a hormone primarily released by the pineal gland and helps regulate the circadian rhythm. Melatonin acts as an important analgesic, sleep inducer, antioxidant, immunoregulatory, and anti-inflammatory agent. Due to its many special responsibilities, some researchers propose that improving melatonin can help reduce or stop the progression of endometriosis. There are quite a few studies showing that taking melatonin supplements not only improves sleep quality but also improves daily pain, dysmenorrhea, painful urination, painful defecation, and reduces the need to take analgesic medications. In addition, BDNF (brain-derived neurotrophic factor), a marker in inflammation, was reduced in those who were part of the melatonin supplement program.

Diet, Sleep and Endometriosis:Endometriosis & Sleep: Improving Melatonin through PFPT and Lifestyle Changes | Image Courtesy of Lux Graves via Unsplash

There are things that we can add to our diet that can help improve our melatonin levels. Often women with endometriosis are placed on anti-inflammatory diets or specific diets that they found were best through the elimination diet strategy. However, one study found that for women who incorporated a diet rich in dairy products and fruits, their sleep quality was better than those who did not integrate those foods. These foods contain tryptophan, which is converted to serotonin, then via various chemical processes, is converted into MLT or melatonin. There is also other research that shows kiwi, tart cherry juice and oysters have antioxidants, melatonin and zinc contents that can improve overall sleep quality.  Ask your dietician or gastroenterologist how you can include some of those foods without aggravating your other digestive symptoms for a better night’s sleep.

Exercise, Sleep, and Endometriosis:

Another lifestyle factor that can help improve melatonin is physical activity! Regular exercise can enhance melatonin secretion and improve sleep quality in this way. In addition, endometriosis is also associated with insulin resistance; exercise can help mitigate this and help decrease abdominal pain/menstrual pain. One study showed that diet and physical activity both have a major impact on endometriosis risk. It is important, however, that there is such a thing as too much exercise, as it can elevate Sex Hormone Binding Globule (SHBG) levels creating a hormonal imbalance that can affect pelvic floor function. Walking, yoga, gentle pilates, swimming are all wonderful ways to get exercise for an overall dopamine boost as well as melatonin for improved sleep!

Another lifestyle factor that can help improve your endometriosis symptoms and increase good sleep and melatonin is physical activity!"


It can be a vicious cycle with pain leading to poor sleep, and poor sleep leading to increased sensitivity and more pain. Talk with a specialist about ways to help improve your melatonin levels either through a supplementation program or through diet and exercise. If you are worried about starting an exercise program, please reach out to a pelvic floor physical therapist who understands endometriosis well and can help you get started with a safe, pain-free, enjoyable, and individualized exercise regimen (Bonus: your pelvic floor physical therapist can also work on any other endometriosis symptoms!). Give us a call or contact us through our website



Maggiore, Bizzarri N, Scala C, et al. Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case-control study. European J of Obsteterics & Gynecology and Reproductive Biology 2017; 209:39-43. 

Youseflu S, Sadatmahalleh SJ, Roshanzadeh G, et al. Effects of endometriosis on sleep quality of women: does life style factor make a difference? BMC Women’s Health 2020;20:168, 1-7. 

Schwertner A, Conceicao dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: A phase II, randomized, double-blind, placebo-controlled trial. PAIN 2013;154:874.881. 

What Our Patients Have to Say


Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

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Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

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Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

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Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

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Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

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