Exercise guide
Endometriosis is a long-term condition in which cells similar to the lining of the womb grow elsewhere, mostly in the pelvis, causing pain, heavy periods and tiredness. Exercise isn't an established treatment: guidelines make no recommendation for or against it, because the few small trials leave its benefits and harms unclear. Treatment rests on painkillers, hormones and sometimes surgery.
The trials are small but encouraging. In one trial of 81 women, adding weekly supervised exercise and pelvic floor training to a pain course eased day-to-day pelvic pain a little, and staying active in ways that feel manageable is reasonable.
This guide covers what each trial found, why the biggest yoga trial was disappointing, why your pelvic floor may need relaxing, strengthening or both, how to pace exercise around flares and after surgery, and the warning signs that need help. It ends with gentle moves in 3D and a 20-minute routine built from the trials.
About 1 in 10 women and people assigned female at birth of reproductive age have endometriosis, around 1.5 million in the UK. It can take years to diagnose: an average of 9 years 4 months from first seeing a GP in the UK.
The European Society of Human Reproduction and Embryology (ESHRE) guideline makes no recommendation for or against exercise, because the benefits and harms are unclear, and the National Institute for Health and Care Excellence (NICE) makes none either. Treatment rests on painkillers, hormones and sometimes surgery, and exercise goes alongside them.
Reviews found only a handful of small trials. In one trial of 81 women, weekly supervised exercise with pelvic floor training eased day-to-day pelvic pain by about 1 point out of 10, but not the worst pain, and a 9-week supervised programme improved quality of life in 31 women.
In 334 people, 8 weeks of online yoga didn't improve quality of life more than reading education material, though it eased period symptoms and pain with sex. Online cognitive behavioural therapy (CBT) did better in the same trial.
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With pelvic pain, the pelvic floor muscles are often tight, and the first step is learning to relax them; others need strengthening, and many need both. A pelvic health physiotherapist can tell you which. Slow breathing and letting go suit everyone, so the routine on this page starts there.
Symptoms vary from day to day, and a pain and symptom diary helps you plan. On bad days, use heat and your usual painkillers and keep any exercise gentle. The Norwegian trial's lead author reported no harms from the exercise and stressed balancing activity and rest.
"Endometriosis is where cells similar to those in the lining of the womb (uterus) grow in other parts of the body", most often around the womb, ovaries, fallopian tubes and the lining of the pelvis, sometimes on the bladder or bowel, and occasionally outside the pelvis. NICE describes it as a condition that depends on oestrogen, mainly in the reproductive years. Adenomyosis, where similar tissue grows into the muscle wall of the womb, is a related condition.
Severe period pain that stops normal activities, heavy periods, pain in the lower tummy and back, pain during or after sex, pain when peeing or pooing, extreme tiredness, low mood, and difficulty getting pregnant. The World Health Organization (WHO) adds bloating and nausea, and notes that heavy bleeding can cause low iron and fatigue. Some people have endometriosis without symptoms.
About 10% of women of reproductive age worldwide (190 million) have endometriosis. Endometriosis UK puts it at 1 in 10 women and those assigned female at birth in the UK, about 1.5 million people. It can affect anyone who has or had a womb, including transgender men and non-binary people who menstruate. Diagnosis is often slow: NICE says delays of 4 to 10 years can occur, WHO puts the average at 4 to 12 years, and Endometriosis UK reports an average of 9 years 4 months in the UK.
There's no cure, but treatment can ease symptoms: painkillers, hormonal medicines such as the combined pill, surgery to remove patches of endometriosis or cysts, and support for pain, tiredness, fertility and mental health. Symptoms usually stop after the menopause, though not always.
A tight (high-tone) pelvic floor is found in 60% to 90% of women with long-term pelvic pain, and endometriosis is one of the conditions that can set it off; WHO notes that problems with the pelvic floor muscles can add to pelvic pain. At one endometriosis clinic, 73% of patients examined had tense or tender pelvic floor muscles.
Lack of energy was the commonest barrier to exercise in 154 women with endometriosis, linked with pain, fatigue and depression. In 460 women with endometriosis and 460 without, those with endometriosis did fewer hours of sport a week. In interviews with 15 people, the overarching theme was a strong wish to be active, held back by constant monitoring of pain and energy.
Blood flows backwards into the pelvis around periods in about 90% of women with open fallopian tubes, whether or not they have endometriosis. The cause of endometriosis is unknown, and it isn't something you bring on by exercising or doing yoga inversions on your period, as our menstrual cycle guide explains.
The trials are in women of reproductive age, mostly with confirmed endometriosis and moderate to severe pain. We found no exercise studies in trans or non-binary people with endometriosis, or after the menopause.
ESHRE recommends that clinicians discuss non-medical ways to improve quality of life, but says no recommendation can be made for any specific one, including physiotherapy and exercise, "as the potential benefits and harms are unclear". NICE's only non-drug recommendation is against traditional Chinese medicine and supplements. WHO says pain management that includes physiotherapy and CBT can help reduce pain and improve quality of life.
A 2021 review found 3 small studies (109 women) of flexibility, strength, cardio and yoga, and couldn't determine an effect. A 2025 review found 6 trials (251 women); only 2 (71 women) could be pooled, showing better quality of life scores for pain, control and emotional wellbeing.
In one trial of 81 women in Norway with confirmed endometriosis and pelvic pain of at least 4 out of 10, everyone went on a 4-hour pain course covering exercise, relaxation and deep breathing. Half then had a weekly 60-minute supervised group session of general exercise with pelvic floor training for 4 months, plus home training 2 to 3 times a week. Their day-to-day pelvic pain eased by 1.1 points out of 10 more than in the comparison group at 4 months, and by 1.5 points at 12 months, but their worst pain didn't improve and other outcomes were unclear.
There are gaps. Women managed 1.8 sessions a week on average, and by 12 months many hadn't returned questionnaires (in the follow-up paper, 63% of the exercise group and 73% of the comparison group did), so the 1-year result is less certain. Sexual function scores were better at 4 months but not at 12, and that difference may partly reflect more sexually active women in the exercise group.
In 31 women not helped by standard treatment, 9 weeks of supervised exercise (a week learning to steady the lower back and pelvis, then stretching, aerobic and strength work) improved quality of life with large effects, after the programme and at a year. Pain with sex, strength and fatigue also improved. Adherence was 90.6%, and there were no notable health problems.
In 40 women, 24 sessions of exercise with education about how pain works, over 8 weeks, improved quality of life more than online lifestyle advice, at 8 weeks and 3 months.
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In 64 women, 8 weeks of functional strength training twice a week improved grip strength, jump height, pain and quality of life, with no change in the comparison group.
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In 40 women, 90-minute yoga sessions twice a week for 8 weeks lowered daily pain. But in the largest trial, 334 people did 8 weekly online yoga sessions or online CBT, or read education material: yoga was no better than education for quality of life, though it improved period symptoms and pain with sex, while CBT improved quality of life and pain. 40% dropped out of the yoga and CBT groups. Studies without a comparison group were positive.
In a review of 7 studies, physiotherapy treatments, mostly electrical stimulation, laser and other treatments applied to the painful area, eased pain by about 2 points out of 10. Other reviews of mixed physical therapies were positive, but the studies varied widely.
The supervised programmes reported no notable health problems, and the Norwegian trial's lead author reported no adverse effects. In the yoga and CBT trial there were 12 mild adverse events, mostly flare-ups of existing problems.
Medicines that switch off oestrogen (gonadotrophin-releasing hormone, or GnRH, medicines) cause bone loss, so ESHRE suggests add-back hormone treatment with them. In a pilot trial of 19 women, training didn't stop the early hip bone loss, but a year later trained women were 0.6% below their starting level, against 3.6% below in the comparison group.
In 9 studies, recent physical activity wasn't significantly linked with a lower risk of endometriosis. ESHRE says there's no direct evidence of benefit, but a healthy lifestyle with regular activity can be advised.
NICE suggests a short trial, for example 3 months, of paracetamol or an anti-inflammatory, and offers hormonal treatment such as the combined pill or a progestogen, which "can reduce pain and has no permanent negative effect on subsequent fertility". ESHRE strongly recommends hormone treatment, and surgery as one option for pain.
Squeezing may not be the answer if you have:
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A tight (overactive) pelvic floor is found in 60% to 90% of women with long-term pelvic pain, and endometriosis is one of the conditions that can set it off. In a 2024 consensus, experts agreed the first treatment is pelvic floor physiotherapy for at least 8 to 12 weeks, aimed at relaxation rather than strengthening. In a trial in women with deep endometriosis and pain at the entrance of the vagina during sex, 5 sessions of relaxation-focused physiotherapy eased that pain (by 3 points out of 10, as a median) and helped the muscles relax, without changing bladder, bowel or sexual function scores; 30 of 34 women finished. In bladder pain with a tender pelvic floor, hands-on physiotherapy helped 59% of 81 women, against 26% with general massage.
But tightness isn't the whole story. In 80 women with endometriosis, how tense the resting muscles were didn't match their pain, and the Norwegian trial's programme included pelvic floor strengthening, which its authors think may work partly by improving the ability to let the muscles go after each squeeze. So some people need to relax first, others need strengthening, and many need both: an assessment tells you which.
If you have the signs above, stop adding squeezes until you've been assessed, and practise letting the pelvic floor soften as you breathe in: the steps below and our relaxation routine show how. For people who can't get to a physiotherapist, the experts suggest guided relaxation, and yoga or stretching aimed at relaxing the pelvic floor, at home. These steps are low risk, but no trial has tested them on their own.
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Ask your GP about a pelvic health physiotherapist (also called a women's health physiotherapist). The NHS lists physiotherapy, such as exercises for the pelvic floor muscles, among the treatments for pelvic pain, and Endometriosis UK says a physiotherapist can develop a programme of exercise and relaxation techniques. Our pelvic floor guide explains squeezing and letting go in more detail.
From the relaxation move on our pelvic floor guide: an editorial starting point, as no trial has tested it on its own. Never push down or strain.
See the movement on the 3D figure: Slow breathing (6 breaths a minute)
NICE suggests keeping a pain and symptom diary. Use it to spot your harder days and plan easier sessions for them (our suggestion).
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Gentle movement if it helps, such as a short walk, the relaxation routine or the period pain routine, with heat and your usual painkillers; leave hard or high-impact sessions for better days. Pain during exercise isn't something to push through. The trial's physiotherapists found that some women did better by easing off and others by being encouraged to start.
Lying face down if you feel bloated; sit-ups, crunches and long breath-holding efforts if they bring on pelvic pain or pressure; and jumping or running. None of these is banned: they're swaps for bad days (our suggestion).
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Tiredness is common, and heavy periods can cause low iron, so mention it to your GP. In one small trial, a 9-week supervised programme reduced fatigue, and the effect lasted a year. Start with short sessions on your better days, and see a GP if exertion leaves you wiped out for days (our suggestion).
The long-term aim is the general guideline: 150 minutes of moderate activity a week and strength work on 2 days. The trials used 2 to 3 sessions a week for 8 to 16 weeks, supervised at first. Start well below that if you need to and build up as you can (our suggestion).
No trial has tested these positions for the pelvic floor, but they are comfortable places to practise letting go as you breathe in, for 1 to 2 minutes each (our suggestion, as on our pelvic floor guide). Skip lying face down on bloated days.
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
3D demoPelvic floor relaxation (reverse Kegel)Beginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoChild's Pose (Balasana)Beginner · No equipment
3D demoHappy Baby (Ananda Balasana)Beginner · No equipment
3D demoReclining Bound Angle (Supta Baddha Konasana)Beginner · No equipment
3D demoCrocodile Breathing (prone diaphragmatic breathing)Beginner · No equipment30 to 60 seconds each, to a mild pull, breathing slowly (our suggestion).
3D demoCat-cowBeginner · No equipment
3D demoLow cobra (Bhujangasana)Beginner · No equipment
3D demoSupine spinal twist (Supta Matsyendrasana)Beginner · No equipment
3D demoReclined figure four (eye of the needle, Sucirandhrasana)Beginner · No equipment
3D demoDouble knee-to-chest stretchBeginner · No equipment
3D demoHalf-kneeling hip flexor stretchBeginner · No equipment
3D demoBound angle pose (Baddha Konasana)Beginner · No equipment6 to 10 slow repetitions, 2 rounds, breathing out on each effort, with no breath-holding or bearing down (our suggestion, after the 9-week trial's work on the lower back and pelvis).
3D demoDead bug heel tapsBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoGlute bridgeBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipment2 days a week, as in the strength trial. Start with 2 sets of 8 to 12 and breathe out as you lift (our suggestion).
3D demoSit to stand from a chairBeginner · A bench or box
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoHip-hinge practiceBeginner · No equipment
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell
3D demoStep-upBeginner · A step
3D demoFarmer's carryBeginner · A dumbbell + A kettlebellBuild towards 150 minutes a week. If a bike saddle presses on a sore pelvis, try the recumbent bike.
Start with the gentle routine built for this page. If your pelvic floor feels tight, do the relaxation routine first; the period pain routine suits harder days.
A gentle 20-minute routine for endometriosis: slow breathing and letting the pelvic floor go, then trunk and hip control, then stretches for back and hips.
20 minBeginner10 movesNo equipmentAn 8-minute routine for a tight pelvic floor: slow breathing and comfortable positions to help the muscles let go, with no strengthening squeezes.
8 minBeginner5 movesNo equipmentA gentle 20-minute routine for period pain: an easy walk, then cat-cow, cobra, supported fish, child's pose, bound angle, a twist and bridges.
20 minBeginner9 movesCardio machineA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.
25 minBeginner14 movesNo equipmentA 35-minute yin-style session: seated and lying poses held for 2 to 4 minutes with slow breathing, finishing with legs up the wall and a long rest.
35 minBeginner9 movesA wallA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.
15 minBeginner10 movesNo equipmentSeven gentle stretches and mobility moves for a stiff lower back, done lying and kneeling.
12 minBeginner7 movesA wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 20-minute full-body dumbbell workout: two supersets of squats, rows, Romanian deadlifts and push-ups. Twice a week covers the minimum dose.
20 minBeginner8 movesA dumbbell, A bench or boxAdjust sessions to how you feel each day, and swap in the relaxation routine on flare days.
A free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginner3 days a weekA weekly workout plan for women: three strength days, cardio and pelvic floor training, with the evidence on periods, pregnancy and menopause.
3 training days45 minBeginnerAfter a laparoscopy (keyhole surgery), the NHS says recovery usually takes up to 10 days if it was to diagnose a condition, it may be up to 3 weeks before you can return to work, and full recovery after surgery can take up to 6 to 8 weeks. Move around as much as you can, and do foot and leg exercises, such as ankle circles, while you're resting.
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Endometriosis UK says gentle exercises, yoga or Pilates can help after surgery. Follow your surgical team's timeline for lifting and core work, and build up gradually (our suggestion).
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Ask for an urgent GP appointment or get help from NHS 111 if you have:
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After a laparoscopy, for a very fast heartbeat, chest pain or severe difficulty breathing.
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NICE suggests a short trial, for example 3 months, of paracetamol or an anti-inflammatory, alone or together. Endometriosis UK says anti-inflammatories work better started the day before, or several days before, the pain is expected.
Hormonal treatment, such as the combined pill or a progestogen, can reduce pain with no lasting effect on future fertility. ESHRE strongly recommends hormone treatment and surgery as options, with GnRH medicines as a later step and add-back therapy to protect bone. Exercise works alongside these treatments, not instead of them.
NICE wants specialist endometriosis services to include pain management. WHO names physiotherapy and CBT, and in a trial of 334 people, online CBT improved quality of life and pain.
Heat helps many people with period pain. Endometriosis UK describes a TENS machine (transcutaneous electrical nerve stimulation: a small device that sends mild electrical pulses through the skin) as an alternative to painkillers, and says to check with your GP first, as they're "not suitable for those who may be pregnant or who have a heart condition".
If you have pelvic pain and any of these. Don't drive yourself to A&E.
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If you have pelvic pain and any of these. Sudden, severe pelvic pain, or tummy pain with feeling or being sick, can also be a problem with an ovarian cyst: get an urgent GP appointment or call NHS 111.
If pelvic or period pain is severe or worse than usual, and painkillers haven't helped.
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Guidelines make no recommendation for or against exercise because the evidence is too thin, and in one trial of 81 women, exercise eased day-to-day pain a little but not the worst pain. Staying active in ways that feel manageable is reasonable; treatment rests on painkillers, hormones and sometimes surgery.
No study shows exercise making the disease worse; supervised programmes reported no notable problems, and the trials found small benefits. Some activities can aggravate pain on a bad day, which is a reason to adjust, not to stop (our suggestion).
With pelvic pain, pain with sex or trouble emptying, the pelvic floor is often too tight, and the first treatment aims at relaxation; more squeezing can make it worse. Some people do need strengthening, though, so get assessed by a pelvic health physiotherapist.
The largest trial found 8 weeks of online yoga no better than education for quality of life, though it helped period symptoms and pain with sex. Smaller studies were more positive but weaker. Yoga is fine if you enjoy it; it isn't a proven pain treatment.
This rests on a snapshot study of 21 women, in which longer exercise sessions went with lower oestrogen in saliva. No trial has shown exercise changing the disease, and in 9 studies activity wasn't significantly linked with a lower risk of getting endometriosis.
Blood flows back into the pelvis around periods in about 90% of women with open fallopian tubes, whatever they do, and the cause of endometriosis is unknown. Exercise and yoga inversions on your period aren't a cause.
It may help a little, but the evidence is too thin to be sure. Guidelines make no recommendation for or against exercise, and only a few small trials exist; in the best one, day-to-day pelvic pain eased slightly, but not the worst pain. Staying active in ways that feel manageable is reasonable, alongside painkillers, hormones and sometimes surgery.
There isn't one best type. The trials used supervised general exercise with pelvic floor training, work to steady the lower back and pelvis with stretching, strength training twice a week, and yoga, and most helped a little. Choose what you can keep doing, start gently and go by how you feel each day.
There's no evidence that exercise makes the disease worse, and supervised programmes reported no notable problems. Some activities, such as jumping or long hard sessions, can aggravate pain on a bad day, so swap them for something gentler then. Pain during exercise isn't something to push through.
It may help some symptoms. In the largest trial, 334 people who did 8 weeks of online yoga didn't improve their quality of life more than people who read education material, though their period symptoms and pain with sex improved. Online CBT did better in the same trial.
Not as a first step if you have pelvic pain, pain with sex or trouble emptying your bladder or bowel: the pelvic floor is often too tight then, and the first treatment aims at relaxing it. Some people do need strengthening, so ask a pelvic health physiotherapist to check what you need.
It means the muscles at the base of the pelvis stay tense instead of letting go, which can add to pelvic pain and pain with sex. Practise letting them soften and drop as you breathe in, lying down or in child's pose; our relaxation routine shows how. In one small trial in women with endometriosis, relaxation-focused physiotherapy eased pain during sex.
Yes, if it feels OK. The NHS suggests gentle exercise such as yoga, swimming, walking or cycling for period pain, alongside heat and painkillers. On heavy or painful days, a shorter or gentler session is fine.
Move around and do foot and leg exercises from the start, and follow your surgical team's timeline for lifting and core work. The NHS says recovery from a diagnostic laparoscopy takes up to 10 days, and full recovery after surgery can take 6 to 8 weeks. Build up gradually.
Possibly: in one small trial, a 9-week supervised programme reduced fatigue, and the effect lasted a year. Lack of energy is the commonest barrier, so start with short sessions on your better days. Heavy periods can cause low iron, so mention tiredness to your GP.
It hasn't been shown to. In 9 studies, physical activity wasn't significantly linked with a lower chance of having endometriosis, though the ESHRE guideline says a healthy lifestyle with regular activity can still be advised.
Yes, if it feels manageable: in a small trial, 8 weeks of strength training twice a week improved strength, pain and quality of life. Breathe out on each effort rather than holding your breath, and swap running or heavy sessions for something gentler on flare days.
Painkillers such as anti-inflammatories, hormonal treatments such as the combined pill, and surgery have the strongest evidence, and specialist services include pain management. Talking therapy (CBT) helped pain in a large trial. Exercise works alongside these, not instead of them.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
