Pelvic Pain Unpacked, Episode 11 — with Tamar Hill and Dr. Sarahann Callaway, PT
🌿 Key Takeaways
- Endometriosis affects roughly 10% of women worldwide — about 190 million people — and is significantly under-diagnosed because women are routinely told that discomfort with their periods is normal.
- The current gold standard for diagnosis is laparoscopic surgery, and it takes an average of 7 to 10 years for women to receive a confirmed diagnosis.
- The biggest red flag most people don’t know about: discomfort during bowel movements specifically during your period.
- Surgery alone rarely resolves endometriosis symptoms — ongoing management through lifestyle, pelvic physical therapy, and natural alternatives like CBD is essential.
- CBD suppositories are emerging as a meaningful complementary tool for managing the cyclical discomfort of endometriosis, without the functional impairment of prescription medications.
If you’ve spent years being told your period discomfort is normal, been passed from specialist to specialist without answers, or found yourself Googling symptoms at midnight wondering if something is actually wrong — this conversation is for you.
In Episode 11 of Pelvic Pain Unpacked, host Tamar Hill of MedRoots — a company specializing in CBD products for pelvic discomfort relief, muscle discomfort, menopause support, wellness, and increasing pleasure — sat down with Dr. Sarahann Callaway, a pelvic health physical therapist with over a decade of experience and founder of Just Breathe Physical Therapy and Wellness in Ardmore, Pennsylvania. Dr. Callaway has become one of the Philadelphia area’s go-to practitioners for persistent pelvic discomfort, with endometriosis at the center of much of her work.
What followed was one of the most grounded, clinically informed, and genuinely compassionate conversations about endometriosis we’ve had — covering everything from why diagnosis takes so long, to what a natural alternative approach actually looks like in practice.
What Is Pelvic Health Physical Therapy — And Why Does It Matter for Endometriosis?
Dr. Callaway is quick to clarify a distinction she feels strongly about: she’s a pelvic health physical therapist, not just a pelvic floor PT.
Dr. Sarahann Callaway: “I don’t just treat the pelvic floor. I treat the whole body — and that’s especially important when we’re talking about endometriosis.”
Pelvic health PT looks at the intersection of bladder function, bowel function, sexual function, and any discomfort related to those systems. Most practitioners come from an orthopedic background before specializing into this lens — and what sets them apart is the ability to assess the pelvic floor internally, vaginally or rectally, with full consent.
The analogy Dr. Callaway uses is memorable: physician specialists are looking at their own house in a neighborhood. Pelvic health practitioners are looking at the entire neighborhood, watching how all the neighbors interact with each other. That whole-body perspective is exactly what makes this field so valuable for a condition as complex and far-reaching as endometriosis.
The field is relatively new — the pioneers are still actively practicing — and it’s booming. Most practitioners have waiting lists, which is part of why education and awareness matter so much.
What Endometriosis Actually Is (And Why It’s So Hard to Find)
Endometriosis affects approximately 10% of women — roughly 190 million people worldwide. Despite those numbers, it remains significantly under-diagnosed.
The endometrium is the lining of the uterus, which builds up each cycle in preparation for a fertilized egg and sheds when pregnancy doesn’t occur. With endometriosis, endometrial-like lesions grow outside the uterus. In extreme cases they’ve been found on the diaphragm and in the lungs — but most commonly they’re in the abdominal cavity, where they like to hide on the intestines and surrounding structures.
Dr. Sarahann Callaway: “They’re like little inflammation factories — little gremlins — that feed on estrogen and create all sorts of problems on a cyclical basis.”
It’s important to distinguish endometriosis from adenomyosis, a related condition where those same endometrial-like tissues grow inside the uterine wall. Both are driven by the same estrogen-fueled process but present and behave somewhat differently.
One of the most disorienting things about endometriosis is that the number of lesions doesn’t necessarily equal the severity of symptoms. Someone can have minimal endometriosis and debilitating discomfort. Someone else can have extensive lesions and very few symptoms at all. This makes diagnosis by symptom alone genuinely difficult — and it’s part of why the average time from first symptoms to confirmed diagnosis is seven to ten years.
The current gold standard for diagnosis is laparoscopic surgery — physically going in to find and identify the lesions. There is no blood test, no non-invasive screening equivalent. Dr. Callaway expressed a clear wish that would change.
The Diagnostic Maze: Why It Takes So Long
The path to an endometriosis diagnosis is often a long loop through specialists who are each doing their jobs — but only looking at their piece of the puzzle.
Dr. Callaway described a current patient with cyclical abdominal discomfort who had been to GI, undergone both a colonoscopy and endoscopy, was incorrectly treated for C. diff (a serious hospital-acquired infection), given antibiotics that made things worse, and still had no answers. Every test came back normal. She was exhausted from getting normal findings on exams that weren’t looking in the right place.
This experience is not unusual. Endometriosis, IBS, and interstitial cystitis (painful bladder syndrome) are what Dr. Callaway calls the “evil triplets” — they frequently co-occur, they mimic each other, and they’re all tied to the same underlying driver: chronic low-level inflammation. When one area becomes sensitized, the surrounding systems start reacting. It all tends to converge at the pelvis.
Adding to the complexity, women with endometriosis are frequently treated for UTIs they don’t actually have. Antibiotics prescribed for infections that aren’t there disrupt the gut microbiome and compound the problem. Dr. Callaway is clear on this: antibiotics are valuable when there’s an actual confirmed infection. The issue is prescribing them without a positive test.
And underlying all of it is a systemic problem: cisgender women are historically undertreated and dismissed in the medical system. Being told “your period is supposed to hurt, take a Midol and move on” is not a diagnosis. It’s a delay.
The Red Flags You Need to Know
So what should actually raise the alarm?
The cyclical nature of symptoms is the biggest overall signal — discomfort that reliably tracks with the menstrual cycle. But the red flag that surprises most people is this:
Dr. Sarahann Callaway: “The biggest red flag for endometriosis is painful bowel movements during your period. Estrogen is at its highest on day one of your cycle — and estrogen is miracle-grow for these lesions. If you have cyclical discomfort plus gut symptoms, endometriosis or adenomyosis needs to be on the radar.”
Other signals to watch for include urinary urgency and frequency, recurring “UTIs” that don’t test positive for infection, discomfort around ovulation or specifically with periods, and fertility struggles without any workup for endometriosis. Dr. Callaway shared a case of a patient who went through multiple fertility doctors, none of whom checked for endometriosis — and she turned out to have stage four infiltrating endo.
Why Surgery Isn’t the Whole Answer
Excision surgery — laparoscopically removing as many lesions as possible — is the gold standard treatment for endometriosis. But patients often expect surgery to resolve everything, and that expectation frequently leads to disappointment.
The body isn’t just a gut. It’s a nervous system. Surgery addresses the lesions, but it doesn’t address the sensitized nervous system, the disrupted sleep, the chronic stress, the gut dysfunction, or the pelvic floor that has been bracing against discomfort for years. Those all need their own attention.
Post-surgical management is often where the system falls short. Surgeons who are excellent at excision aren’t always equipped to guide the recovery and long-term lifestyle management that follows. That’s where pelvic health practitioners come in.
On the hormone therapy side, endometriosis treatment often involves suppressing estrogen through oral contraceptives or IUDs to stop feeding the lesions. Synthetic progesterone (norethindrone) is commonly prescribed post-surgery — it works well for some patients, but many still struggle. Dr. Callaway notes that topical vaginal estrogen, which recently had its black box warning removed, is considered safe for endometriosis patients because it stays local and doesn’t enter systemic circulation.
CBD for Endometriosis: A Natural Alternative Worth Talking About
This is where the conversation takes a turn that a lot of conventional providers haven’t caught up with yet.
Tamar raised CBD as a natural alternative for endometriosis symptom management, and Dr. Callaway’s response was grounded in both clinical experience and her own genuine curiosity about the research.
The connection isn’t arbitrary. The endocannabinoid system plays a direct role in the body’s inflammatory response — the same system that endometriosis disrupts. There’s also a notable co-occurrence of endometriosis in people with hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome, which researchers believe may share an underlying inflammatory mechanism. CBD’s anti-inflammatory properties are relevant across all of it.
In practice, Dr. Callaway introduces CBD strategically. For patients who know their discomfort tends to peak around ovulation, she recommends using a CBD suppository the night before expected ovulation. For those whose worst symptoms come with their period, the approach is the same — get ahead of it the night before, rather than waiting until the discomfort peaks.
She described a post-hysterectomy patient who had undergone a second round of excision surgery. Their PT sessions were getting things settled for about six days before symptoms would flare again. The prescribed vaginal Valium was sedating her all day, leaving her unable to care for her children. Dr. Callaway introduced MedRoots CBD suppositories as a bridge — something to extend the benefit of their PT work between sessions, without any functional impairment. The result: the discomfort that had been showing up as burning at the end of each day was noticeably reduced.
Dr. Sarahann Callaway: “Why would we reach for a controlled substance when we have something more natural that lets you still function, still parent, still work?”
For patients who are skeptical, Dr. Callaway has a graduated approach: start with CBD lotion applied to the arm to build comfort with the idea. Then move to a low-level suppository — MedRoots makes one with just a small amount of CBD, magnesium, and hyaluronic acid. Then build from there based on response.
Her personal favorite MedRoots product — and the brand’s bestseller — is the Wellness+ suppository, which combines CBD with a low level of THC. For patients in states where THC is more sensitive culturally, or for those who simply prefer to start without it, the standard Wellness suppository is a solid entry point. The key framing she returns to: CBD is a complement to pelvic PT, not a replacement for it. It’s a tool that helps maintain progress between sessions.
The Care Team Endometriosis Patients Actually Need
No single provider can address all dimensions of endometriosis. Dr. Callaway is direct about what an ideal team looks like: a pelvic health PT or OT, an endo-informed gynecologist or excision surgeon, an endo-aware dietician (because diet directly affects the chronic inflammation that drives symptoms), a mental health provider for stress management and coping, and when appropriate, an acupuncturist — whose approach to herbal medicine and inflammation Dr. Callaway describes as “mind-blowing.”
She spoke about missing the multidisciplinary team model she experienced at the University of Chicago, where pelvic PT, pharmacy, urogynecology, OBGYN, colorectal, psychiatry, and interventional radiology would all gather once a month to discuss complex cases together. That kind of collaboration is rare, but it’s exactly what endometriosis patients need.
The Tri-State Pelvic Health Summit, which Dr. Callaway founded for pelvic PTs and OTs in the Philadelphia area, is her contribution to building that kind of community locally — a lower-stakes space to learn together, share knowledge, and raise the overall quality of care in the region.
What to Do If You Think You Have Endometriosis
If this conversation sounds familiar, here’s the practical path forward:
Start tracking your cycle meticulously — note when discomfort occurs, whether it’s cyclical, whether gut symptoms coincide. The two biggest red flags: cyclical discomfort and bowel movement discomfort specifically during your period.
Go to your gynecologist prepared. Bring your symptom history. Name endometriosis as a possibility. Advocate for yourself clearly. If you can’t get a gynecology appointment quickly — and in many areas, wait times are running 12 to 18 months — consider finding a pelvic health PT first. They may know which local physicians are endo-aware, and a PT appointment is often accessible sooner.
And when you’re ready to explore natural alternatives alongside your medical care, CBD is worth a real conversation with your care team.
Dr. Sarahann Callaway: “Your symptoms are real. Keep advocating for yourself even when you want to give up. Find your people — because more and more people are going to be your people as awareness grows.”
You Don’t Have to Navigate This Alone
If you’re living with endometriosis and looking for natural alternatives that work alongside your treatment — not instead of it — MedRoots is here to help. Our CBD suppositories, wellness supplements, and pelvic health products are designed specifically for people navigating conditions like endometriosis, with options ranging from THC-free formulas to our bestselling Wellness+ suppository.
📞 Call us: 833-797-7576 🌐 Contact us online: medroots.com/pages/contact
You’ve spent enough time being dismissed. Let’s find what actually helps.
This article is based on Episode 11 of Pelvic Pain Unpacked featuring Dr. Sarahann Callaway, pelvic health physical therapist and founder of Just Breathe Physical Therapy and Wellness. It is for informational purposes only and does not constitute medical advice. Please consult your healthcare provider before making changes to your health regimen.