Endometriosis and Exercise

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Exercise has been noted to affect levels of inflammatory markers and estrogen, which might influence endometriosis symptoms; however, chronic pelvic pain and fatigue can severely limit the ability to exercise (Buggio et al., 2017; Moradi et al., 2014). One study noted that a strength exercise program helped pain in healthy participants but not the pain in women with endometriosis (Poli-Neto et al., 2019). Physical activity is important for your overall health but can be difficult with chronic pelvic pain. Pelvic physical therapy can be a useful tool for women with endometriosis and chronic pelvic pain (Sarrel, 2019).


  • Poli-Neto, O. B., Oliveira, A. M. Z., Salata, M. C., Cesar Rosa-e-Silva, J., Machado, D. R. L., Candido-dos-Reis, F. J., & Nogueira, A. A. (2019). Strength Exercise Has Different Effects on Pressure Pain Thresholds in Women with Endometriosis-Related Symptoms and Healthy Controls: A Quasi-experimental Study. Pain Medicine.  Retrieved from https://academic.oup.com/painmedicine/article-abstract/doi/10.1093/pm/pnz310/5653106  

“The strength exercise regimen used in this study increased pain thresholds in healthy women but not in women with endometriosis-related painful symptoms. The maintenance or even worsening of pain perception after exercise in women with persistent pain, such as those with endometriosis, may limit their adherence to a physical training program, which in turn could prevent them from experiencing the long-term beneficial effects of exercise.” 

“Pain in particular was reported to limit their normal daily physical activity like, walking and exercise.

‘Prior to having endometriosis, I used to run every day and was very active. For the last six months while I waited for surgery to remove the cyst and endometriosis, my level of exercise was severely reduced. I could only walk about once or twice a week and it was very painful. I gained weight and felt dissatisfied with my body. It also impacted on my self-confidence. I began wearing more baggy clothes, also watched more TV and had general feelings of being lethargic and spaced out’. (P1, Group 3)

“Women who had small children mentioned that they were not able to care for them as they would like…. Fatigue and limited energy were also among reported physical impacts of endometriosis.” 

“Even post excision of endometriosis patients may continue to experience pain across multiple systems from gynecological pain to abdominal and musculoskeletal pain. Current best practices leaves women with the disease few options beyond surgery, especially for those suffering with central sensitization and nerve up-regulation due to the long term adaptations of the disease. Pelvic Physical Therapy can be a critical component to mobilize the body post operatively. An exercise prescription designed by a physical therapist may help integrate and quiet long standing nerve patterns thereby returning the woman with endometriosis back to her best possible quality of life.”

  • Buggio, L., Barbara, G., Facchin, F., Frattaruolo, M. P., Aimi, G., & Berlanda, N. (2017). Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care. International Journal of Women’s Health, 9, 281. Retrieved  from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422563/  

“With regard to endometriosis, various etiopathogenic assumptions may contribute to explain why physical activity may be a protective factor. First, exercise may reduce estrogen levels and frequency of ovulation when performed at high levels of intensity;27 second, physical activity may increase SHBG levels, which would decrease bioavailable estrogens.28–30 Moreover, regular physical activity also reduces insulin resistance and hyperinsulinemia,28 which has been hypothesized to be associated with endometriosis. In addition, regular exercise leads to an increase in the systemic levels of cytokines with anti-inflammatory properties.29,30

“Recently, Ricci et al27 performed a systematic review and meta-analysis of the literature to clarify the potential association between endometriosis and physical activity. The meta-analysis combined data from nine studies – six case-control studies and three cohort studies – involving 3,355 cases for recent physical activity and 4,600 case for past physical activity. The summary odds ratio for endometriosis for any recent versus no physical activity was 0.85 (95% confidence interval [CI] 0.67–1.07). Compared to no recent physical activity, odds ratios for low and moderate/high exercise were 1 (95% CI 0.68–1.28) and 0.75 (95% CI 0.53–1.07), respectively. The authors concluded that although physical activity may reduce the risk of the disease, the meta-analysis had not provided definitive support to this hypothesis.

“The possible anti-inflammatory effect of physical activity has also been evaluated in a rat model. Rosa-e-Silva et al31 divided 70 female rats with experimentally induced endometriosis in seven groups of ten animals each: sedentary-, light-, moderate-, and intense-exercise programs. Endometriosis was induced before physical activity in three groups and after disease induction in the other three. A reduction in levels of oxidative stress, MMP9, and proliferating cell nuclear antigen (PCNA) was identified in all the groups that practiced physical exercise, indicating a reduction in proliferation, migration, and differentiation of endometriotic tissue.

“Recently, the practice of yoga has gained worldwide spread, due to its ability to integrate the body and mind through a balanced mixture of contemplative techniques that are able to reduce stress and, at the same time, strengthen musculature.32 As stated by the World Health Organization, yoga has been classified as a mind–body practice33 that improves symptoms of various disorders, such as asthma and high blood pressure.34–36 Gonçalves et al32 evaluated the effects of yoga on 15 women with symptomatic endometriosis. All patients attended yoga practice twice a week for 8 weeks, and at the end of the program all participants reported a beneficial effect of yoga in pelvic pain management. In addition, women stated that through the practice of yoga, they developed self-control and self-awareness, with improved self-care and self-esteem. In conclusion, through the learning of specific postures and breathing and meditation techniques, yoga improved the ability of patients experiencing pain to control their symptoms. Further research is needed to confirm these promising preliminary and uncontrolled results.”