Living Intentionally with Endometriosis with Acceptance & Commitment Therapy
- Nina Isabella
- 2 days ago
- 4 min read
In 2021, I wrote an article for my website - mamashanti, titled Please Don't Call Me An Endo Warrior. At that stage, it had been seven years when at the age of 46, I was finally diagnosed with endometriosis. By that point, I had been living with symptoms for over 30 years - pelvic pain, fatigue, and menstrual disruption that shaped my life long before I had a name for it.
I am now 4 years post menopausal, however March of every year is Endometriosis Awareness Month and I am reminded again of all it took and continues to takes - because Endometriosis is a condition that affects more than the quality of a woman's mentrustrual cycle (but I think I'll save that for future posts).
This post is not about stoicism, heroics, or enduring decades of misdiagnosis. Those experiences are real, and they matter.
This is about what it means to live with endometriosis, and how decades of personal yoga and mindfulness practice and laterly, Acceptance and Commitment Therapy (ACT) has given me tools to navigate chronic pain in a sustainable, empowered way.
I am not a Warrior - for I choose not be in a battle with endometriosis.
That is the role of researchers and medical professionals. My role is to live with it - to honour the reality of my body while making choices aligned with my values.
Why “Living With” Matters
Endometriosis does not define me. Yet it is undeniably part of me. To be at war with it would be to be at war with myself - a strategy that leads to exhaustion and frustration rather than empowerment.
Over decades, I cultivated somatic awareness and self-care practices. I have learned to recognize pain as a signal rather than an enemy. These practices inform my work as a holistic pelvic floor practitioner, supporting women through pelvic pain, pregnancy, postpartum, and long-term pelvic floor health.
Acceptance and Commitment Therapy (ACT) for Chronic Pain
ACT is a psychological approach that emphasizes living fully while accepting difficult internal experiences. It focuses on psychological flexibility - the ability to notice and accept challenging thoughts, emotions, and physical sensations, while taking actions aligned with your values (Hayes et al., 2006).
Research shows ACT can:
Reduce pain-related anxiety and distress in chronic pain conditions (Vowles et al., 2014)
Improve quality of life and functional outcomes in women with chronic pelvic pain and endometriosis (Zhang et al., 2022)
Support long-term wellbeing by helping individuals engage in meaningful activities, even in the presence of pain
ACT encourages:
Acceptance of physical sensations without over-identifying with them
Mindful awareness of the body and thoughts
Values-driven action, focusing on what matters most despite discomfort
Cognitive defusion, noticing thoughts without becoming dominated by them
For someone living with endometriosis, this approach is transformative. It shifts the narrative from “fighting pain” to “living fully with pain.”
How ACT Shapes My Relationship With Endometriosis
Living with endometriosis using ACT has reshaped my experience of chronic pain:
Pain is informational, not adversarial - it signals attention, care, or rest, rather than being a personal enemy.
Self-compassion replaces self-criticism, conserving energy for meaningful engagement rather than struggle.
I can participate intentionally in work, relationships, and creativity, even when symptoms flare.
Pain becomes part of the lived experience, not the defining narrative of my life.
This framework aligns with decades of embodied learning and is especially relevant for women navigating pelvic floor dysfunction, postpartum recovery, and chronic pelvic pain.
Supporting Women With Chronic Pelvic Pain
Endometriosis is hard work. But living fully, with awareness and intention, is possible. ACT provides practical strategies to navigate chronic pain, build psychological resilience, and maintain life engagement.
In my work as an ACT informed women's health counsellor, I integrate:
Embodied awareness and breath regulation
ACT-informed psychological strategies
Values-based action planning
Support for chronic pelvic pain, pregnancy, and postpartum recovery
The “warrior” metaphor has its place, but for me, living with endometriosis mindfully is more sustainable, psychologically nourishing, and empowering.
A Message to Women Living With Endometriosis
If you identify as an “endo warrior,” know that I deeply respect your courage. And if that metaphor feels exhausting, know that living with endometriosis mindfully and intentionally is equally brave.
Endometriosis is challenging, but you can live fully, embrace self-compassion, and take meaningful action - even in the presence of pain. ACT provides tools to make this possible.
About Nina Isabella - Womanly Counsellor
I have a Master of Counselling; Advance Diploma of Therapeutic Yoga; I am a somatic movement practitioner; Trauma-Focussed Acceptance and Commitment Therapist. My practice is holistic, with over twenty years of experience in empowering women during their significant life transitions.
My compassionate practice is affirming and inclusive, centring the voice of women and gender-diverse individuals. I combine person-centred counselling with somatic psychotherapies including mindfulness, breathwork, and therapeutic yoga, creating a unique and relational approach to support women and gender-diverse individuals in their journey towards wellness.
References
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Vowles, K. E., McCracken, L. M., & O’Brien, J. Z. (2014). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 82(6), 1148–1157. https://doi.org/10.1037/a0037450
Wicksell, R. K., Olsson, G. L., & Melin, L. (2008). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain — A pilot study. European Journal of Pain, 12(6), 742–751. https://doi.org/10.1016/j.ejpain.2007.10.005
Zhang, W., et al. (2022). Psychological interventions for endometriosis: A systematic review and meta-analysis. Journal of Psychosomatic Research, 158, 110932. https://doi.org/10.1016/j.jpsychores.2022.110932
