Endometriosis and adenomyosis are complex conditions affecting a significant portion of the reproductive-aged population. Common symptoms include pelvic pain, fatigue, and Heavy Menstrual Bleeding (HMB), which often lead to psychological distress and reduced quality of life (QOL). Despite their prevalence, there is limited research exploring these conditions from a physical therapy (PT) perspective, particularly regarding physical activity.

The primary aim of this study was to identify the facilitators and barriers to physical activity for individuals diagnosed with endometriosis and/or adenomyosis. Secondary aims included evaluating the perceived efficacy of PT interventions and assessing the correlation between symptom management self-efficacy, pain interference, and biopsychosocial factors (anxiety and depression) using the Patient Reported Outcomes Measurement Information System (PROMIS®).

A cross-sectional study was conducted via an anonymous, web-based survey. Participants were recruited through public links and data was managed via a secure, HIPAA-compliant platform. The survey collected demographic data, surgical history, and information regarding physical activity barriers. Validated PROMIS instruments were used to measure Self-Efficacy for Management of Symptoms, Pain Interference, Depression, and Anxiety. Statistical analysis was performed using SPSS version 30. Spearman’s correlation was used to assess relationships between PROMIS domains.

The study included 329 participants (Table 1). Diagnoses included endometriosis (95.4%), adenomyosis (35.0%), and infertility (14.9%). Symptom duration was chronic, with 72.3% experiencing symptoms for over 7 years. Surgical history was reported by 82.7%, including laparoscopy (77.8%) and hysterectomy (14.3%).

Regarding physical therapy, 51.4% had received treatment specifically for their condition, with 47.8% seeing a pelvic health specialist. On a 0–100 satisfaction scale, the mean score for pain relief was 46.7 (±2 7.3) and for physical function was 47.18 (± 27.3).

The primary facilitator for physical activity was medical treatment (82.4%), followed by physical environment (79.6%). The most significant barrier was abdominal/pelvic pain, reported by 97.6% of participants, while 91.5% stated their condition limited their overall physical activity.

Statistical analysis revealed moderate inverse correlations between PROMIS Self-Efficacy and Pain Interference (⍴=-.460, p < 0.001) and between Self-Efficacy and Depression (⍴=-.422, p < 0.001).

These findings suggest that while medical and surgical interventions are common, they do not fully mitigate the barriers to physical activity, as nearly all participants feel limited by pain. The moderate satisfaction scores for physical therapy indicate a potential gap in current PT protocols regarding functional return to exercise. Furthermore, the inverse correlation between self-efficacy and pain/depression highlights that psychological resilience and symptom management confidence are intrinsically linked to the physical burden of the disease. High levels of pain interference directly undermine a patient's belief in their ability to manage their condition

Pelvic pain remains the near-universal barrier to physical activity for those with endometriosis and adenomyosis. While physical therapy is a frequently utilized intervention, there is a need for more specialized, function-oriented PT strategies to improve patient satisfaction and self-efficacy. Clinicians should adopt a biopsychosocial approach, addressing not only the physical pain but also the psychological barriers (anxiety and depression) to improve overall physical activity participation and quality of life.