More than 830,000, or around one in nine, Australian women suffer from endometriosis, a condition that can cause debilitating pain during the menstrual cycle as well as during ovulation, sex, urination and bowel movements. Other symptoms include inflammation, bloating, heavy bleeding and fatigue, and it can affect fertility.
The pain and discomfort can lead women to restrict exercise but this can create other chronic health problems, says accredited exercise physiologist Dr Angela Spence from Curtin University. Physical activity can also have myriad benefits.
“Regular exercise is associated with reduced risk of developing endometriosis,” she explains, and can also directly help reduce the inflammation associated with the condition. Other potential benefits include pain management, improved mental health and mitigation of side effects from commonly prescribed medications.
Spence notes that more research is needed to give conclusive support for the role of exercise in managing endometriosis. But considering the benefits, experts have several general recommendations – with some provisos.
“Women should be encouraged to be active and maintain routine activity,” says Spence, “but this should be progressed gradually as tolerance improves, ideally under the direction of an exercise specialist.”
The move: the Jacobsen method
A progressive muscle relaxation technique called the Jacobsen method has been found to improve quality of life and reduce anxiety and depression in women with endometriosis, reports Emma Wise, a pelvic health physiotherapist.
“This involves contracting and relaxing the major muscles of the body, one by one, as a form of mental and physical relaxation,” she explains. “It can be done easily at home in 30 to 40 minutes.”
Start by relaxing and contracting the right hand, forearm, upper arm, and then left side, in that order. Move to the face, neck, chest, shoulder and upper back, and then the stomach, right thigh, calf and foot, followed by the left thigh, calf and foot.
A specific focus on pelvic floor muscle training can improve range and relaxation of those muscles and help with pain associated with endometriosis, says Wise, adding that a specialised physiotherapist can help with this. “It is common for people with pelvic pain, including endometriosis, to have decreased tone of their pelvic floor muscles,” she explains. “This can further contribute to pelvic pain and other symptoms such as bladder and bowel issues [and] pain with sex.”
For strengthening the pelvic floor and glutes, accredited exercise physiologist Brittany Cogger recommends clams or lying leg raises, sit to stands and glute bridging with resistance band.
The class: pilates or yoga
Pilates or yoga classes can help to release muscles that are tensed against the pain, writes Cogger. Indeed, Wise notes that women with endometriosis who took part in a study exploring Hatha-style yoga found improved quality of life and pain relief. This involved movements focussing on relaxation, breathing and posture exercises performed twice a week for eight weeks.
The activity: stretching
Exercises based on Pilates and yoga principles can help release tensed muscles, according to Cogger, as well as stretches including seated glute stretch, seated hip flexor stretch and a wall side-bend stretch. She explains that lengthening and strengthening the pelvic floor, abdominal wall and hip flexor muscles are important for relaxing them before embarking on exercise.
In this regard, Spence recommends walking or any other type of low-impact aerobic exercise that you enjoy, such as swimming or bike riding.
The hard pass: high-impact exercises
Vigorous activity can worsen symptoms and result in flare-ups for some women and exacerbate cramping and fatigue, advises Wise. Specifically, it might be prudent to avoid high-impact exercises such as running and burpees, according to Cogger, as well as sit-ups and crunches.