THE ROLE OF PHYSICAL ACTIVITY IN THE MANAGEMENT OF ENDOMETRIOSIS: A LITERATURE REVIEW

Karolina Marrodán-Wojtczak, Paulina Krzeszowska, Adrianna Zajączkowska, J Zajåczkowski, Jan Wilk, Kacper Stępniak, Jakub Jarmołowicz, Aleksandra Kujawa, Karolina Krochmal, Radosław Kuźma
In: International Journal of Innovative Technologies in Social Science · 2025 · vol. 5(3(47)) · doi:10.31435/ijitss.3(47).2025.3916 · W4415123575
article OA: gold CC0
🔓 Open OA copy Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

Physical activity is associated with reduced endometriosis symptoms, particularly chronic pelvic pain, by modulating inflammation and hormonal balance.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This literature review evaluated how physical activity and exercise affect the course of endometriosis-associated pain and quality of life, using English-language databases (PubMed and Google Scholar) to review studies from 1985 to 2025. Across the included heterogeneous studies, physical activity was consistently reported to reduce endometriosis-related symptoms, especially chronic pelvic pain, with benefits also described for fatigue. The authors’ major limitation is the methodological heterogeneity across studies and the need for further standardized, large-scale trials to determine the optimal type, duration, and intensity of exercise and to confirm long-term effects. This paper is centrally about endometriosis — it specifically reviews evidence on physical activity and exercise as a complementary management approach for endometriosis symptoms.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Background: Endometriosis is a chronic gynecological disorder characterized by ectopic endometrial tissue, leading to inflammation, chronic pelvic pain and reduced quality of life. While hormonal and surgical treatments remain standard, interest in non-pharmacological interventions, including physical activity, has grown due to its potential anti-inflammatory, analgesic, and psychosocial benefits. Purpose: To evaluate the impact of physical activity on the course of endometriosis Material and Methods: Information was collected using the english language literature databases such as PubMed and GoogleScholar. The literature from 1985-2025 was reviewed to evaluate the pain management in endometriosis. Specific attention was paid to publications on the impact of physical activity and exercises on endometriosis associated pain and the quality of life. Results: The reviewed literature consistently indicated that physical activity contributed to a reduction in endometriosis-related symptoms, most notably chronic pelvic pain. Despite methodological heterogeneity, all studies reported either clinical or statistically significant benefits of PA in endometriosis symptom management. However, several authors emphasized the need for further standardized, large-scale trials to determine optimal exercise type, duration, and intensity. Conclusions: Physical activity appears to be a promising complementary therapy for managing endometriosis symptoms, particularly pain and fatigue, by modulating inflammation, stress responses, and hormonal balance. While current data are encouraging, further high-quality, longitudinal studies are required to establish standardized exercise protocols and confirm long-term benefits.
Full text 11,207 characters · extracted from oa-doi-fallback · 5 sections · click to expand

Background

Endometriosis is a chronic gynecological disorder characterized by ectopic endometrial tissue, leading to inflammation, chronic pelvic pain and reduced quality of life. While hormonal and surgical treatments remain standard, interest in non-pharmacological interventions, including physical activity, has grown due to its potential anti-inflammatory, analgesic, and psychosocial benefits. Purpose: To evaluate the impact of physical activity on the course of endometriosis

Material and methods

Information was collected using the english language literature databases such as PubMed and GoogleScholar. The literature from 1985-2025 was reviewed to evaluate the pain management in endometriosis. Specific attention was paid to publications on the impact of physical activity and exercises on endometriosis associated pain and the quality of life.

Results

The reviewed literature consistently indicated that physical activity contributed to a reduction in endometriosis-related symptoms, most notably chronic pelvic pain. Despite methodological heterogeneity, all studies reported either clinical or statistically significant benefits of PA in endometriosis symptom management. However, several authors emphasized the need for further standardized, large-scale trials to determine optimal exercise type, duration, and intensity.

Conclusions

Physical activity appears to be a promising complementary therapy for managing endometriosis symptoms, particularly pain and fatigue, by modulating inflammation, stress responses, and hormonal balance. While current data are encouraging, further high-quality, longitudinal studies are required to establish standardized exercise protocols and confirm long-term benefits.

References

Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26; 382(13):1244-1256. doi: 10.1056/NEJMra1810764. PMID: 32212520. Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocr Rev. 2019 Aug 1; 40(4):1048-1079. doi: 10.1210/er.2018-00242. PMID: 30994890; PMCID: PMC6693056. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014 May; 10(5):261-75. doi: 10.1038/nrendo.2013.255. Epub 2013 Dec 24. PMID: 24366116. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019 Nov; 15(11):666-682. doi: 10.1038/s41574-019-0245-z. Epub 2019 Sep 5. PMID: 31488888. De Graaff AA, D'Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L; WERF EndoCost Consortium; Simoens S. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod. 2013 Oct; 28(10):2677-85. doi: 10.1093/humrep/det284. Epub 2013 Jul 11. PMID: 23847114. Stratton P, Berkley KJ. Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update. 2011 May-Jun; 17(3):327-46. doi: 10.1093/humupd/dmq050. Epub 2010 Nov 23. PMID: 21106492; PMCID: PMC3072022. Greaves E, Temp J, Esnal-Zufiurre A, Mechsner S, Horne AW, Saunders PT. Estradiol is a critical mediator of macrophage-nerve cross talk in peritoneal endometriosis. Am J Pathol. 2015 Aug; 185(8):2286-97. doi: 10.1016/j.ajpath.2015.04.012. Epub 2015 Jun 12. PMID: 26073038; PMCID: PMC4530129. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol. 2017 Feb; 209:8-13. doi: 10.1016/j.ejogrb.2016.07.497. Epub 2016 Aug 3. PMID: 27522645. Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord. 2022 Jun; 23(3):333-355. doi: 10.1007/s11154-021-09666-w. Epub 2021 Aug 17. PMID: 34405378; PMCID: PMC9156507. Giudice LC, As-Sanie S, Arjona Ferreira JC, Becker CM, Abrao MS, Lessey BA, Brown E, Dynowski K, Wilk K, Li Y, Mathur V, Warsi QA, Wagman RB, Johnson NP. Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2). Lancet. 2022 Jun 18; 399(10343):2267-2279. doi: 10.1016/S0140-6736(22)00622-5. Erratum in: Lancet. 2022 Aug 27; 400(10353):660. doi: 10.1016/S0140-6736(22)01581-1. PMID: 35717987. Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2017 Jan 23; 1(1):CD004753. doi: 10.1002/14651858.CD004753.pub4. PMID: 28114727; PMCID: PMC6464974. ETIC Endometriosis Treatment Italian Club. When more is not better: 10’don'ts' in endometriosis management. An ETIC* position statement. Hum Reprod Open. 2019 Jun 12; 2019(3):hoz009. doi: 10.1093/hropen/hoz009. PMID: 31206037; PMCID: PMC6560357. Muñoz-Gómez E, Alcaraz-Martínez AM, Mollà-Casanova S, Sempere-Rubio N, Aguilar-Rodríguez M, Serra-Añó P, Inglés M. Effectiveness of a Manual Therapy Protocol in Women with Pelvic Pain Due to Endometriosis: A Randomized Clinical Trial. J Clin Med. 2023 May 6; 12(9):3310. doi: 10.3390/jcm12093310. PMID: 37176750; PMCID: PMC10179466. Tandon HK, Stratton P, Sinaii N, Shah J, Karp BI. Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment. Reg Anesth Pain Med. 2019 Jul 8:rapm-2019-100529. doi: 10.1136/rapm-2019-100529. Epub ahead of print. PMID: 31289238; PMCID: PMC6946887. Giese N, Kwon KK, Armour M. Acupuncture for endometriosis: A systematic review and meta-analysis. Integr Med Res. 2023 Dec; 12(4):101003. doi: 10.1016/j.imr.2023.101003. Epub 2023 Oct 28. PMID: 38033648; PMCID: PMC10682677. Barnard ND, Holtz DN, Schmidt N, Kolipaka S, Hata E, Sutton M, Znayenko-Miller T, Hazen ND, Cobb C, Kahleova H. Nutrition in the prevention and treatment of endometriosis: A review. Front Nutr. 2023 Feb 17; 10:1089891. doi: 10.3389/fnut.2023.1089891. PMID: 36875844; PMCID: PMC9983692. Bonocher CM, Montenegro ML, Rosa E Silva JC, Ferriani RA, Meola J. Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol. 2014 Jan 6; 12:4. doi: 10.1186/1477-7827-12-4. PMID: 24393293; PMCID: PMC3895811. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr; 100(2):126-31. PMID: 3920711; PMCID: PMC1424733. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr; 2(2):1143-211. doi: 10.1002/cphy.c110025. PMID: 23798298; PMCID: PMC4241367. Cramer DW, Wilson E, Stillman RJ, Berger MJ, Belisle S, Schiff I, Albrecht B, Gibson M, Stadel BV, Schoenbaum SC. The relation of endometriosis to menstrual characteristics, smoking, and exercise. JAMA. 1986 Apr 11; 255(14):1904-8. PMID: 3951117. Carpenter SE, Tjaden B, Rock JA, Kimball A. The effect of regular exercise on women receiving danazol for treatment of endometriosis. Int J Gynaecol Obstet. 1995 Jun; 49(3):299-304. doi: 10.1016/0020-7292(95)02359-k. PMID: 9764869. Koppan A, Hamori J, Vranics I, Garai J, Kriszbacher I, Bodis J, Rebek-Nagy G, Koppan M. Pelvic pain in endometriosis: painkillers or sport to alleviate symptoms? Acta Physiol Hung. 2010 Jun; 97(2):234-9. doi: 10.1556/APhysiol.97.2010.2.10. PMID: 20511133. Awad E, Ahmed HAH, Yousef A, Abbas R. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. J Phys Ther Sci. 2017 Dec; 29(12):2112-2115. doi: 10.1589/jpts.29.2112. Epub 2017 Dec 7. PMID: 29643586; PMCID: PMC5890212. Bergström I, Freyschuss B, Jacobsson H, Landgren BM. The effect of physical training on bone mineral density in women with endometriosis treated with GnRH analogs: a pilot study. Acta Obstet Gynecol Scand. 2005 Apr; 84(4):380-3. doi: 10.1111/j.0001-6349.2005.00558.x. PMID: 15762970. Loewenthal J, Innes KE, Mitzner M, Mita C, Orkaby AR. Effect of Yoga on Frailty in Older Adults: A Systematic Review. Ann Intern Med. 2023 Apr; 176(4):524-535. doi: 10.7326/M22-2553. Epub 2023 Mar 14. PMID: 36913687. Gonçalves AV, Barros NF, Bahamondes L. The Practice of Hatha Yoga for the Treatment of Pain Associated with Endometriosis. J Altern Complement Med. 2017 Jan; 23(1):45-52. doi: 10.1089/acm.2015.0343. Epub 2016 Nov 21. PMID: 27869485. Tennfjord MK, Gabrielsen R, Tellum T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Womens Health. 2021 Oct 9; 21(1):355. doi: 10.1186/s12905-021-01500-4. PMID: 34627209; PMCID: PMC8502311. Ensari I, Lipsky-Gorman S, Horan EN, Bakken S, Elhadad N. Associations between physical exercise patterns and pain symptoms in individuals with endometriosis: a cross-sectional mHealth-based investigation. BMJ Open. 2022 Jul 18; 12(7):e059280. doi: 10.1136/bmjopen-2021-059280. PMID: 35851021; PMCID: PMC9297219. Artacho-Cordón F, Salinas-Asensio MDM, Galiano-Castillo N, Ocón-Hernández O, Peinado FM, Mundo-López A, Lozano-Lozano M, Álvarez-Salvago F, Arroyo-Morales M, Fernández-Lao C, Cantarero-Villanueva I. Effect of a Multimodal Supervised Therapeutic Exercise Program on Quality of Life, Pain, and Lumbopelvic Impairments in Women With Endometriosis Unresponsive to Conventional Therapy: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2023 Nov; 104(11):1785-1795. doi: 10.1016/j.apmr.2023.06.020. Epub 2023 Jul 17. PMID: 37467936. Abril-Coello R, Correyero-León M, Ceballos-Laita L, Jiménez-Barrio S. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2023 Jul; 162(1):233-243. doi: 10.1002/ijgo.14645. Epub 2023 Jan 17. PMID: 36571475. Afreen S, Perthiani A, Sangster E, Lanka N, Acharya P, Virani S, Malasevskaia I. Comparing Surgical, Acupuncture, and Exercise Interventions for Improving the Quality of Life in Women With Endometriosis: A Systematic Review. Cureus. 2024 Jul 24; 16(7):e65257. doi: 10.7759/cureus.65257. PMID: 39184701; PMCID: PMC11342590. Xie M, Qing X, Huang H, Zhang L, Tu Q, Guo H, Zhang J. The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis. PLoS One. 2025 Feb 13; 20(2):e0317820. doi: 10.1371/journal.pone.0317820. PMID: 39946383; PMCID: PMC11824993. Endometriosis: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2024 Nov 11. PMID: 38815122. Downloads Published Issue Section License All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles. CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosischronic_pelvic_pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (30)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK