Endometriosis is often talked about as a pelvic disease, but it's actually a systemic inflammatory condition that affects the entire body. And the way we diagnose and treat it is still failing too many patients.

In this episode, I sit down with Jandra Mueller, a pelvic floor physical therapist in San Diego and the incoming educational chair for the International Society for the Study of Women's Sexual Health. Jandra specializes in treating patients with endometriosis and has a unique perspective both as a clinician and as someone who went through the diagnostic odyssey herself.

Her own experience getting diagnosed drove her to focus on this work. She spent years dealing with symptoms that kept getting dismissed and saw multiple specialists who couldn't figure out what was wrong. Even as a pelvic floor PT working in a hospital-based women's health center with access to specialists, it took years to get the right diagnosis.

We discuss why the new guidelines for diagnosing endometriosis are a step forward but still fall short. We talk about the pelvic pentad the association between endometriosis, hypermobility, mast cell activation syndrome, pelvic floor dysfunction, and vestibulodynia. And we get into why fibrotic endometriosis is often overlooked during surgery and what that means for patients who continue to have symptoms after excision.

Highlights

Doctors can now start treating endometriosis based on your symptoms without requiring surgery first.
Scar tissue from endometriosis is often missed during surgery because it doesn't always show up on the biopsy.
Endometriosis often shows up alongside other conditions like hypermobility, mast cell issues, and pelvic pain with sex.
Not all surgeons who say they specialize in endometriosis actually have the advanced training needed.
If you still have symptoms after surgery, keep pushing for answers—it doesn't mean the pain is in your head.
Treating endometriosis with pelvic floor PT means looking at your whole body, not just your pelvis.
Pain before bowel movements is a classic endometriosis symptom that often gets overlooked.

If you're experiencing symptoms that aren't improving with treatment, don't stop advocating. Finding the right endometriosis specialist matters not all surgeons have the same level of training.

Consider working with a pelvic floor physical therapist who understands endometriosis and can look at your whole body, not just your pelvis.

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