How to exercise with endometriosis

Start small, go gently and keep a lighter option ready for bad days. For most people with endometriosis, walking, gentle strength work, stretching and yoga are reasonable to try, and a handful of small trials suggest exercise may ease pain and improve quality of life. Exercise doesn't treat endometriosis, though, and the research is still early, so think of it as one part of your care alongside your doctor, not a replacement for it.

Endometriosis in brief

The NHS describes endometriosis as a condition where cells similar to the lining of the womb grow in other parts of the body, often around the ovaries and fallopian tubes. The World Health Organization estimates it affects about 10% of women of reproductive age, roughly 190 million people worldwide, and says the average time to diagnosis is between 4 and 12 years.

Symptoms vary a lot from person to person. The NHS lists:

• Period pain severe enough to stop you doing your normal activities
• Heavy periods
• Pelvic pain, pain when you pee or poo, and pain during or after sex
• Extreme tiredness
• Low mood or anxiety

There's no cure yet. The NHS says treatment aims to manage symptoms, using painkillers, hormone treatments such as the combined pill, and sometimes surgery. Any exercise plan sits next to that care, so talk to your doctor before you start something new.

What the research says, and what it doesn't

The honest answer is that we don't know much yet. Here's what the main reviews found.

• A 2021 review in BMC Women's Health found only three usable studies, with 109 women between them. In one trial with 40 women, those who did Hatha yoga twice a week for 8 weeks reported less daily pain than a usual-care group. In another, adding a cardio program to a hormone medicine gave no clear extra pain relief. The authors concluded that exercise might help, but that the effects can't be robustly determined from the studies available.
• A 2025 meta-analysis in PLOS One pooled six randomized trials with 251 women. The programs ranged from yoga and supervised stretching and strength work to walking and relaxation training. Two trials could be combined for quality of life, and together they showed better scores for pain, emotional well-being and feeling in control. The trials were small, short and very different from each other, and safety wasn't assessed in a systematic way.
• The 2022 endometriosis guideline from ESHRE, the European Society of Human Reproduction and Embryology, tells clinicians to discuss non-medical ways to improve quality of life. It doesn't recommend any specific one, including exercise and physiotherapy, because the potential benefits and harms are still unclear.

Why might exercise help? Researchers have suggested that the anti-inflammatory effects of regular exercise could calm some of the inflammation behind endometriosis pain. That idea is reasonable but hasn't been proven. The trials above measured symptoms and quality of life. None of them showed that exercise changes the disease itself.

Exercise is still good for almost everyone. The NHS recommends adults get at least 150 minutes of moderate activity a week and do strength work on at least two days. Endometriosis doesn't change that goal, but it may change how fast you get there.

Start with pacing

Endometriosis UK's pelvic exercise leaflet, produced with help from a University of Oxford team, sets out the principles that matter most:

• Start with very small amounts, and build up only when your body feels ready.
• Don't push into discomfort or pain. A stretch should feel like a stretch, nothing more.
• Leave a recovery day between sessions so you can check how your body coped.

The Physio-EndEA trial in Spain gives a useful model of how slow "slow" can be. Its program ran twice a week, and a physiotherapist set a daily ceiling for how tired each woman was allowed to feel, starting low and rising over 8 weeks. The walking part grew from 20 minutes to 40. That's a study design, not proof that it works, but it shows the shape of a careful build.

In practice:

1. Pick a starting dose you're confident you can handle, even on an average day. Ten minutes counts.
2. Rate your effort from 0 to 10 and keep most sessions around 3 to 5 for the first few weeks: you can talk, and you'd be fine doing it again tomorrow.
3. Do the next-day check. If pain or tiredness is worse than your usual the day after a session, go back to the last level that felt fine.
4. Add one thing at a time. Five more minutes of walking, or one more set, then hold there for a week.

What kind of exercise to try

The stretches and mobility moves come from the Endometriosis UK leaflet. Its reasoning is that muscles can get tight and sore, partly from the way you hold yourself when you're in pain, and partly because they end up doing extra work for weaker muscles.

A few tips for strength days:

• Breathe out as you lift instead of holding your breath. Bracing hard and holding your breath can raise pressure in your belly, which some people find makes pelvic pain worse.
• If crunches or sit-ups make pain worse, swap them for gentler core work, such as dead bugs or bird dogs, done slowly.
• Keep your weights light at first. You can always add load once you know how you respond. Our home workout plan has a full-body routine with easier versions of every move if you'd like a structure to follow.

Pelvic floor: relax before you squeeze

Kegels aren't always the answer. A 2021 study of 160 women in Brazil found that those with deep endometriosis had more pelvic floor tension and weaker contractions than women without it. Nearly half of them (45%) couldn't fully relax these muscles, compared with about 14% of the other women, and pain went along with that tension and difficulty relaxing.

If your muscles are already tight, more squeezing may not help. Signs worth raising with your doctor include pain during sex and pain or difficulty when you pee or poo. A pelvic health physiotherapist can check whether your pelvic floor needs relaxing, strengthening or both. Endometriosis UK notes that physiotherapists can put together a program of exercise and relaxation techniques for endometriosis.

A sample week

This is a starting point for someone new to exercise or coming back after a break. Every session has a flare-day version. Use the one that fits the day you're having.

Hold the week as written for two weeks. If your next-day checks are fine, add 5 minutes to the walks or one set to the strength days, then hold again.

On flare days

Rest counts as part of the plan. The NHS lists period pain that stops you doing your normal activities as a main symptom of endometriosis. Pain at that level is a reason to rest and tell your doctor, not something to train through.

If you want to move, keep it small. Slow belly breathing, a few minutes of walking around the house or a supported child's pose are enough. Endometriosis UK says a hot water bottle or a warm bath may help reduce pain.

It's also worth logging your flares next to your cycle and your sessions. After a few months, you may see that flares cluster around your period, or after a certain kind of workout. If they follow your period, our period workouts guide has gentler options for those days. If you're on a hormone treatment that changes or stops your periods, our guide to cycle syncing on birth control explains what that means for planning around your cycle.

You may also see cycle syncing pitched as an answer for endometriosis. We haven't found a study that tests it in people with the condition. Our review of whether cycle syncing works covers what the research does show.

If you'd like help putting a week together, HerShape lets you add endometriosis as a health condition and takes it into account, along with your cycle, goals and equipment, when it builds your plan.

After surgery

Follow your surgeon's advice first. The NHS says that after a laparoscopy (keyhole surgery), recovery usually takes up to 10 days if it was done to diagnose a condition, and up to 6 to 8 weeks to fully recover if it was done to treat one. It also advises moving around as much as you can after the operation.

Walking is usually the first step. Endometriosis UK lists gentle exercise, yoga and Pilates as ways to rebuild your stomach and back muscles after surgery. Ask your surgeon when you can start strength work again, and start lighter than you were before.

Medicines and bone health

GnRH medicines, one of the hormone treatments the WHO lists for endometriosis, can lower bone density. In one small trial in the 2025 review, women on this treatment who also trained lost less bone at the hip over 12 months than those who didn't, although training didn't stop bone loss in the first six months. That's a single study, so don't read too much into it. If you take one of these medicines, ask your doctor about bone health and whether strength or impact training makes sense for you.

When to talk to a clinician

Check in with your doctor or gynecologist:

• Before you start a new exercise plan, if you have deep endometriosis, bowel or bladder symptoms, or recent surgery
• If exercise leaves you with more pain for more than a day or two, or with a new kind of pain
• If your symptoms affect your everyday life, work or relationships, or don't improve with treatment (the NHS's advice)
• If you think you might have endometriosis but haven't been diagnosed. A symptom log can help that conversation.

Get emergency care right away if your pelvic pain is severe or getting worse, or comes with heavy vaginal bleeding or feeling faint or dizzy. The NHS lists these among the signs that need immediate help.

The bottom line

Exercise with endometriosis is about pacing, not pushing. Start with less than you think you can do, leave a recovery day between sessions and build up slowly. The research is small but encouraging for pain and quality of life, and no guideline yet backs a specific program. Keep your doctor in the loop, and treat rest on flare days as part of the plan.

Sources

• NHS: Endometriosis
• NHS: Pelvic pain
• NHS: Laparoscopy (keyhole surgery)
• NHS: Physical activity guidelines for adults aged 19 to 64
• World Health Organization: Endometriosis
• Human Reproduction Open (2022): ESHRE guideline: endometriosis
• BMC Women's Health (2021): Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review
• PLOS One (2025): The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis
• International Journal of Environmental Research and Public Health (2022): 'Physio-EndEA' Study: A Randomized, Parallel-Group Controlled Trial to Evaluate the Effect of a Supervised and Adapted Therapeutic Exercise Program to Improve Quality of Life in Symptomatic Women Diagnosed with Endometriosis
• International Journal of Clinical Practice (2021): Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association
• Endometriosis UK: Pelvic Exercise Programme
• Endometriosis UK: Pain relief for endometriosis