Exercise and Activity Recommendations
We recommend graduated low level activity to help with blood supply and oxygen circulation to the pelvic cavity. Physical exercise reduces estrogen, inflammation, and mental fatigue. If patients have advanced stage disease, high level physical activity may cause additional pain due to the fact that patients can have adhesions and rapid movement can cause discomfort. The Endometriosis Treatment Center of America recommends low level, low impact exercise, increasing the level and impact of exercise as the patient can tolerate.
Patients increasing their exercise level during the treatment and maintenance of endometriosis disease can impact their long-term quality of life.
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.
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A weak protective effect among fertile participants for total recreational physical activity reported two years before diagnosis and a slightly stronger protective effect for aerobic exercise on the rate of laparoscopically confirmed endometriosis. These findings were considerably smaller than the relations previously reported in case-control studies. We found that activity reported six years prior to diagnosis and inactivity were not associated with endometriosis
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Though it suggests that PA may reduce the risk of endometriosis, this meta-analysis does not conclusively support the hypothesis. Whether our findings are really explained by the benefit of exercise at molecular and endocrine level, or related to confounding mechanisms, such as study design, choice of controls, and PA potentially improving pain, needs to be further investigated.
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Endometriosis and Exercise