The Interplay Between Endometriosis, Athletic Performance, and Physical Activity: A Narrative Review on Symptom Management and Training Adaptations in Active Women

Endometriosis is a chronic, systemic inflammatory condition affecting 10% of women, characterized by chronic pelvic pain, "endo-fatigue" and myofascial hypertonia. In athletes, these symptoms compromise exercise tolerance and neuromuscular function, yet performance-limiting impacts remain under-researched. A critical gap exists regarding training adaptations in active women, as studies traditionally focus on sedentary cohorts. Aim: This review evaluates the bi-directional relationship between endometriosis and athletic performance, synthesizing evidence-based strategies for tailored exercise and training load periodization.

PubMed and Scopus were searched using integrated clinical and exercise science terminology. Eligibility focused on peer-reviewed studies of active populations and physical activity interventions, using thematic narrative synthesis to integrate pathophysiology with performance metrics.

Endometriosis induces objective neuromuscular deconditioning, specifically reduced isometric strength and compromised lumbopelvic control. Structured physical activity and pelvic floor rehabilitation act as anti-inflammatory modulators, reducing pain perception and fatigue while improving cardiorespiratory tolerance. Cycle-adjusted periodization, intensifying loads during peak estrogen phases and utilizing symptom-triggered modifications, maintains training adaptations without provoking flare-ups.

Endometriosis is a systemic performance constraint requiring interdisciplinary sports medicine care and proactive screening. Success requires flexible, symptom-aligned periodization and normalizing menstrual health in competitive sports. Individualized interventions are essential for the well-being and performance longevity of active women.

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