Exercising With Endometriosis for Pain Relief and Well-Being

Endometriosis is a complex medical condition affecting millions of women globally, with around 190 million reproductive-aged women (about 10%) dealing with it. Symptoms include severe pelvic and lower back pain, particularly during menstruation. Read our guide to understand how you can best support your body, potentially reducing endometriosis-associated pain — with practical tips and exercises to help.

What is endometriosis, and who might be affected?

Endometriosis is a condition in which endometrial-like tissue (endometrium) grows outside of the womb, in areas such as fallopian tubes, ovaries, pelvic tissues, and bowels. The endometrium serves several important functions within the womb, such as implantation, menstruation, and hormonal responses.

During implantation, the endometrium helps a fertilized egg develop into an embryo and fetus. During menstruation, the tissue thickens and sheds, causing a period. However, adverse effects may occur when this tissue grows outside of the womb. Symptoms may include inflammation and scar tissue, pelvic and abdominal pain, and fertility issues. It is important to remember, that symptoms are different for each individual.

Endometriosis can affect females of any reproductive age, from the first menstruation until menopause. Endometriosis responds to the secretion of hormones, estrogen and progesterone. Post menopause, estrogen levels significantly decrease lowering the chances of developing symptoms.

How does endometriosis affect a woman's ability to exercise?

While pain severity levels differ for each individual, some women may struggle to exercise due to pain-related symptoms. An endometriosis-based study shows that around 20–80% of women with chronic pelvic pain have endometriosis. This pain may manifest in other areas of the body such as the lower abdominals, lower back, and thighs.

Pelvic and abdominal pain flare-ups, fatigue, nausea, and stress — potential symptoms of endometriosis — may all affect a woman's ability to exercise. Keeping a symptom-related diary may be useful for tracking and recognizing certain patterns. You can then schedule exercise accordingly to best support your body.

Can regular exercise help manage endometriosis-related pain?

Regular exercise may help reduce endometriosis pain-related symptoms by balancing hormones, reducing stress, and improving overall physical and mental well-being. An endometriosis-based study showed a significant reduction in endometriosis-related pain for those who took part in an exercise program, along with improved pelvic alignment.

Exercise leads to the production of cytokines, small proteins that the body uses for cell signaling and immune system functioning. This may be beneficial for endometriosis to boost the immune system and balance hormones. Low-impact resistance training may help improve strength, alignment, and posture. A mind-body connection may aid stress reduction.

Gentle exercises for women with endometriosis

Pelvic tilts

1. Lie on your back, legs bent, feet roughly under knees, hands on either side of your hip bones.
2. Inhale. Create a small pocket of air under your lower back. Exhale. Imprint and lengthen your lower spine into the mat.
3. Keep alternating between these two positions, tilting forward and back. Keep smooth transitioning with your knees still.
4. Perform 8 repetitions.

Pelvic clocks

1. Lie comfortably on your back, legs bent and feet roughly under knees, hands on each hip bone.
2. Imagine your pelvis resembles a clock, 12 o’clock is the ceiling, 3 o’clock is to the right, 6 o’clock is to your tailbone, and 9 o’clock is to the left.
3. Inhale. Press your belly button up toward the ceiling (12 o’clock). Exhale. Gently press your pelvis out to the right side (3 o’clock). Inhale. Imprint your lower spine into the mat (6 o’clock). Exhale. Gently press your pelvis out the left (9 o’clock).
4. Reverse, anti-clockwise. Keep changing direction once you have finished each full circle.
5. Repeat 4 repetitions, each direction.

Pelvic curls

1. Lie on your back, legs bent, feet roughly under knees, arms long down by your sides.
2. Inhale prepare. Create a pocket of air under the lower back. Exhale. Imprint your spine, start to peel the tailbone then spine off the mat, lifting your hips up toward the ceiling. Inhale and hold.
3. Exhale and gradually release the spine all the way back down to your mat until tailbone is heavy.
4. Repeat 6 repetitions.

Mermaid stretch

1. Begin seated with legs bent to the right side, knees stacked. Place hands down by your side for support.
2. To get into position, slide your left leg in front and your right leg behind you, your legs in a ‘zigzag’ shape. Center and stack your pelvis and torso as much as feels comfortable.
3. Take your left hand out to the left side, in line with your shoulder, fingertips facing away.
4. Inhale. Reach your right arm up and over your head into a side flexion stretch.
5. Exhale. Engage your abdominals as you bring your right hand down toward your right side. Simultaneously reach your left arm up and over head to counter stretch.
6. Repeat 3 repetitions, then switch your legs around, to your second side.

Final thoughts

Endometriosis is a unique journey for each individual, with varying levels of symptoms and impacts on everyday life. Taking into account lifestyle factors such as exercise, nutrition, sleep, and stress levels may be beneficial to manage symptoms. Low-impact resistance-based exercise has been shown to have significant improvements in pain-related symptoms within studies.

Consider tracking your symptoms and schedule workouts around how your body is feeling. If you are experiencing a flare-up or increased pain, consider avoiding high-intensity exercise such as HIIT which may trigger pain responses or aggravate pelvic pressure. Focus on mindful movement such as Pilates for improving pelvic floor strength and stability. Incorporate breath into your practice to lower stress levels and perform gentle stretches to release potential tightness in the surrounding muscles.