How exercise can influence pain and development of endometriosis

WHAT TYPES OF EXERCISE?

1. Low to moderate intensity aerobic exercise

Walking, swimming, cycling at low resistance, light hiking.

Swimming is particularly beneficial — the hydrostatic pressure reduces pelvic inflammation and the non-weight bearing nature avoids jarring impact on an inflamed pelvis.

2. Yoga

Yin and restorative yoga are particularly relevant

Long held passive stretches release the psoas, hip flexors, and pelvic floor muscles that chronically contract in response to endometriosis pain.

3. Pilates

Strengthens the deep core and pelvic floor without the intra-abdominal pressure spikes of high intensity exercise. Improves pelvic stability, reduces lower back and pelvic pain, and supports postural alignment that chronic pelvic pain disrupts.

4. Strength training

Moderate intensity

Not only incredible for endometriosis pain and disease progression, but for joint health, strength and bone density as we age.

THE BENEFITS

• Anti-inflammatory ⟶ modulates local and systemic inflammatory pathways - reducing development of lesions

• Improves Oestrogen Clearance ⟶ Increases sex hormone binding globulin (SHBG) which binds free oestrogen to reduce likelihood of lesion stimulation and growth

• Improves Blood Sugar Regulation ⟶ Improves insulin sensitivity which promotes stable glucose levels. This reduces chronically high insulin and inflammation which feeds endo lesions

• Aids Restoration of Hormonal Balance ⟶ By reducing insulin levels,, insulin-like growth factor 1 (IGF-1) also reduces, which when high, indirectly stimulates oestrogen production

• Normalises HPA-Axis ⟶ Reduces cortisol levels long-term which stabilises the HPA axis, improving cyclical hormonal signalling and release (improved ovulation capacity and progesterone buffering of oestrogen)

• Reduces Pain Perception ⟶ Increases release of chemicals (opioids, serotonin and endocannabinoids), which activate the brain’s pain-inhibiting pathways and reduce sensitivity

• Reduces Muscle Tension ⟶ Improves peripheral circulation, reduces pelvic muscle tension and promotes tissue oxygenation, directly reducing local pain and muscle spasms

• Improves Mental Health ⟶ Increases feelings of self-efficacy, improves body image and emotional balance, reducing anxiety and depression symptoms

CAUTION

High intensity interval training

HIIT or cycle classes

Significant cortisol spike with high intensity exercise directly worsens the HPA axis dysregulation driving endometriosis. Acutely elevates inflammatory cytokines. Not appropriate during symptomatic phases or flares — and should be approached cautiously even when asymptomatic given the cortisol driven immune suppression mechanism.

Excessive endurance training

Chronic cortisol elevation from high volume endurance training suppresses immune function and worsens the inflammatory environment — counterproductive in endometriosis management.