How to Exercise with Endometriosis

“Try exercising,” the doctor tells you for the n-billionth time. You roll your eyes.

You’ve just asked your doctor what more you can do to relieve endometriosis-related pain and stress. Yet again, he’s told you to just “exercise,” as if lifting weights is a cure for endo. Little does he know (somehow, it’s always a ‘he’) that a single crunch can leave you doubled-over with cramps for weeks.

Let’s get real for a sec. Your doctor isn’t lying when they tell you that exercise has benefits for endometriosis — but we also need to stop acting like it’s oh-so easy to pick up and go for a run when your insides are attacking themselves. I know firsthand that it’s incredibly difficult to strike a balance between exercising enough to get the health benefits, and making sure you don’t exercise so much that you exacerbate your pain.

In my experience, working out too hard, with too few days of rest, can lead to the world’s worst endo flare. (And trust me, I had orthorexia. I know a thing or two about working out way too hard!) At the same time, avoiding exercise altogether doesn’t feel good, either. Exercise has important benefits for your physical and mental health.

So, what can you do to get in shape without making your endo pain worse? Read on to learn a little more about the relationship between endometriosis pain and exercise, and what types of exercise are best to try when you have endometriosis.

Why Exercise With Endometriosis?

I know what you might be thinking: when you’re in pain all the time, why bother trying to exercise? When my endo flares up, sweating it out in a 90-degree yoga studio is pretty much the last thing I want to do. So, why not chill in bed all day and worry less about the squats and crunches?

Well, believe me: the last thing I want you to do is worry about exercise. It’s easy to get wired about your workout when you’re anticipating being in pain afterwards (and not the good, “my-muscles-are-sore” kind of pain). If working out is more stressful than it is fun, it’s time to reassess your workout routine, to see if you either need a break or to try something different.

I’ll talk more about changing up your workout routine to become more endometriosis-frendly later in this blog post — but for now, here are some of the reasons why you should consider squeezing in a light workout, even when your endo pain leaves you breathless:

  • Exercise relieves pain. As Elle Woods said, “Exercise gives you endorphins. Endorphins make you happy.” To take a note from Elle’s playbook, happy people just don’t feel as much pain as people who don’t exercise. Not only are endorphins a powerful happy hormone, but they’re also a natural analgesic.
  • Exercise reduces menstrual flow. Um, what?! If I had known that working out could make my periods lighter, I would have started working out a lot sooner, thank you very much. But it’s true: people with periods who exercise regularly have lighter menstrual flow than those who do not.
    • It’s important, however, not to cross the line between working out to get a lighter menstrual flow, and working out to “lose your period” altogether. Some people with eating disorders suffer from amenorrhea, or lack of a menstrual period, due to excessive weight loss — that’s not healthy, and that’s definitely not what we’re trying to do here!
  • Exercise lowers estrogen levels. You probably know that endometriosis is an estrogen-dependent disease. Endometriotic implants need a steady supply of estrogen to continue growing and bleeding every month. Studies have found that elite athletes have lower estrogen levels than the average person. While you don’t need to work out at the same intensity as LeBron James, you should definitely consider the benefits of a little light exercise on your endometriosis.
  • Exercise reduces inflammation. I’ve talked extensively about how endometriosis is an inflammatory disease. You’ve probably read my posts about an anti-inflammatory diet and endometriosis — but did you know that exercise can also curb inflammation in the body? Initial evidence comparing exercise to NSAIDs found that both were equally as effective at reducing the severity of menstrual cramps.
  • Exercise works better than heat. Don’t reach for your heating pad when you could reach for your gym shoes instead. When compared to both heat and acupressure, exercise had the best results when used as a self-care tool for reducing menstrual pain. Both are great drug-free alternatives for pain relief, but exercise appears to be slightly more effective — plus, there’s no risk of burning yourself if you jog too much!

The Best Types of Exercise for Endometriosis

You might be rearing to get a workout in after reading all the amazing benefits of exercise for endo — but take a minute and pause first. It’s important that you know that not all exercise is created equal for endometriosis. In fact, some types of exercise might be more likely to leave you hunched over in pain afterward than happy you did them. Other types of exercise might make problems related to your endo, such as pelvic floor dysfunction, worse.

So, what types of exercise can you do with endometriosis? Here are some “dos” and “don’ts” to keep in mind when planning out your workout routine.

DON’T:

  • High intensity interval training (HIIT) and other types of high-impact exercise, like running, are a no-go for endometriosis. These exercises fire up the nervous system, potentially increasing your pain.
  • Strength training at the gym, with weights or machines, does not appear to benefit patients with endometriosis, according to a study summarized by Endo News.
  • Intense abdominal or pelvic floor exercises should be avoided by endometriosis patients. This includes moves like squats, lunges, and crunches. Since your goal is to relax the pelvic floor and abdominal muscles, exercises that contract those muscles may be counterproductive.
    • You might be worried that almost every exercise class incorporates these types of moves — but you should know that trainers are usually willing to help you modify them if you speak to them about your limitations before class.
  • Kegel exercises have become fashionable, thanks to “lifestyle gurus” like Gwyneth Paltrow. You might even have heard that they’ll improve your sex life. The goal of kegels is to strengthen and contract the pelvic floor. With endometriosis, most patients have problems relaxing the pelvic floor, and contracting it is counterintuitive.

DO:

  • Low-impact aerobic exercise gets your heart pumping without upregulating your nervous system, so you get the benefits of cardio without exacerbating endo pain. Swimming and walking are both great options for endo patients.
  • Yoga is great for endometriosis patients because it incorporates deep breathing, progressive muscle relaxation, and stretching in addition to building strength. This helps you release the tight muscles of your pelvic floor, without really having to think about it!
    • Next time you need to relax, check out this yoga sequence from instructor Brett Larkin. It’s available for free on YouTube, and incorporates research into the best yoga poses for endometriosis and fertility.
  • Pilates fuses flexibility, strength, and breathwork exercises into a challenging mind-body workout. The goal of Pilates is to synchronize your movements with your breath, much like in yoga. This promotes mindfulness, which has been shown to reduce pain.

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