What are the best exercises for endometriosis?

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According to the Office on Women’s Health (OWH), regular exercise can help maintain low levels of the hormone estrogen.

This hormone thickens the lining of the uterus during the menstrual cycle, contributing to endometriosis. As a 2022 study explains, the aim of endometriosis therapy is to reduce estrogen levels to ease endometriosis symptoms.

The 2022 study notes that women who engage in regular physical activity tend to have decreased estrogen production, reduced ovarian stimulation, and lighter periods. Exercise also triggers the release of “feel-good” chemicals called endorphins, which help ease pain.

The OWH recommends that people with endometriosis exercise for more than 4 hours per week to help maintain a low percentage of body fat and decrease levels of circulating estrogen.

The United Kingdom charity Endometriosis UK adds that regular exercise can help rebalance core and pelvic floor muscles that often have issues in endometriosis. Therefore, this can help improve a person’s experience of pain. The charity recommends three main types of exercise, including the below.

Endometriosis pain can cause problems with posture. This may result in muscle imbalances as certain muscles weaken and other muscles overcompensate for those weaknesses.

Below are some stretching exercises that may help with these issues:

Standing hip flexor stretch

• Step 1: Stand with one leg in front of the other.
• Step 2: Raise the heel of the back foot and bend the knees slightly.
• Step 3: Tuck in the buttocks so that the pelvis tilts under, causing a stretching sensation at the front of the hip.
• Step 4: Hold the position for 30 seconds and repeat on the opposite side.

Seated piriformis stretch

• Step 1: Sit on a chair with the back straight and both feet flat against the floor.
• Step 2: Cross the legs so that the outer part of the left ankle rests atop the right knee.
• Step 3: Slowly lean forward while keeping the back straight. If the stretch feels too intense, slouch back a little into the chair.
• Step 4: Hold the position for 30 seconds, then switch to the opposite side.

Core muscle and pelvic floor exercises help strengthen the muscles of the abdomen and pelvic floor. People who experience pelvic pain tend to have weaknesses or imbalances in these muscle groups.

Below are some exercises that can help.

Transverse abdominis activation

The transverse abdominis (TA) muscle is a deep muscle layer that supports the back and pelvis.

Often, people who experience chronic pelvic pain have TA weakness that leads to overcompensation from other abdominal muscles.

The following exercise helps activate the TA muscles and address muscular imbalances in this area of the body.

• Step 1: Lie on the left side, placing the right hand just inward from the right hip so that it rests on the lower abdomen.
• Step 2: Gently push the abdomen away from the waistband until there is a feeling of gentle tension underneath the right hand. The upper abdominal muscles and back should remain still with minimal movement in the abdomen.
• Step 3: Try to maintain the hold for a few seconds while continuing to breathe typically.

If the upper abdominal muscles, pelvic floor muscles, or other muscles start to tense during this exercise, simply relax and start the exercise again.

Diaphragmatic breathing

• Step 1: Lie on the back with both knees bent. Place one hand over the abdomen and the other on the chest.
• Step 2: Take a deep breath in through the nose so that the tummy expands outward while the chest remains still. Repeat this 2–3 times and return to breathing typically.
• Step 3: Tighten the muscles around the back passage as if trying to stop gas escaping. Then, immediately relax.
• Step 4: Repeat steps 2 and 3 up to 10 times in total.

A 2023 review explains that yoga helps ease muscle tension and pain and regulates mood and emotion. These may all help alleviate endometriosis symptoms and improve the quality of life for people with the disease.

Below are three yoga stretches that may help with endometriosis pain, according to Endometriosis UK.

Child’s pose

• Step 1: Kneel with the buttocks resting on top of the heels and both palms resting on top of the thighs.
• Step 2: Gently exhale while lowering the upper body toward the floor, arms outstretched in front with palms facing down.
• Step 3: Place the forehead against the floor and relax both shoulders toward the ground.
• Step 4: Hold the position for a few seconds to increase the stretch.

Bridge pose

• Step 1: Lie on your back with both knees bent, arms resting to the sides, and palms facing down.
• Step 2: Engage your deep abdominal muscles and squeeze the buttocks.
• Step 3: Starting with the tailbone, slowly raise the hips off the ground.
• Step 4: Slowly return to the starting position, ensuring the tailbone is the last part of the body to touch the ground.

Clamshell pose

• Step 1: Lie on the left side with both legs bent at the knees so that the feet are in line with the hips.
• Step 2: Engage the deep abdominal muscles.
• Step 3: Keeping both feet together, raise the right knee upward while keeping the hips facing forward.
• Step 4: Slowly lower the right knee back to its starting position.
• Step 5: Complete as many repetitions as possible and repeat the exercise on the opposite side.

Aerobic exercises help maintain the health of the heart, lungs, and circulatory system. They can also help people achieve and maintain a moderate weight.

This may help reduce levels of circulating estrogen. People with estrogen may find that aerobic exercise helps ease their endometriosis symptoms.

The Centers for Disease Control and Prevention (CDC) recommends that people perform up to 150 minutes of moderate-intensity aerobic activity (MIAA) each week.

According to the CDC, MIAA is any exercise that noticeably increases breathing rate and heart rate but does not affect a person’s ability to carry on a conversation.

Examples include:

• a brisk 15-minute walk
• biking at a casual pace
• light yard work, such as mowing the grass or raking and bagging leaves
• light snow shoveling
• actively playing with children

Although moderate exercise is definitely beneficial for endometriosis and overall health, a 2023 review suggests that intense physical activity may worsen endometriosis symptoms.

As the United Kingdom’s National Health Service (NHS) explains, intense or vigorous activities are those in which a person cannot say more than a few words without pausing for breath.

Examples include:

• running or jogging
• fast swimming
• fast cycling, or cycling on hills

However, endometriosis symptoms and severity can differ greatly between individuals. A person may find that they can perform these exercises without worsening symptoms.

It is best to start slowly with exercises and see what level of intensity is right for an individual.

Research suggests that certain types of exercise may help manage endometriosis and ease its symptoms.

Some of the best exercises for endometriosis include those that strengthen and stabilize the core and pelvic floor muscles. These exercises typically involve yoga and stretching.

Moderate-intensity aerobic activity can also help a person maintain a moderate weight, thereby reducing their levels of circulating estrogen — a major contributor to endometriosis.

Some research suggests intense physical activity may worsen endometriosis. As such, people with this condition may want to avoid vigorous activities, such as running, jogging, or fast cycling.