Exercises for Endometriosis

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

Endometriosis affects roughly 1 in 10 women of reproductive age and is one of the most pain-dominant chronic conditions I treat. The catch-22 with exercise is real: movement is one of the most useful non-pharmacological interventions for endometriosis, but the very pain that exercise can help also makes it hard to do. Many women with endometriosis end up either pushing through inappropriate exercise that worsens flares, or avoiding movement entirely and losing the inflammation-modulating, mood-supporting benefits it offers. The right approach — appropriate intensity, the right type of movement, cycle-phase awareness, and pelvic-floor consideration — gives you the benefits without the cost. This page is a practical, evidence-based guide.

On this page

1. Why exercise helps endometriosis
2. The evidence base
3. Best types of exercise
4. Yoga for endometriosis
5. Pilates and core work
6. Cardio — walking, swimming, cycling
7. Strength training
8. Specific stretches that help
9. What to avoid (or modify)
10. Pelvic floor — overactive vs underactive
11. Cycle-phase tips
12. Exercising during a flare
13. TCM perspective on movement
14. Sample weekly routine
15. FAQs

Why exercise helps endometriosis

• Reduces systemic inflammation — directly relevant to endometriosis pain and progression.
• Lowers oestrogen levels — by reducing body fat and improving liver oestrogen clearance.
• Modulates prostaglandin production — reducing menstrual cramping.
• Releases endorphins — natural pain modulation.
• Improves pelvic blood flow — reduces stasis-related pain.
• Supports gut motility — helps with endo-belly bowel symptoms.
• Reduces stress and cortisol — both worsen endometriosis pain.
• Improves sleep — pain-amplifying when poor.
• Supports mood — depression and anxiety are more common with endometriosis.
• Maintains bone density — particularly important if on hormonal suppression like GnRH analogues.
• Maintains lean muscle mass — supports metabolic health and weight management.
• Improves body image and confidence — endometriosis affects both significantly.

The evidence base

• Several observational studies show physically active women with endometriosis have lower pain scores than sedentary patients.
• RCT evidence supports yoga (8-week programmes) for endometriosis pain reduction.
• Pilates studies show improved core stability and reduced pelvic pain.
• Aerobic exercise reduces inflammatory cytokines (IL-6, TNF-α) — relevant to endometriosis pathophysiology.
• Pelvic floor physiotherapy combined with exercise improves dyspareunia (painful sex) in endometriosis.
• Modest exercise during the menstrual phase reduces dysmenorrhoea in trials.

Best types of exercise

• Yin yoga and restorative yoga — gentle hip openers and forward folds; reduces inflammation and pelvic tension.
• Swimming and aquatic exercise — buoyancy reduces impact; excellent cardiovascular benefit.
• Walking — daily 30-45 minutes; the best low-effort, high-benefit option.
• Pilates (mat or reformer) — controlled core engagement, supports pelvic stability.
• Cycling (gentle to moderate) — particularly stationary or recumbent if saddle pressure causes pain.
• Tai chi and qi gong — gentle qi-moving, particularly suited to TCM blood-stasis pattern.
• Pelvic floor physio — particularly if overactive pelvic floor is contributing to pain.
• Dance, low-impact aerobics, Zumba — fun and effective for many women.
• Light strength training — supports lean mass and metabolism.

Yoga for endometriosis

Yoga has the strongest single evidence base for endometriosis pain reduction. Particularly useful styles and poses:

• Yin yoga — long-held passive poses; releases deep fascial tension; calms nervous system.
• Restorative yoga — supported postures with bolsters; deeply relaxing.
• Hatha yoga — gentle traditional yoga with focus on breath.
• Specific helpful poses:
  • Reclining bound angle (Supta Baddha Konasana) — opens the hips and pelvis.
  • Child's pose (Balasana) — gentle abdominal release.
  • Cat-cow — mobilises the spine and pelvis.
  • Pigeon pose (Eka Pada Rajakapotasana) — deep hip opening.
  • Legs up the wall (Viparita Karani) — supports pelvic circulation.
  • Supported bridge (Setu Bandha) — opens the pelvis gently.
  • Forward folds — calming and abdominally compressing in a useful way.
  • Goddess pose (Utkata Konasana) — strengthens the pelvic floor without overactivation.
• Avoid in flares: deep twists, intense backbends (can compress endometriotic lesions), inversions if heavy bleeding.
• Avoid during heavy menstruation: all inversions traditionally avoided in TCM and many yoga schools.
• Practical: 2-3 times per week, 45-60 minutes; classes specifically for women's health are particularly useful.

Pilates and core work

• Mat Pilates — accessible, no equipment needed.
• Reformer Pilates — additional resistance and support; can be more comfortable for some.
• Focus on deep core engagement (transversus abdominis) — supports pelvic stability without overworking superficial abs.
• Avoid intense crunches — can pull on adhesions and worsen pain.
• Pelvic-floor-aware Pilates — best with an instructor experienced in women's health.
• Frequency: 2-3 times per week.

Cardio — walking, swimming, cycling

• Walking — start with 20 minutes daily and build to 30-45. The simplest, most accessible cardio. Particularly good after meals to support gut motility (relevant for endo-belly).
• Swimming — buoyancy reduces impact on pelvic structures. Front crawl and backstroke; breaststroke can be uncomfortable for some.
• Cycling — gentle road or stationary; recumbent if saddle pressure hurts. Avoid mountain biking and trail bumping during flares.
• Elliptical / cross-trainer — low impact alternative to running.
• Aim for 150 minutes moderate cardio per week — same as general health guidelines.

Strength training

• Light to moderate weights, 2 times per week — supports lean mass, metabolism and bone density.
• Particularly important if on hormonal suppression (Zoladex, dienogest) which can affect bone density.
• Compound movements: squats, deadlifts, push-ups, rows — but with appropriate weight.
• Avoid Valsalva manoeuvre (holding breath under heavy load) — can worsen pelvic floor and adhesion-related pain.
• Reduce intensity if pain or flare — switch to bodyweight only.
• Pelvic floor breathing with strength work supports the pelvic floor rather than overactivating it.

Specific stretches that help

• Hip flexor stretch — releases tension that pulls on the pelvis.
• Piriformis stretch (figure-four) — releases the deep gluteal area.
• Cat-cow — gentle spinal mobilisation.
• Knee-to-chest hugs — releases the lower abdomen.
• Wall-supported leg stretches — releases the inner thighs.
• Diaphragmatic breathing — supports the pelvic floor and abdominal tension.
• Foam rolling — gentle on the back, glutes and IT band.
• Self-myofascial release — gentle abdominal massage and pelvic floor release.

What to avoid (or modify)

• High-intensity training during the period — can increase prostaglandins and worsen cramping. Modify to gentler movement.
• Heavy weightlifting with breath-holding — increases intra-abdominal pressure; can pull on adhesions.
• Long-distance running on hard surfaces — high impact can aggravate pain in significant disease.
• HIIT during flares — wait until acute symptoms settle.
• Deep abdominal compression in poses with intense crunching.
• Excessive endurance training — chronic high cortisol worsens inflammation.
• Hot yoga or Bikram during heavy bleeding (controversial; some women fine, some worse).
• Equestrian sports during flares — saddle pressure on the pelvis.
• Anything that causes pain during or after — listen to your body.

Pelvic floor — overactive vs underactive

Pelvic floor dysfunction is extremely common in endometriosis — and crucial to understand because the wrong exercises can make it worse:

• Overactive (hypertonic) pelvic floor — chronic tension; causes deep dyspareunia, urinary urgency, constipation, painful periods. Common in endometriosis. Don't do Kegels for this — needs relaxation, not strengthening. Diaphragmatic breathing, hip openers, and pelvic floor physio with biofeedback are the right approach.
• Underactive (hypotonic) pelvic floor — weakness; causes incontinence, prolapse, reduced sexual sensation. More common postnatally. Kegels and pelvic floor strengthening appropriate.
• Most endometriosis patients have overactive pelvic floor — assessment with women's health physio is essential before assuming Kegels are needed.
• NHS pelvic floor physio referrals are available; private specialists also available.

Cycle-phase tips

• Menstrual phase (days 1-5) — gentle yoga, walking, swimming. Avoid intensity. Heat over the abdomen.
• Follicular phase (days 6-13) — peak energy. Strength training, cardio, more intense yoga, longer walks.
• Ovulation (around day 14) — mid-cycle pain may limit some activity; modify around the ovulation discomfort.
• Luteal phase (days 15-28) — moderate activity. Reduce intensity in late luteal as PMS sets in.
• Track symptoms for 2-3 cycles to identify your personal pattern.

Exercising during a flare

• Don't push through — pain in endometriosis is genuine inflammation and can worsen.
• Switch to gentle — slow walking, yin yoga, restorative yoga, breathing practice, gentle stretching.
• Heat over the abdomen and lower back — improves circulation, reduces cramping.
• Magnesium glycinate and omega-3 — anti-inflammatory and muscle-relaxing.
• TENS machine — useful for chronic pelvic pain.
• Resume normal exercise gradually after the flare settles, not all at once.
• Use flares as data — note triggers (food, stress, sleep, exercise type) and adjust.

TCM perspective on movement

In Chinese medicine, endometriosis is fundamentally blood stasis in the lower jiao — and movement is one of the primary ways of moving qi and blood to prevent and resolve stasis. Regular moderate exercise:

• Supports the Liver's role in smooth qi flow.
• Reduces Liver qi stagnation (the stress and emotional component).
• Promotes pelvic blood circulation.
• Supports the Spleen's transformation function (relevant for damp accumulation).
• Tonifies overall qi without depleting it.

The gentle rhythmic movements of yoga, tai chi, qi gong and walking are particularly valued in TCM because they move qi without depleting it. Acupuncture and Chinese herbal medicine work synergistically with movement practices to address the root pattern.

Sample weekly routine

A balanced weekly routine for moderate endometriosis (adjust to your pain level and cycle):

• Monday: 45-minute walk + 15 minutes gentle stretching.
• Tuesday: 60 minutes Pilates or strength training.
• Wednesday: 30-45 minutes swimming.
• Thursday: 60 minutes yoga (yin or hatha).
• Friday: 30 minutes walking + 30 minutes light strength.
• Saturday: 60-90 minutes longer walk or cycle ride or yoga class.
• Sunday: rest day or restorative yoga + stretching.
• Daily: 5-10 minutes diaphragmatic breathing or pelvic floor practice.

Total: ~5-6 hours per week. Modify down during flares or menstruation.

Frequently asked questions

What's the best exercise for endometriosis?

Yoga (yin, restorative, hatha), swimming and walking have the best balance of evidence and tolerability. Pilates is excellent for core stability without aggravation.

Should I do Kegels for endometriosis?

Usually no. Most endometriosis patients have overactive (hypertonic) pelvic floor; Kegels make this worse. Get assessed by a women's health physio before assuming Kegels are appropriate.

Can I exercise during a flare?

Switch to gentle — yin yoga, slow walking, restorative practice, breathing. Don't push through. Resume normal exercise gradually after the flare settles.

Is running bad for endometriosis?

Not necessarily, but high-impact long-distance running on hard surfaces can aggravate pain in significant disease. Modify intensity, surface, and duration; substitute swimming, cycling or elliptical during flares.

Should I avoid exercise during my period?

No, but reduce intensity. Gentle walking, yoga, swimming and stretching are all helpful. Avoid HIIT and heavy weights during the period.

Will yoga really help?

Yes. RCT evidence supports yoga for endometriosis pain reduction. Yin and restorative styles particularly useful.

Can I do strength training with endometriosis?

Yes — light to moderate weights 2x per week supports lean mass and bone density (particularly important if on hormonal suppression). Avoid breath-holding under heavy load.

To discuss endometriosis treatment, contact me or book a consultation at my Wokingham clinic.

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Related reading: Chinese medicine for endometriosis | Endo belly | Getting pregnant with endometriosis

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