Best exercises for endometriosis

28 Aug Exercising with Endometriosis

Posted at 09:12h in Women’s Health by Exercise Right

Endometriosis. It’s a chronic health condition affecting one in eight women worldwide, yet unfortunately there is little information available around how exercise can help manage and improve the painful symptoms associated with an Endo diagnosis.

Exercise may be the last thing you feel like doing, and there are some inappropriate exercises that may worsen your current symptoms, but returning to exercise post diagnosis can be important for both your physical and mental health!

What is Endometriosis?

Endometriosis is a gynecological condition where endometrial-like tissue grows outside the uterine cavity. We say endometrial-like, as this tissue is not identical to the cells found within the uterine cavity, however it has a lot of similar properties.

Endometriosis is fuelled by the hormone oestrogen, however we are still learning and discovering exactly what causes this tissue growth! This tissue can attach itself anywhere within the pelvic and abdominal cavity, with reports of endometriosis even found on the diaphragm (though this is very rare)! Unfortunately the human body is not equipped to remove these tissue growths, and they continue to act as endometrial-like cells, so with every menstrual cycle, scar tissue and adhesions can form through the release of oestrogen. This can cause a wide range of symptoms, including inflammation, bloating, pelvic pain and cramping.

Best exercises to do after an Endo diagnosis:

Looking to start moving again at home or in the gym?

Regular physical exercise can have protective effects against diseases (like Endo!) that involve inflammatory processes since it causes an increase of the anti-inflammatory and antioxidant markers within the body, and also acts by reducing oestrogen levels, making it a great idea to incorporate exercise into your recovery and disease management.

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 – the anterior side of the body. So firstly, when resuming exercise, it is important to first focus on the lengthening and strengthening of these muscle groups. You can’t strengthen a tight muscle! Exercises based around the principles of Pilates and Yoga can be fantastic to help these muscles release or stretches such as seated glute stretch, seated hip flexor stretch and a wall side bend stretch can really help to release those muscle groups.

It is great to then progress to reconnect with your core and the muscles around the pelvis – the pelvic floor and glutes! Gentle progression into resistance-based exercises to start activating the glutes include exercises such as:

  • Clams or side lying leg raises
  • Sit to stands
  • Glute bridging with theraband

These muscles help to support the lumbo-pelvic region of the body, so gradually adding in strengthening exercises can help manage your symptoms by balancing out that bracing and tightness through your anterior core muscles.

Some exercises to avoid following an Endo diagnosis:

  • Sit-ups and crunches
  • High-impact exercises eg. Running/burpees

That’s not to say you can never return to high-impact exercise, however your body will require some rest and recovery to allow itself to heal while reducing these guarding postures!

It’s always best to start slowly if you’re experiencing pain or discomfort, or after surgery. It’s also best to seek the guidance of an Accredited Exercise Physiologist to help return you to the exercise that you love to do – and help you to manage your symptoms going forward!


Heba ShaheedFollow Mar 16, 2016 · 6 min read Heba Shaheed from The Pelvic Expert

March is Endometriosis Awareness Month and 1 in 10 women suffer from endometriosis with an estimated 176 million women affected worldwide. Women with endometriosis often experience many different forms of pain including period pain, pelvic pain, ovulation pain, painful sex, painful urination, pain with bowel movements, and nerve pain.

As a pelvic pain physiotherapist, I treat a lot of women with endometriosis. Endometriosis is a condition where the cells, similar to the cells that make up the lining of the uterus, exist in other places too. These cells can be found on the ovaries, the fallopian tubes, the bladder, the bowels, in the vaginal walls, on the pelvic ligaments inside the pelvis, in the Pouch of Douglas (which is the space between the uterus and the bowels) and even on the lungs and diaphragm too! These cells will behave just like the lining during the monthly cycle, except they have nowhere to go, so they build up and cause inflammation and pain.

Because women with endometriosis often spend a lot of time in pain, often curled up in bed, the muscles and connective in their pelvis, abdomen, back and hips can become tight and sore as well. It’s important to keep the body moving to allow the muscles and connective tissue to lengthen, and to allow the nerves to slide and glide freely within the tissues.

Here are a few simple exercises I recommend for women with endometriosis to do at home:

1. Diaphragmatic Breathing

Heba Shaheed from The Pelvic Expert : Diaphragmatic Breathing

Don’t underestimate the incredible benefits of taking a deep wide breath into your diaphragm. Deep breathing helps to allow for the ribs to expand, easing tension in the back, right up to the neck, and down into the pelvis. Often women with pain will take shallow breaths into their upper chest so their diaphragm doesn’t really get a stretch. The diaphragmatic breath calms the nervous system, which leads to less pain. You can do deep, wide breathing anywhere, but I like to have a yoga strap or band around my lower ribcage, so I can get that feedback of my breath into the band. I suggest taking 5–10 deep wide breaths every hour.

2. Pelvic Floor Drops

Heba Shaheed from The Pelvic Expert : Pelvic Floor Drops

Very often women with endometriosis and pelvic pain actually have a tight and tense pelvic floor, so I recommend reverse kegels or pelvic floor relaxation exercises. We want to lengthen and relax the pelvic floor, especially with women who have pain with sex. Imagine the way a pebble drops into a pond, and imagine the ripples it makes outwards. Visualise this in your pelvic floor, and feel the way the pelvic floor muscles let go. Another image is visualizing your pelvic floor as an elevator in a 3 story building, then imagining the elevator at the roof coming down to ground floor and the elevator doors opening. You can combine this with your diaphragmatic breath and as you breathe in feel the elevator dropping to ground floor, and to get more relaxation, as you breathe out, feel the elevator coming down to the basement. Again try to do 5–10 breaths combined with pelvic floor drops every hour.

3. Hip & Buttock Stretch

Heba Shaheed from The Pelvic Expert : Hip & Buttock Stretch

This is a really great simple hip opening stretch that also allows your buttocks and deep hip rotators to stretch. Simply lay back on your mat or on your bed with your knees bent, then take one ankle onto the opposite knee and use your hand to gently press away at the knee. Because a lot of women with endometriosis and pelvic pain often curl up in pain, we really want to open the hips, but in a gentle way. Hold this stretch for 60 seconds or as long as your feel comfortable and repeat daily.

4. Groin Stretch

Heba Shaheed from The Pelvic Expert : Groin Stretch

This is another effective hip opening stretch that also lengthens the pelvic floor and allows the tailbone to soften away from the hips. You can do this laying back on your mat or in bed. Slowly bring both knees up towards your chest, and then when you are comfortable, slowly take the knees apart towards your shoulders. You can rest here for 60 seconds, and focus on your deep breathing and pelvic floor drops.

5. Hip Flexor Stretch

Heba Shaheed from The Pelvic Expert : Hip Flexor Stretch

I love this yoga variation of the hip flexor stretch because you get a lot of lengthening of the muscles and connective tissue along the front of the body. The front of the hips, the pelvis, the belly and the chest all get a deep stretch. Start in kneeling on your knees on a mat (you can have a towel or blanket under your knee), then take a step forwards with one foot. Rest here for a moment before starting to bring bot arms up towards the ceiling. Rest here again and start to lunge forwards and lift your belly to the ceiling. Take a slow deep breath as you move from each position, but only go to a place where you are comfortable. Hold this stretch for 60 seconds as your breathe deeply and feel your pelvic floor melting down.

6. Shell Stretch

Heba Shaheed from The Pelvic Expert : Shell Stretch

Finish off with a shell stretch by sitting back on your heels and curling forwards bringing your forehead to the mat. Reach your arms forward on the mat. If you feel comfortable, you can even take your knees out into a child pose stretch. This is a really great restorative pose that allows you to expand into your diaphragm more as your breathe in, and also lengthens the pelvic floor. Spend some time here whilst you breathe and visualize your pelvic floor muscles softening down, as your chest and breastbone also melt to the mat.

NB: March is Endometriosis Awareness Month. A really awesome event that I am taking part of is the Worldwide EndoMarch (

You can check it out here: where I have interviewed global experts in endometriosis on all the ways to manage this disease holistically. The event runs from March 21–30 where you will receive 2 interviews everyday for 10 days about endometriosis, available for 48 hours. If you watch all the videos during March, you go into the running to win 1 of 8 amazing prices which you can see here: so register now!

By signing up for TENDO, not only will you get this free access to interviews, you will also receive a free endometriosis E-book and infographic. Here’s a sneak peek:

Endometriosis Infographic

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Head to to find out more about me and sign up to the mailing list to keep updated about my awareness events and available programs.

The most common question I received from women with endo on Patient’s Day on March 10 was, “What’s the best exercise for me?” (Check out my presentation “I’m in Pain. Can Exercise Help Me?”). Attendees shared with me their success and failure stories of attempting to exercise before and after surgery. Most said they had tried group exercise classes, weights, spinning, yoga and running, but they eventually stopped due to pain.

So, how do you choose the right exercise program so that you can set yourself up for success rather than failure?

As a physical therapist, I am used to people asking, “What’s the best exercise for me?” My clients are men and women, fit and sedentary, young and old, and with an assortment of injuries and varied degrees of pain. Most of them have usually asked their friends, family members, doctors, or other healthcare providers this question long before meeting me. And with the best intentions, the answers they often receive are, “You should walk on the treadmill,” “You should join a gym,” “Try lifting weights,” “Take a swimming class,” or “Start running.” The problem with these responses is that they don’t truly connect with you or the situation you are in.

Early in my career I couldn’t wait to rattle off lists of exercises and routines that I felt would improve my clients’ pain and injuries, but I noticed a strong common theme from them: “I hate to run,” “I’ve never done yoga before,” “I don’t know how to lift weights,” “I don’t have access to a gym or pool,” “I don’t feel comfortable going to a gym,” or “My work (or family) schedule is too hectic to commit to an exercise program.”

So, the answer to your question of “What’s the best exercise for me?” should be followed with another question: “What is your goal?”

Every person has a different goal. Some common goals clients first talk about are: “I want to be stronger,” “I want to be more fit,” “I want to get rid of my pain,” “I want to lose weight,” “I want to return to my favorite exercise routine,” or “I want to feel like me again!” This is a wonderful start, but I encourage clients to be more specific. For example, “What do you want to be able to do if you are stronger, fitter, healthier, or in less pain?” Responses might be, “I want to have less pain so I can go back to work,” “I want to be stronger so I can walk up my driveway and stairs again,” or “I want to have more energy so I can cook for my family.” The more specific you can be with your goals, the better you can plan your exercise program.

Next, you must identify what exercises or physical activities you like to do. Again, as an expert on exercise, I can rattle off lists of exercises that would make your head spin. Healthcare providers, friends, and family will tell you what they think you should be doing. But if you have no interest whatsoever in the exercises or activities suggested to you, then I can guarantee you will not do them. So, then, what’s the point?

I recommend that you think about activities you truly enjoy. If you are a fan of socializing and being around others, check out a gym’s group exercise or yoga class schedule. If you’re yearning for some quiet time, try a meditation podcast to practice your deep breathing. If you enjoy some fresh air, get outdoors for a walk, hike, or bicycle ride. If you used to enjoy the toning feeling you got after lifting weights, try some squats, planks, or grab some water bottles for arm curls. If it’s just been way too long due to pain and injury since you were able to participate in your fun activities, partner with a physical therapist who can show you how to get rolling safely again.

Here are a few conversations I had at Patient’s Day with women who had stopped being active due to endo pain and asked me, “What’s the best exercise for me?”

Mary had a hysterectomy earlier this month. To improve her recovery, weight gain, and energy, she was advised by a physician to walk on her treadmill every day for 30 minutes. Mary told me, “I don’t usually walk more than 10 minutes due to pain, and I hate walking on a treadmill because it is so boring!” I asked Mary, “What are your goals? What activities make you happy?” She stated that she loved her two dogs, and she missed being able to walk them. She had sadly relied on others to walk her dogs due to pain. Based on her goals and activity preferences, we agreed that walking her dogs daily would allow her to get her walking in, be outside, socialize with other dog owners and neighbors, and spend time with her beloved dogs. Mary will walk her dogs for 15 minutes, then increase her time slowly as her fitness improves. Great success!

Friends and healthcare providers recommended to Diane that she start yoga to help alleviate her endo pain. Unfortunately, she found herself in more severe pain afterwards. To her credit, she did not stop and sought other enjoyable exercises to further her goals of improved endo pain and fitness. Diane found CrossFit’s H.I.I.T (high intensity interval training) to be very beneficial to improving her strength, fitness, and pain. She described how she started a CrossFit beginners’ classes a few months ago and is now gradually moving toward advanced classes. Awesome!

Jessica was advised by co-workers that lifting weights or taking a spin class would help her lose weight after endo surgery, but Jessica felt awkward and self-conscious at the gym. There were too many machines, and Jessica did not know how to exercise. Jessica decided to try yoga because the classes focused on balance, gentle strength and stretching, and deep breathing. Now Jessica attends yoga regularly. Wonderful!

Three women with endometriosis pain, three different goals, and three different activity interests.

To answer the question, “What’s the best exercise for me?” you must ask yourself, “What are my goals?” and “What activities do I like to do?” Answering those questions will help you naturally find the answer for the correct exercise program. And if you do find that the yoga class, group exercise, weight training, jogging, or CrossFit program is too intense and causes more pain, please consult a physical therapist who is willing to partner with you so that you can successfully achieve your goals.

I look forward to writing for you again next month on more topics, including good versus bad pain, controlling your “controllables,” and exercise specifics. I welcome your feedback and ideas for future articles.

Yours in better health,

Dr. Jim Palmer, PT, DPT, CMP, COMT Founder Palmer Concierge Physical Therapy New York, NY [email protected] O: 212-289-1586

Endometriosis is a condition characterized by the tissue that normally lines the uterus developing elsewhere in the body.

Pain and fatigue are two primary symptoms of endometriosis; exercise is thought to have the potential to alleviate these symptoms. However, fatigue and pain might also keep a woman from exercising.

How exercise can alleviate the symptoms of endometriosis

Endometriotic lesions cause inflammation, which is thought to cause pain and fatigue.

There are several mechanisms by which exercise can potentially reduce these two symptoms.

  • Exercise stimulates the release of hormones called endorphins. Endorphins have several positive effects on the body. They are known to improve mood, relieve stress, and prevent depression. Endorphins can also reduce pain.
  • Exercise is known to improve sleep quality and consequently increase energy levels. For this reason, exercise might help reduce fatigue.
  • Regular exercise is associated with a decreased menstrual flow. The pain associated with endometriosis is most severe during menstruation, and a heavy menstrual flow is associated with higher levels of pain. Exercise could, therefore, decrease endometriosis-associated pain in the long term.
  • Exercise lowers estrogen. The growth of endometriotic lesions is dependent on estrogen. This is supported by the observation that endometriosis symptoms improve when women enter menopause, a phase in which estrogen levels go down. Anything that lowers the levels of estrogen is thought to decrease the growth of endometriotic tissue and reduce pain.
  • Physical activity reduces inflammation. Because inflammation plays a significant role in the pathology of endometriosis, this might be a further mechanism by which exercise reduces pain.
  • Exercise increases circulation. A healthy blood flow ensures the supply of nutrients and oxygen to the organs. Poor circulation is associated with fatigue, cramps, and discomfort. Increasing circulation can help reduce these symptoms.

Scientific evidence supporting the benefits of exercise in endometriosis

There are no randomized controlled studies that have investigated the effect of exercise on endometriosis. However, research has shown that women who are physically active have a reduced risk of developing endometriosis.

It is not clear whether it is the physical activity itself that plays a role or whether physically active women have something else in common that reduces their risk of developing endometriosis.

Similarly, it is not possible to say whether exercise improves endometriosis or whether symptoms such as pain and fatigue prevent women from exercising and so women who have milder symptoms and feel better naturally exercise more. For this reason, it is difficult to say whether there is only a correlation between exercise and the occurrence of endometriosis or whether exercise leads to some relief of the condition.


Many women with endometriosis report that exercise helps them better manage the condition. Endometriosis differs in the level of severity, and exercise routines must be adapted accordingly. It is advisable to start with low-intensity exercises, such as walking, swimming, and dancing. If the physical activity has a positive effect, the intensity can be gradually increased.


Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

How to Train If You Have Endometriosis

Endometriosis affects one in 10 women worldwide with the main sign being period pain. Thriving with endometriosis can be challenging, and many women with endo may find it difficult to train and exercise in the way they love, if at all. Yet, women with endometriosis can live a healthy, productive life, and can achieve their fitness goals.

Although endometriosis is commonly characterized by pain, which can sometimes be aggravated by certain activities, it is really important for overall health and well-being that women continue to be physically active. After all, movement is medicine.

Endometriosis occurs when cells that are similar to the cells that make up the uterine lining exist in other places, such as on the ovaries, fallopian tubes, bowels and even the lungs . During a period, these cells behave in the same way as the uterine lining. However, as there’s nowhere for them to leave the body, this results in inflammation, scarring, adhesions, pain and infertility.

Symptoms of Endometriosis

Women with endometriosis can have a varied assortment of symptoms, including :

  • Period pain
  • Heavy, prolonged and irregular periods, including spotting between periods
  • Pelvic pain
  • Painful sex (during and after)
  • Painful urination during periods
  • Pain with bowel movements
  • Abdominal pain
  • Bloating (“endo belly”)
  • Food intolerances e.g. dairy, wheat, soy and sugars
  • Constipation
  • Diarrhea
  • Infertility

Endometriosis and Pelvic Floor Dysfunction

Many women with endometriosis will develop hypertonic pelvic floor muscles. Due to pain, holding patterns, inflammation and adhesions, the pelvic floor muscles may become tight and unable to relax.

The pelvic floor muscles need to be released and retrained to relax, so it is ideal for women with endometriosis to see a pelvic health physical therapist. The physical therapist can also address other contributors to pain such as tight abdominal tissue, sensitized nerves and weak muscles.

If you have endometriosis, it is important to identify if you have a hypertonic pelvic floor. This will affect the way you exercise and the types of exercise you need to do.

Endometriosis and Exercise Considerations

Women with endometriosis can become generally weakened from the cycle of inflammation, stress and pain. Strength training becomes especially important in order to build strength through all the muscles groups, especially the weakened muscles.

In most women, pelvic floor engagement is recommended during the exhale breath. However in women with hypertonic pelvic floor muscles, cueing for pelvic floor engagement can cause more pain and discomfort. Therefore, in these circumstances, pelvic floor relaxation is encouraged.

Instead of doing “kegels” or pelvic floor lifts, women with hypertonic pelvic floor muscles need to do “reverse kegels” or pelvic floor drops. Visualize the way a pebble drops into a pond, and the ripples the pebble makes outwards; now feel this in your pelvic floor.

It is also important for women who have endometriosis to stretch the muscles around their hips, pelvis, back and abdomen. Incorporating yoga into your exercise habits, or having a diligent stretch routine during your warmup and cool-down that flows through these muscles on the days when you’re strength training, are both useful ways of addressing this.

Keep in mind that the connective tissue in the pelvic floor and in the abdomen can become tight due to scarring and adhesions. Therefore, exercises that shorten these muscle groups such as crunches and sit-ups may not be ideal. Exercises that strengthen the muscles in these areas in an elongated position would be more justified.

Endometriosis and Nutrition Considerations

Women with endometriosis will typically have some gut dysbiosis — an imbalance of the microbiota — due to the ongoing inflammatory and immune responses, as well as persistent pain and stress. Many women with endometriosis may have received a previous or concurrent diagnosis of irritable bowel syndrome, and may have food sensitivities.

Research shows that women with endometriosis are likely to benefit from a gluten-free diet . Eliminating other food sensitivities, such as sugars, dairy or soy, can also be beneficial . Taking supplements and eating foods that are high in omega-3 fatty acids, B-vitamins, antioxidants, and zinc have all been shown to reduce the inflammatory and immune responses in women with endometriosis .

Having lived with endometriosis myself, with a delayed diagnosis of 11 years resulting in persistent pelvic pain and gut issues, I know it’s possible to exercise and live pain-free, because I’ve been there myself and am now on the other side. I’ve also personally helped hundreds of women with endometriosis to overcome their pain and return to the exercise that they love.

If you are a woman with endometriosis or suspect you may have endometriosis, it is important to seek professional help from your gynecologist. I also recommend searching for a physical therapist and a functional nutrition practitioner who works with endometriosis and pelvic pain.


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We all know that exercise is one of the most beneficial ways to relieve stress, even though we sometimes don’t want to do it. Those who live with endometriosis often find that exercise also works for their painful symptoms as it releases endorphins, which help to ease and slow pain. Let’s look at why, and the ways, exercising to improve symptoms of endometriosis may work for you.

Start Slowly

If you decide to give this idea a try, don’t do too much on day one. The idea is to move. Start with walking for 15 minutes a few times a week. Walking boosts those happy endorphins and reduces the nasty stress hormones. It can also reduce inflammation.

Resist your impulse to stay on the sofa and not move. Even a little movement can help curb the pain of endometriosis.

Try Yoga

Yoga gives your body the low impact stretching it needs. Check out some common poses to get you started if you’re not ready to join a class just yet. There are several unique poses that have been used specifically by women with endometriosis! Even a little bit of stretching can reduce pain from endometriosis.

Do What You WILL Do

That may sound confusing, but it simply means to find your happy place. You may not be able to endure heavy-duty cardio workouts because it aggravates your pain. If walking and swimming are more your speed and they help relieve your symptoms, then stick with that plan. In other words, don’t start something you can’t do comfortably. This situation will only leave you to end up doing nothing.

Any type of activity will boost your mood and help you to avoid depression and anxiety, which are commonly associated with endometriosis due to the significant toll that the condition can take on a woman’s life.

Keep It Consistent

Regular movement or exercise is the key. Pelvic pain, cramping, and bleeding are not exactly an inducement to exercise, but trust that it will help you both physically and mentally.

Exercising consistently helps to provide protection against inflammation, and doing it regularly also reduces estrogen production that can worsen symptoms of endometriosis.

Consider a Physical Therapist

Find a physical therapist who specializes in pelvic floor exercises. When you have endometriosis, you can develop scar tissue that binds together important tissues and organs. A physical therapist can help you with a customized plan for strengthening muscles and ligaments near your vagina, bowels, and bladder to reduce endometriosis pain.

More research is needed to find the most beneficial amount of exercise to improve symptoms of endometriosis. Meanwhile, keep moving and find the best amount and type of exercise that works specifically for you.

Talk to Dr. Hyler & Associates about what exercises you do right now, and what other types of physical activity would be a safe addition or alternative.

As always, if you have any further questions or would like to schedule an appointment, please call Dr. Hyler & Associates at (904) 264-1628 or request an appointment online today!

Key Facts

  • Eating a well-balanced diet will keep you healthy.
  • Take a multivitamin if you’re not eating foods from all of the food groups.
  • Exercising may help improve your endo symptoms.

If you’ve been diagnosed with endometriosis, you may be wondering if there is anything you can do to feel better besides taking medication. Healthy nutrition and exercise play an important role in maintaining overall health.

Is there a special diet for girls with endometriosis?

We know that some foods can boost our immune system and protect our bodies from some illnesses and diseases. Unfortunately, there has been very little research done to figure out if eating certain foods can help improve endometriosis symptoms. Although, we do know that young women who eat lots of fruits, vegetables, and healthy fats while limiting their intake of red meat and unhealthy fats are less likely to have endometriosis. Some young women with endometriosis say they feel better when they eat a nutritious diet and some experts believe that eating certain foods can help endometriosis symptoms by reducing inflammation and estrogen levels in the body. Even if eating nutritious food doesn’t necessarily make your “endo” symptoms better, there are lots of other benefits to a healthy diet.

Consider making changes that can improve your overall health:

  • Eat a high fiber diet that includes plenty of fruits, vegetables, beans, whole grains, and nuts
  • Limit saturated fat by eating mostly plant–based foods, choosing low–fat dairy products, and selecting lean meats
  • Eat more sources of omega–3 fats such as fish (salmon, mackerel, herring, and sardines), fish oil, canola oil, flaxseeds, walnuts, and pumpkin seeds

How can I make sure I am getting all of the nutrients I need?

Eating a balanced diet with lots of fruits and vegetables, whole grains, plant–based protein, lean meats, and healthy fats can help you get all of the vitamins, minerals, and other nutrients you need to keep your immune system and body healthy.

Do I need take a vitamin supplement?

If you eat three nutritious meals a day and healthy snacks which include a variety of fruits and vegetables, protein, dairy foods, and whole grains, you are probably getting enough of most vitamins and minerals through the food you eat. If you aren’t getting in all of your food groups on a regular basis, you may want to consider taking a daily multivitamin so you will get the total amount of nutrients that your body needs. Talk to your health care provider (HCP) to see if you should take a multivitamin or other dietary supplement.

Do I need to take extra calcium?

Some endometriosis medications work by lowering estrogen levels. If you are on an estrogen–lowering medication for more than 6 months, you may be at risk of developing osteoporosis (brittle bones). Ask your health care provider if you should take calcium and vitamin D supplements to help protect your bones.

What about other vitamins and herbs?

You may see ads or stories on the internet, in magazines, and even personal blogs that claim certain vitamins and herbs help to treat endometriosis. The truth is, there are no published scientific studies that prove that extra supplements improve endometriosis symptoms. It is important to remember that some herbs (such as ginseng) can actually interfere with medications that treat endometriosis because they contain plant–estrogen. It is always best to talk with your health care provider first before taking any over–the–counter herbs.

What information should I pay attention to on food labels?

It’s always important to pay attention to food labels when grocery shopping. The Nutrition Facts Label is on most foods (except fresh foods such as fruits and vegetables) and has important information including portion size and what vitamins/minerals the food contains.

Will exercise make my endometriosis symptoms worse?

Probably not. In fact, exercise may actually improve endometriosis symptoms. Daily exercise (about 60 minutes each day) such as walking, swimming, dancing, or other activities will help you maintain a healthy weight and give you energy. It’s a good idea to check with your HCP or physical therapist to find out whether it’s okay to participate in very active sports or other strenuous exercise, and the right about and type of exercise that’s best for you. Occasionally, very active exercise such as running and jumping may bring on or increase endometriosis symptoms or other medical conditions.

Can exercise improve my endometriosis symptoms?

Yes. Here are a few reasons why exercise may help your endometriosis symptoms:

  • Exercise releases endorphins. When we exercise, our brain releases “feel good” chemicals called endorphins. These naturally occurring hormones work like pain relievers to lower pain. It only takes about ten minutes of moderate exercise (any exercise that makes you sweat or breathe hard) for your body to start making these chemicals.
  • Exercise improves circulation. Moderate exercise gets our heart pumping and improves the blood flow to our organs. This is important because our blood carries oxygen and nutrients to important body systems.
  • Regular exercise lowers the amount of estrogen in the body. Since the goal of endometriosis treatment is to lower estrogen levels, regular exercise may help improve endo symptoms.

Although nobody knows for sure what the best diet is for someone with endometriosis, healthy eating can improve your overall health, which may help your endometriosis symptoms. Consider eating foods that are high in fiber, plant–based foods, and omega–3 fats, and low in saturated and trans fats. Don’t forget to balance healthy eating with exercise you enjoy. Even if your endometriosis symptoms don’t decrease as much as you would like, eating a healthy diet has plenty of other health benefits!

A Pain You Can’t Ignore: Endometriosis

Because of the likelihood of recurrence, many women look for additional methods to ease their pain. The good news is that regular exercise and reducing your BMI naturally lower the body’s estrogen levels, which helps alleviate some of the worst symptoms and in some cases may even prevent the disease in the first place. “Women who are very fit may find protection from endometriosis,” Dr. Lessey says. In a groundbreaking study of women ages 18 to 39, the Fred Hutchinson Cancer Research Center in Seattle found that high-intensity workouts, such as running, biking, and playing tennis, three or more times a week slashed endometriosis risk by 76 percent. Women who exercised more than seven hours a week, especially if they started before age 26, decreased their risk of developing endometriosis by 80 percent. “In your teens and early 20s, regular menstrual patterns are forming. This is a critical window during which physical activity may help moderate estrogen production,” says Stacey Missmer, a top endometriosis researcher and assistant professor of obstetrics and gynecology at Harvard Medical School.

If you already have endometriosis, medium- to high-intensity exercise, such as running and cycling, may help lessen the symptoms. Research shows that regular physical activity helps reduce estrogen levels and moderates the production of prostaglandin hormones, the body’s pain receptors, which are released during your cycle. Yoga and Pilates moves also gently stretch the pelvic tissues and muscles that can be literally bound together by endometriosis, says Beth Heller, owner of Pulling Down the Moon holistic fertility centers in Chicago, who provides integrative care for endometriosis patients, including acupuncture, exercise, and diet. “Working out is imperative to treating the symptoms,” Heller says, noting that yoga also helps reduce stress, which can aggravate inflammation in the body.

And then there’s the feel-good effect that comes from a satisfying workout. “The immediate relief is from endorphins and serotonin, but the sustained effect is the estrogen dip,” says Thom Lobe, MD, founder of Beneveda Medical Group in Beverly Hills, which specializes in pain management.

Treatment Options for Endometriosis

Beyond regular physical activity, endometriosis treatment depends on how aggressive the condition is. Doctors often suggest ibuprofen and other nonsteroidal anti-inflammatory medications like Naproxen for women with mild cramps. Also, “hormones that suppress ovarian function are highly effective” for severe cases, says Beth Rackow, MD, an assistant professor of obstetrics and gynecology at Yale University School of Medicine. Extended-cycle or continuous hormonal birth control options can reduce the number of periods and are often prescribed. Other doctors recommend aromatase inhibitors, generally used to treat breast and ovarian cancer. “These drugs suppress aromatase, an enzyme your body produces that promotes more potent estrogens, which contributes to endometriosis,” explains Ken Sinervo, MD, a surgeon at the Center for Endometriosis Care in Atlanta and an expert in the field of advanced laparoscopic excision. “Limiting aromatase production in the body with drugs like Letrozole temporarily suppresses endometrial growth,” he adds. Natural progesterone creams and the Mirena IUD are often prescribed, as are drugs like Lupron, which send the body into a menopause-like state for six-month periods.

In the do-it-yourself realm, dietary adjustments may make a big difference. Resveratrol in wine may reduce the growth of endometriosis, according to a 2009 American College of Obstetricians and Gynecologists study. Omega-3 fatty acids have anti-inflammatory properties, so eating salmon and other fatty fish that contain them is key. Researchers believe the lycopene in tomatoes may stop the production of proteins that contribute to endometrial adhesions, and some studies suggest that flavones in celery and parsley can inhibit aromatase. Vegetables like broccoli, cabbage, and bok choy contain compounds called indoles, which might improve the body’s ability to moderate estrogen levels, and flaxseeds are high in lignans and fiber, which studies show may also ease estrogen-related conditions. What to avoid? Red meat: Women who ate it at least daily had twice the risk for endometriosis as those who ate three or fewer servings per week, according to research done at the University of Milan. Some experts attribute the link to the high levels of PCBs that can accumulate in animal fat via contaminated feed, which in turn may trigger symptoms by altering hormone functions and the immune system.

This is the place I now find myself, after finally being diagnosed and treated. Scott and I are trying for a baby, with the bonus that pregnancy may suppress my endometriosis symptoms. In the meantime, I continue to exercise, see an acupuncturist, and follow an anti-inflammation diet to manage my condition. I’m also eating plenty of Thai food again — bring on the salmon and bok choy!

The Top 10 Symptoms of Endometriosis

  • Pelvic pain before, during, or after menstruation or during ovulation
  • Intestinal pain during your period
  • Pain while urinating
  • Pain and/or bleeding during or after sexual intercourse
  • Pain in the lower-back region
  • Frequent diarrhea or constipation, often in connection with menstruation
  • Abdominal bloating in connection with your period
  • Heavy or irregular bleeding
  • Fatigue
  • Infertility

If you have one or more of these symptoms, talk with your ob-gyn about the possibility of endometriosis.

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There is limited information currently available on the relationship between endometriosis and exercise, however, some individuals report that exercise helps reduce symptoms of endometriosis, such as chronic pelvic pain. Exercising in general also provides other health benefits that could impact a woman’s endometriosis, as well as improve her overall health, including reducing the risk of developing comorbid conditions such as diabetes and some cardiovascular conditions, among others.1 Exercising can take on many forms, from rigorous to mild. Finding the most appropriate exercise routine for you is a personal journey, and can be very different from those around you. Although it may be difficult to get motivated to exercise when dealing with endometriosis-related symptoms and pain, there are many health benefits that can accompany even light activity.

Current guidelines set forth by the Centers for Disease Control and Prevention (CDC) suggest that adults perform at least two and a half hours per week of moderate physical activity, or an hour and fifteen minutes of vigorous physical activity per week. Examples of moderate intensity exercises include brisk walking, gardening, and bicycling less than 10 miles per hour. Examples of vigorous intensity exercise include jumping rope, jogging, running, swimming laps, or uphill hiking. There are also a variety of other exercise types that can be tailored to all needs and abilities. These include practices like yoga, dancing, water aerobics, and more.2,3

How exercise might help relieve endometriosis symptoms

Exercise affects our body in a variety of ways when we’re performing it, and even after we’re done. Exercise improves circulation, increases energy levels, decreases stress, and causes the body to release endorphins. Endorphins are chemicals that make us feel “good” and reduce pain. Also, regular exercise reduces levels of estrogen in the body, a hormone connected to the production, thickening, and breakdown of endometriosis lesions. All of these characteristics of exercise may contribute to its ability to potentially reduce endometriosis-related symptoms.1,4,5

Small studies have suggested that regular exercise may improve endometriosis on a cellular level as well as improve its symptoms.5-8 However, these studies are few in number, and several are based only on non-human (animal) models. Much more research is needed to determine the relationship between exercise and endometriosis risk and symptom alleviation. Regardless of the nature of this relationship, exercise does provide many overall health and wellness benefits, and can improve mental and physical health.

Things to note

Although finding what exercises are right for you is a personal journey, it is important to check in with your healthcare provider regularly on your exercise plans and goals. Not all exercise types and routines are for everyone, and there are some exercises or durations of exercise that may not be safe for you to perform, especially if you have other underlying health conditions. Your provider will be able to give you a basic overview of what kinds of activities and routines you are safe to try, and instruct you to build at your own pace. Additionally, enlisting the help of a fitness professional, if possible, may be a good idea to get you on the right track. If this is not feasible for you, there are also many free fitness videos online that can be utilized anywhere.

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