Exercise and Endometriosis: Exploring Your Options

Research suggests exercise and endometriosis are actually quite the match! Choosing the right movement routine could help alleviate some of your symptoms. So, let’s explore some of the options and considerations.

First up, we’ll look at the definition of endometriosis as well as some of the potential causes. 

Endometriosis is the condition where tissue similar to the uterine lining grows outside of the uterus. It can cause debilitating pain and infertility. 

It’s a chronic, idiopathic condition, meaning there is no definitively known cause, though some theories are accepted. Exciting new hope appeared recently with studies indicating the possible causal links with bacteria (Nishimoto-Kakiuchi et al., 2023) and imagined treatment interventions (Muraoka et al., 2023). Could we cure endometriosis with a simple antibiotic? Maybe someday. The promising studies are criticized by some “Endo” organizations as preliminary and flawed, but they do offer new possibilities for those in pain or struggling to conceive, and they strongly underscore the critical need for continued research.

The research is coming but currently there’s no cure, only treatments and pain management strategies including: 

• Pain medication
• Hormone therapy (including birth control and fertility treatment)
• Surgery (various levels)
• Complementary and alternative medicine (CAM) therapies
• Exercise

Health and symptom management with exercise

So, let’s delve into the concept of management through exercise a little further.

Exercise is a key component to overall good health. Exercise mitigates stress, prevents excess weight, reduces oxidative stress leading to inflammatory pain, and alleviates constipation, all of which can dial up the discomfort for those with endometriosis. The new studies mentioned are inconclusive, stressing the need for further randomized clinical trials. Their hypotheses however, make a strong case for exercise as a component of endometriosis pain management, supported by statements from endometriosis support organizations, patient surveys, and numerous testimonials from endometriosis sufferers. 

Best exercises to choose

Admin (2023) mentions a study showing pain reduction with a yoga program and there are encouraging discussions on benefits of low impact activities like walking and swimming, which are also encouraged by physical therapists. Some women find short bouts of higher intensity exercise tolerable. Since endometriosis adhesions can cause restriction, guarding mobility in the pelvic area is a good strategy and can alleviate painful sex or bowel movements. There is evidence that correct posture, diaphragmatic breathing, relaxation and stretching the back and pelvic floor muscles are beneficial (Wiginton, 2023), making Pilates an excellent choice, while also conditioning the muscles of the core, pelvis, hips and gently stretching visceral fascia (like a net that supports your organs) where you may have restrictions. 

Warning: Since many women with endometriosis have tight or overactive pelvic muscles (Admin, 2023) it is important to attend to flexibility and function. Strengthening the pelvic floor further, especially before attention to length, flexibility, and mobility, could actually increase restriction and pain, so ease up on the Kegels and get zen with your pelvis.

Choosing the right exercise for YOU

Do take note of the following when choosing your exercise approach as an endometriosis sufferer. 

• It’s not a one-size-fits-all. The best exercise for YOU is the one you will do, regularly and consistently, that does not flare up symptoms
• Some endo sufferers have cross-over with fibromyalgia and chronic fatigue as well as fertility issues, so the smart thing is to not train to exhaustion
• Understand that high impact activities may exacerbate pelvic or back pain
• Your needs and tolerance may change across your menstrual cycle, so vary activities
• Don’t discount the mood boost and analgesic effects of exercise to help manage pain flare-ups until you sort out what works best for you
• Be encouraged, seek expert medical help, and listen to your body

References:

Admin. (2023, May 2). Move to improve – The benefit of exercise for endometriosis. Endometriosis Australia. endometriosisaustralia.org/move-to-improve-the-benefit-of-exercise-for-endometriosis/

De Moraes Bonocher, C., De Souza Montenegro, M. L. L., Silva, J. C. R. E., Ferriani, R. A., & Meola, J. (2014). Endometriosis and physical exercises: a systematic review. Reproductive Biology and Endocrinology, 12(1), 4. doi.org/10.1186/1477-7827-12-4

Endometriosis | Office on Women’s Health. (n.d.). womenshealth.gov/a-z-topics/endometriosis

Endometriosis caused by bacteria? Not so fast, warn CEC experts — the Center for Endometriosis Care. (n.d.). The Center for Endometriosis Care. centerforendo.com/bacteria 

Muraoka, A., Suzuki, M., Hamaguchi, T., Watanabe, S., Iijima, K., Murofushi, Y., Shinjo, K., Osuka, S., Hariyama, Y., Ito, M., Ohno, K., Kiyono, T., Kyo, S., Iwase, A., Kikkawa, F., Kajiyama, H., & Kondo, Y. (2023). Fusobacterium infection facilitates the development of endometriosis through the phenotypic transition of endometrial fibroblasts. Science Translational Medicine, 15(700). doi.org/10.1126/scitranslmed.add1531 

Nishimoto-Kakiuchi, A., Sato, I., Nakano, K., Ohmori, H., Kayukawa, Y., Tanimura, H., Yamamoto, S., Sakamoto, Y., Nakamura, G., Maeda, A., Asanuma, K., Kato, A., Kawamura, K., Konno, R., & Yamada-Okabe, H. (2023). A long-acting anti–IL-8 antibody improves inflammation and fibrosis in endometriosis. Science Translational Medicine, 15(684). doi.org/10.1126/scitranslmed.abq5858 

Tennfjord, M. K., Gabrielsen, R., & Tellum, T. (2021). Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Women’s Health, 21(1). doi.org/10.1186/s12905-021-01500-4 

Wiginton, K. (2023, April). The Good and Bad of Exercise For My Endo. endometriosis.net. endometriosis.net/living/best-worst-exercise