Exercise and Endometriosis
What is endometriosis?
Endometriosis, or ‘Endo,’ has recently received more attention and awareness due to more women speaking and discussing this silent health issue. You may even know a close friend, work colleague, or family member who suffers from this devastating condition. For those who may have never heard of endometriosis, it can be defined as the presence and growth of functional endometrial tissue outside the uterus, leading to a chronic inflammatory response within the tissue. The established inflammatory process may cause adhesions and scar tissue, leading to debilitating symptoms and infertility.
The most common symptoms of endometriosis include:
- Painful periods
- Heavy bleeding
- Painful intercourse
- Lower back pain
- Intense cramping
- Pain during bowel or bladder motions
- Nausea
Endometriosis currently affects 1 in 10 females and is often associated with pain that impacts quality of life. It is as common as other conditions, such as asthma and diabetes. During the menstruation cycle, most females dismiss their pain symptoms and believe it is a ‘normal part’ of being female. Some have to call in sick for work because they may feel nauseous or faint. People are thought to believe that it is expected to have intense lower back pain a week before their period and then horrific pelvic pain and cramping during their period. For many people, it also means missing out on important life events. Those with endometriosis often suffer in silence or have symptoms dismissed as just period pain. Due to symptoms varying significantly from person to person, this can lead to extensive delays in diagnosis. Currently, an accurate diagnosis can take between 7 and 12 years.
There is no cure for endometriosis; however, there are ways it can be safely managed. One of those ways is through exercise and movement.
How Can Exercise Help Females Who Have Endometriosis?
Exercise is the last thing on your mind when you’re having horrible stomach cramps. However, it can play an essential role in the treatment, recovery, and severity of the symptoms of endometriosis. Benefits of exercise include:
Exercise can act as a natural pain reliever. When we exercise, our body releases feel-good chemicals (hormones) such as endorphins that interact with the receptors in our brain to help reduce our perception of pain.
- A recent randomised controlled trial found that women with endometriosis who completed two 90-minute yoga sessions per week over two months had reduced daily pain and improved quality of life compared to women who did not participate in yoga.
- Regular physical exercise can also protect against diseases involving inflammatory processes, such as endometriosis, as it causes an increase in the anti-inflammatory and antioxidant markers within the body. This is similar to other conditions, such as heart disease, in which our inflammatory markers are reduced through exercise.
- Exercise can improve mobility and reduce cramping in the pelvic floor and abdomen. It is common for people living with endometriosis to spend days in the foetal position, curled up tight. Mobility exercises and stretching can help reduce tension in your muscles (i.e., muscles of the abdomen, hips, and pelvis), increase blood flow, and decrease pain. Studies have found that physical exercise can benefit the relaxing of the muscles of patients with endometriosis, which helps to break or improve their pain cycle. A survey conducted in 2017 found a statistically significant decrease in the intensity of endometriosis pain and improvements in posture associated with endometriosis after completing an 8-week exercise program.
- Exercise can help manage constipation. Constipation, bowel pain, and bloating are all common symptoms of endometriosis. Exercise has proven benefits for digestion and bowel health as it stimulates intestinal contractions, making bowel movements easier.
- Exercise can improve mood and help manage the symptoms of depression and anxiety. Endometriosis can affect not only your physical health but also your emotional well-being, especially if you are experiencing pain. Anxiety and depression have been shown to impact and increase stress negatively, and the pain continues. Exercise can help break this cycle through the release of endorphins and by providing moments of mindfulness.
Recommended Exercises for Endometriosis:
There are no specific guidelines surrounding exercise prescriptions for individuals with endometriosis. Exercise is prescribed to assist with symptom management rather than as an actual treatment.
The pain and discomfort associated with endometriosis can cause a guarding mechanism within the body, where the body braces to protect itself from pain. This bracing can affect the pelvic floor, abdominal wall, and hip flexors. Stretching exercise prescriptions for the hips, groyne, and back muscles can help improve pelvic floor muscle tension. Tests such as a seated glute stretch, a seated hip flexor stretch, and a wall side bend stretch may help to release tension in these muscle groups.
Other exercises may include low-impact strengthening exercises that involve strengthening the muscles around the pelvis—the pelvic floor and glutes. Increasing the strength of the muscles in the lumbopelvic region can help reduce pelvic pressure and associated lower back pain. These may include exercises such as clam shells and glute bridges with resisted hip abduction. These exercises should be introduced gently to start with and progress over time.
Some exercises to avoid when experiencing symptoms of endometriosis:
Following an initial endometriosis diagnosis, some activities should be avoided until you have enough time for healing and recovery. These include:
- High-intensity abdominal exercises load the abdominal wall and lower back—for example, sit-ups and crunches, planks, scissors, etc.
- High-impact exercises, such as running, burpees, or box jumps, may cause more discomfort and pain.
If you live with and suffer from endometriosis, know you are not alone. Endometriosis is individual, and no single treatment is effective across the board. Everyone’s endo experience is unique; some may need to avoid certain activities during that month to ensure they are not exacerbating their symptoms.
Inertia Health Group‘s team of Exercise Physiologists will be able to work with you to begin to find an exercise programme that suits you and your journey while also teaching you how to work with your cycle so you can better manage your endometriosis and reduce and manage any flareups.
References
Awad, E., Ahmed, H.A.H., Yousef, A., and Abbas, R., 2017. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within-subject design Journal of Physical Therapy Science, 29(12), pp. 211-2115.
Gonçalves, A.V., Barros, N.F., and Bahamondes, L., 2017. The practice of hatha yoga for the treatment of pain associated with endometriosis. The Journal of Alternative and Complementary Medicine, 23(1), pp. 45–52
Hansen, S., Sverrisdóttir, U., and Rudnicki, M., 2021. Impact of exercise on pain perception in women with endometriosis: A systematic review Acta Obstetricia et Gynecologica Scandinavica, 100(9), pp. 1595–1601.
EIM-FactSheet_Endometriosis_Professional_2021.pdf (exerciseismedicine.com.au)
