Written by Malcolm Camilleri
In March, MHSA is celebrating Endometriosis Awareness Month. This article gives insight into endometriosis and how exercise can improve its symptoms.
Endometrium overview
The endometrium is the inner lining of the uterus. It thickens and renews itself every month, in preparation for pregnancy. Therefore, if conception takes place, the endometrium thickens and the embryo sticks to it. Alternatively, it sheds through menstruation if pregnancy does not occur.
Endometriosis is a gynaecological condition where the endometrium-like tissue grows outside of the uterus, most commonly in other parts of the pelvis. This condition often causes pain, pelvic inflammation, and a forward-leaning posture, amongst others. These, to some extent, can all be limited through exercise.
Decreasing inflammation
Regular physical activity has protective effects against inflammation as it increases the anti-inflammatory and antioxidant cytokines in the blood. It also controls oestrogen levels, which are usually high in endometriosis. Research shows that moderate-intensity physical activity, such as brisk walking and swimming, for 20 to 30 minutes daily, can produce said anti-inflammatory effects.
It is important to note that decreasing inflammation will often decrease the severity of other symptoms.
Breaking the pain cycle
Similar to other pain-inducing medical conditions, eliminating one of the factors in the pain cycle will decrease pain itself.
Physical activity has been shown to release endorphins. These hormones work similarly to opioid drugs, relieving stress, and pain. Deep breathing exercises and visualisation follow a similar system by also producing endorphins.
Pain, discomfort, and cramping in the front part of the pelvis usually cause muscle tension in the pelvic floor, abdominal wall, and hip flexors. Stretching can reduce the muscle tension in said tight muscles, breaking the pain cycle, and ultimately decreasing pain.
Improving posture
The previously mentioned cramping contributes to a forward leaning posture, which is often assumed to protect oneself from the corresponding pain. Repeated and prolonged time in said position will cause anterior pelvic muscle shortening and weakness of the muscles at the back.
Stretching of the tight areas and concurrent strengthening of the weak areas will improve the body’s kinetic chain, providing a harmonious balance of forces at the body’s core.
| Pelvis strengthening examples | Back strengthening examples |
| Butterfly stretch | Back extensions |
| Forward and side lunges | Reverse leg raise |
| Bridging | Superman |
High-intensity exercises such as circuit training and High-Intensity Interval Training (HIIT), together with high impact exercises such as burpees and plyometrics, may aggravate the inflammation and increase pain perception. This, however, does not mean that one can never perform such tasks. It is suggested to see a physiotherapist for guidance on how to best balance endometriosis and exercise.
Check out MHSA’s previous article!
