For people with endometriosis, a disorder in which tissue that typically forms the uterine lining grows on other parts of the body (like the ovaries, intestines, or bladder) and often painfully sheds during your period, exercising can be hit or miss. But generally speaking, “exercising with endometriosis is a net positive,” says Amy Roskin, MD, a board-certified OB-GYN and chief medical officer at Seven Starling, a women’s health platform. She explains the endorphins, or “feel good” chemicals that release after exercise, can decrease pain—but not for every person, all the time.
“In some people, certain exercises may exacerbate or worsen pain,” she adds. “This can occur, for example, when scar tissue has developed from endometriosis, and activities that cause traction, stretching, or pulling on these areas can worsen pain.”
So what do you do? Dr. Roskin and other experts recommend the following tips for making your workout as healthy and enjoyable as possible.
4 best practices when exercising with endometriosis
1. Stick to shorter workouts
Instead of one long workout, incorporating multiple mini workouts, aka ”exercise snacking,” is key.
“With endometriosis, it’s common for an elevated heart rate for an extended period of time to cause a flare-up of painful symptoms,” explains Aly Giampolo, a certified fitness instructor, professional dancer, and co-founder of The Ness, a fitness studio known for it’s mini trampoline workouts. Exercise is a stress on the body, and the higher the intensity or longer the workout, the more stress, which causes your muscles to tense and spasm and increases inflammation and feelings of pain overtime.
“Splitting your exercise into shorter bursts and sprinkling it in here and there is a great way to get some movement in while reducing the risk of increased pain.” An “exercise snack” could look like five minutes of morning yoga, a short walk after dinner, half of a video dance class, or whatever other movement feels good and fun to you.
Here’s a five-minute barre workout to add into your rotation:
2. Know which exercises cause you the most (and least) pain
You know your body best, of course, but some types of workouts tend to be painful for most people with endometriosis. “You want to avoid higher intensity workouts, particularly those focused on the abdominal region, pelvis, and lower back,” recommends Mariel Witmond, yoga teacher and founder of Mindful Sonder. “That can include things like running, due to the impact on our spine and hips, and crunches, due to the strain on our abdomen and back.”
Other exercises you may want to avoid are ones that involve getting low. “Any exercise that requires bearing down—squats, weight lifting—may put additional stress on the pelvis, causing increased pain to the affected area(s),” adds Somi Javaid, MD, founder and chief medical officer at HerMD.
Witmond suggests low- to moderate-impact yoga and stretching. Flexibility and mobility training, including Pilates, could be beneficial as well. “Many people with endometriosis tend to fare better when doing an exercise program that involves more lengthening and stretching of muscles rather than resistance and weight-bearing exercise, which may not be as comfortable,” says Laurence Orbuch, MD, an OB-GYN, endometriosis surgeon, and director of GYN Laparoscopic/Robotic Associates LA. “That being said, each individual should adjust their workout to a regiment that suits their personal needs.”
3. Listen to your body and don’t push through pain
One of the most important things you can do for your health in general is to trust your body’s signals. “Don’t be a hero,” Giampolo says. “If you begin a workout and your pain level increases, simply stop. This is your body saying, ‘I’m not here for this today.’ There’s no need to power through when your body is going through so much.”
But what’s the difference between pain and the “normal” discomfort that can come with a workout? “Discomfort can be managed, while pain is a warning sign from our body that something is wrong,” explains Dr. Javaid. “With endometriosis, the pain you may experience with exercise will often be dependent on where you are in your menstrual cycle. You should monitor your symptoms throughout the course of your cycle and remember not to push yourself if you are having a ‘bad’ symptom day or experience increased pain with exercise.”
Dr. Roskin emphasizes starting slow and paying attention to your pain. “Worsening or sharp pains are a warning to dial it back,” she says.
4. Take care of yourself before, during, and after exercise
What you wear and how you treat your body can also affect how you feel.
“Wear compression leggings or shorts, which can help to minimize swelling and discomfort,” Dr. Javaid says. “Apply heat patches or ice to inflamed area after exercising to help alleviate any discomfort.” She also suggests stretching, taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, before exercising, and drinking plenty of water throughout. This will “promote optimal performance, prevent dehydration, and stop the onset of muscle cramps,” she explains.
Ultimately, how much you choose to exercise and in what ways is up to you and how you feel. There’s no shame either way. “If you feel pain prior to exercise, then you may find that exercise can help,” Witmond says. “If you feel pain during or after, you may want to reconsider what you’re doing and whether it is helping or worsening how you feel.”