Physical Activity as an Adjunctive Therapy for Endometriosis: A Narrative Review

Endometriosis is a chronic condition that affects approximately one in ten women of reproductive age worldwide. Clinical expression varies among patients, but the most prevalent include pelvic pain, heavy menstrual bleeding, dyspareunia, and impaired fertility. Treatment usually relies on alleviating the symptoms by administering pain medications, hormonal therapies, or performing surgical procedures, which are often associated with side effects and variable long-term outcomes. Physical activity can be considered a beneficial complementary intervention because it may improve pain modulation and mental health. Nevertheless, current research has not yet established consistent evidence regarding the effectiveness of exercise in improving disease outcomes in women with endometriosis. This narrative review aims to summarize and critically evaluate current evidence regarding the impact of physical activity on women with endometriosis.

This narrative review was based on studies identified through searches of the PubMed, Google Scholar, and Europe PMC databases. Relevant studies were reviewed to evaluate the effects of physical activity on pain, quality of life, and other symptoms associated with endometriosis.

The current evidence suggests that physical activity and exercise may reduce pain in endometriosis, improve quality of life, and enhance psychological well-being. However, the available evidence remains limited because of the small number of randomized controlled trials, exercise interventions, and variability in outcome measures.

Physical activity appears to be safe and could be a beneficial adjunctive therapy for the management of endometriosis symptoms. Current literature remains limited and yields insufficient results. Therefore, further high-quality randomized controlled trials are needed to establish evidence-based exercise recommendations for women with endometriosis.References (1) World Health Organization. Endometriosis [Internet]. World Health Organization. World Health Organization; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/endometriosis (2) Lamceva J, Uljanovs R, Strumfa I. The Main Theories on the Pathogenesis of Endometriosis. International Journal of Molecular Sciences [Internet]. 2023 Feb 21;24(5):4254. Available from: https://www.mdpi.com/1422-0067/24/5/4254 https://doi.org/10.3390/ijms24054254 (3) Hoffman BL, Schorge JO, Halvorson LM, Hamid CA, Corton MM, Schaffer JI. Endometriosis. In: Williams Gynecology. 4th ed. New York: McGraw Hill Education; 2020 (4) Zondervan KT, Becker CM, Missmer SA. Endometriosis. Longo DL, editor. New England Journal of Medicine [Internet]. 2020 Mar 26;382(13):1244–56. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra1810764 https://doi.org/10.1056/NEJMra1810764 (5) Ringleb M, Florian Javelle, Haunhorst S, Bloch W, Fennen L, Baumgart S, et al. Beyond muscles: Investigating immunoregulatory myokines in acute resistance exercise – A systematic review and meta‐analysis. The FASEB journal. 2024 Apr 10;38(7). https://doi.org/10.1096/fj.202301619R (6) Pedersen BK, Saltin B. Exercise as Medicine - Evidence for Prescribing Exercise as Therapy in 26 Different Chronic Diseases. Scandinavian Journal of Medicine & Science in Sports. 2015 Nov 25;25(s3):1–72. https://doi.org/10.1111/sms.12581 (7) França PR de C, Lontra ACP, Fernandes PD. Endometriosis: A Disease with Few Direct Treatment Options. Molecules (Basel, Switzerland) [Internet]. 2022 Jun 23;27(13):4034. Available from: https://pubmed.ncbi.nlm.nih.gov/35807280/ https://doi.org/10.3390/molecules27134034 (8) Lalla AT, Onyebuchi C, Jorgensen E, Clark N. Impact of lifestyle and dietary modifications for endometriosis development and symptom management. Curr Opin Obstet Gynecol. 2024;36(4):233-239. https://doi.org/10.1097/GCO.0000000000000969 (9) Cirillo M, Argento FR, Becatti M, Fiorillo C, Coccia ME, Fatini C. Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis. International Journal of Molecular Sciences [Internet]. 2023 Sep 27;24(19):14601. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572576/ https://doi.org/10.3390/ijms241914601 (10) Annelotte Van Haaps, Wijbers J, Schreurs AMF, Vlek SL, Tuynman JB, B De Bie, et al. The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group. Human Reproduction. 2023 Oct 24;38(12). https://doi.org/10.1093/humrep/dead215 (11) Pedersen BK, Febbraio MA. Muscle as an endocrine organ: focus on muscle-derived interleukin-6. Physiological reviews [Internet]. 2008;88(4):1379–406. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18923185 https://doi.org/10.1152/physrev.90100.2007 (12) Petersen AMW, Pedersen BK. The anti-inflammatory effect of exercise. Journal of Applied Physiology. 2005 Apr;98(4):1154–62. https://doi.org/10.1152/japplphysiol.00164.2004 (13) Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature reviews Immunology. 2011;11(9):607–15. https://doi.org/10.1038/nri3041 (14) Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, et al. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. The Journal of Pain. 2019 Nov 1;20(11):1249–66. https://doi.org/10.1016/j.jpain.2019.03.005 (15) Xie M, Qing X, Huang H, et al. The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis. PLoS One. 2025;20(2):e0317820. https://doi.org/10.1371/journal.pone.0317820 (16) Tennfjord MK, Gabrielsen R, Tellum T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Women's Health. 2021;21(1):355. https://doi.org/10.1186/s12905-021-01500-4 (17) Gabrielsen R, Tellum T, Bø K, Engh ME, Frawley H, Tveito SN, Tennfjord MK. Supervised exercise and pelvic floor muscle training eases current pelvic and genital pain but not worst pelvic and genital pain in women with endometriosis: a randomized trial. J Physiother. 2025;71(4):246-253. https://doi.org/10.1016/j.jphys.2025.09.012 (18) Merete Kolberg Tennfjord, Gabrielsen R, Bø K, Marie Ellström Engh, Molin M. Can general exercise training and pelvic floor muscle training be used as an empowering tool among women with endometriosis? Experiences among women with endometriosis participating in the intervention group of a randomized controlled trial. BMC Women s Health. 2024 Sep 12;24(1). https://doi.org/10.1186/s12905-024-03356-w (19) World Health Organization. WHO guidelines on physical activity and sedentary behaviour [Internet]. World Health Organisation. 2020. Available from: https://www.who.int/publications/i/item/9789240015128 (20) Gambadauro P, Carli V, Hadlaczky G. Depressive symptoms among women with endometriosis: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;220(3):230-241.e1. Downloads Published How to Cite Issue Section License Copyright (c) 2026 Martyna Lazar, Łukasz Szkaradowski, Szymon Baranowski, Julia Lewańska, Krzysztof Bogdański, Zuzanna Kruszyńska, Anastasiya Aleshchyk, Michał Adamczak, Marcel Majewski, Bogumił Libura This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Stats Number of views and downloads: 37 Number of citations: 0