Pilates for endometriosis: what it can do for pain, your pelvic floor and flare days

No Pilates trial yet

We found no trial of Pilates for endometriosis. But Endometriosis UK's own pelvic exercise programme is made of Pilates-style moves: breathing, gentle deep tummy work, pelvic tilts, bridges, clams and the hundred.

Sources 1, 2

Exercise helps a little

In the main exercise trial, of 81 women, weekly supervised exercise with pelvic floor training eased day-to-day pelvic pain by about 1 to 1.5 points out of 10, but not the worst pain. In a 2025 review of 17 trials of physical rehabilitation, exercise improved quality of life, but its effect on pain wasn't significant, and the result rests on few, varied trials.

Sources 3, 4

The guidelines don't recommend for or against it

The European guideline can't recommend any exercise or physiotherapy as a treatment "as the potential benefits and harms are unclear", and NICE (the National Institute for Health and Care Excellence) makes no recommendation. Endometriosis UK calls yoga and Pilates "good low-impact options".

Sources 5, 6, 7

Let your pelvic floor go first

At one specialist clinic, 73% of people examined had a tense or tender pelvic floor, and with pelvic pain, pelvic floor exercises "may not be appropriate and could increase pain". Skip "lift your pelvic floor" cues and let it soften as you breathe in.

Sources 8, 9, 10

Start small, and pace it

Endometriosis UK says begin with very small amounts, work within limits that change from day to day, and allow a recovery day between sessions. In a survey, a minority of people who used yoga or Pilates reported that it raised their pain.

Sources 2, 11

On flare days, do less

Breathing, the pelvic floor release and gentle stretches, or rest, with heat and your usual painkillers. Leave stronger sessions for better days (our suggestion).

Sources 2, 12

What endometriosis is

Endometriosis is where cells similar to the lining of the womb grow elsewhere in the body, often around the womb, ovaries, fallopian tubes and the lining of the pelvis. It can cause severe period pain, heavy periods, pain in the lower tummy and back, pain when peeing or pooing or during or after sex, and extreme tiredness. The World Health Organization estimates it affects about 10% of women and girls of reproductive age worldwide, and it can affect anyone who has or has had a womb.

Sources 13, 14

Why the muscles matter

The World Health Organization says pelvic floor muscle problems can contribute to long-lasting pelvic pain. Endometriosis UK describes the pelvic floor in people with pelvic pain as commonly "overworked, shortened and painful", and pain can make you brace and guard without noticing.

Not everyone is tight, though: in 80 women with endometriosis, resting pelvic floor activity wasn't linked with pain, so tightness is something a physiotherapist assesses rather than assumes.

Sources 14, 2, 15

What Pilates offers

Slow breathing, gentle control of the deep tummy muscles, small pelvic and hip movements and stretches. What some Pilates teaching adds, and this guide takes out, is constant bracing: "draw in and lift your pelvic floor" through every move. In a back pain trial of 152 people, Pilates done with a relaxed tummy did slightly better than Pilates with the core held tight.

Sources 2, 16

Where people differ

Symptoms change from day to day and over your cycle, and NICE suggests keeping a pain and symptom diary. Some people are bloated or tender, some have endometriosis on the bowel or bladder, and some are recovering from surgery, so the right class differs from person to person and from week to week.

Source 6

No Pilates trialsMixed evidence

We found no trial of Pilates for endometriosis or adenomyosis. The nearest evidence is Endometriosis UK's programme, which hasn't itself been tested, and exercise trials that included Pilates-like control work for the lower back and pelvis.

Sources 1, 2, 17

Exercise eased day-to-day pain a littleEmerging evidence

In Norway, 81 women with confirmed endometriosis and pain of at least 4 out of 10 all had a pain management course; half then did a weekly 60-minute supervised group session of general exercise with pelvic floor training for 4 months, plus training at home. Their current pelvic pain eased by 1.1 points out of 10 more at 4 months and 1.5 more at a year, but their worst pain didn't change and other results were unclear. No adverse effects were reported.

Sources 3, 18, 19

Quality of life improved in small trialsEmerging evidence

In Spain, 9 weeks of supervised core control, stretching, aerobic and strength exercise improved quality of life a lot in 31 women not helped by usual treatment, with less pain with sex and less tiredness. In 2026 trials, exercise with pain education (40 women) and strength training twice a week (64 women) improved quality of life, and diet and activity coaching on top of hormone treatment eased pelvic pain between periods in 140 women.

Sources 17, 20, 21, 22, 23

The reviews: low certaintyMixed evidence

A 2025 review of 17 trials of physical rehabilitation found that exercise improved quality of life (low certainty), but its effect on pain wasn't significant (very low certainty). The analysis rests on few, small trials of very different programmes: a 2026 review of 33 trials of non-drug treatments found only 2 of exercise, and physical rehabilitation didn't significantly change sexual function. Earlier reviews couldn't determine an effect, or found better quality of life in 2 pooled trials.

Sources 4, 24, 25, 26, 27

Yoga: mixed resultsMixed evidence

In the largest trial, 334 people were randomised to online yoga, online CBT (cognitive behavioural therapy) or emailed education: yoga improved period symptoms and pain with sex but not quality of life, compared with education, and 40% dropped out of the yoga. A small trial of hatha yoga in 40 women lowered daily pain.

Sources 28, 29

Pilates eases period pain, but that isn't endometriosisEmerging evidence

Small trials of Pilates twice a week, in 30, 45 and 22 women without endometriosis, eased period pain or period symptoms, and a Cochrane review found exercise may reduce period pain a lot (low quality evidence). Endometriosis pain is different, so these results don't transfer directly.

Sources 30, 31, 32, 33

NICE

NICE's endometriosis guideline makes no recommendation about exercise. Its only advice on non-drug treatment is that the evidence doesn't support Chinese medicine or supplements.

Source 6

ESHRE (the European Society of Human Reproduction and Embryology)

Clinicians should discuss non-medical strategies for quality of life, but "no recommendations can be made for any specific non-medical intervention", including physiotherapy and exercise, "as the potential benefits and harms are unclear". On prevention, it lists regular physical activity as part of a healthy lifestyle.

Source 5

The World Health Organization

Pain management that includes physiotherapy and CBT "can also help to reduce endometriosis-related pain and improve quality of life".

Source 14

The NHS

For period pain, the NHS suggests gentle exercise such as yoga, swimming, walking or cycling. For pelvic pain, a GP may suggest physiotherapy, such as exercises for the pelvic floor muscles.

Sources 12, 34

Endometriosis UK

Swimming, yoga, Pilates, walking and cycling are "good low-impact options and you can build up slowly and gently". Its booklet says yoga and Pilates can help either strengthen the pelvic floor or relax tension in it; with pelvic pain, the UK's pelvic health physiotherapists and a 2024 expert consensus put relaxing first, so this guide does too.

Sources 7, 9, 10

Tight is common, but not universalEmerging evidence

At one specialist clinic, 73% of 219 people with suspected or confirmed endometriosis had pelvic floor tension or tenderness. In 80 women with endometriosis, resting pelvic floor activity wasn't linked with pelvic pain or pain with sex.

Sources 8, 15

Relaxation comes first with painStrong evidence

POGP (Pelvic, Obstetric and Gynaecological Physiotherapy), the UK's pelvic health physiotherapists, says that with persistent pelvic pain, pelvic floor exercises "may not be appropriate and could increase pain and symptoms", while muscle relaxation and stretching help. A 2024 expert consensus puts relaxation-focused pelvic floor physiotherapy first for a tight pelvic floor, with guided relaxation at home for people who can't get it.

Sources 9, 10

Relaxation physiotherapy eased pain with sexEmerging evidence

In 34 women with deep endometriosis and pain at the entrance to the vagina during sex, 5 sessions of relaxation-focused pelvic floor physiotherapy reduced that pain (by a median of 3 points out of 10) and improved relaxation on ultrasound.

Source 35

In Pilates terms

Drop the "draw up your pelvic floor" cue if you have pelvic pain, pain with sex or trouble emptying. Breathe so your tummy and pelvic floor soften on the in-breath, keep deep tummy work gentle (Endometriosis UK uses about 20% of a full squeeze), and let go fully after every effort (our application of these sources).

If you leak with effort and have no pain, pelvic floor squeezes are the first treatment: our Pilates for the pelvic floor guide covers them. A pelvic health physiotherapist can tell whether your pelvic floor needs relaxing, strengthening or both.

Sources 9, 10, 16, 2

Endometriosis UK's pacing advice

"Begin with very small amounts and gradually build things up if and when your body feels able to." Work within limits that "may change from day to day", and "Allow a recovery day between each session" to check you haven't flared.

Source 2

Adapt to the day

The Norwegian trial's lead author says exercise should be adapted to each person's pain and to daily changes in energy, sleep and pain: some women did better by reducing intensity, and others by being encouraged to get started.

Source 19

Some people do flareMixed evidence

In a survey of 484 Australian women, yoga or Pilates was rated 4.5 out of 10 for pain relief, and 15.9% of those who used it reported side effects, mostly more pelvic pain, against 34.2% of people who exercised in other ways. A survey of 912 people in Germany, Austria and Switzerland rated yoga or Pilates 5.1 out of 10. These figures are self-reported by people who chose to answer, many through support groups.

Sources 11, 36

Our flare-day plan

Our editorial plan, built on these sources:

• Plan easier sessions for days that are usually worse; a symptom diary, which NICE suggests, helps you spot them.
• On a flare day: slow breathing, the pelvic floor release and gentle stretches, or rest, with heat and your usual painkillers.
• On better days: the full class, building up slowly.
• Over the weeks, if and when your body allows: work towards the UK guideline of 150 minutes of moderate activity a week, with strengthening on at least 2 days.

Sources 6, 2, 12, 37

Change position

When you're bloated, put a pillow under your tummy for face-down moves, as Endometriosis UK suggests for swimming, or skip lying face down. Leave curl-ups and roll-ups for another day if they press on a tender tummy (our suggestion). In a lab study, most beginner Pilates moves raised pressure inside the tummy no more than standing up from a chair did; roll-ups kept it high for longest.

Sources 2, 38

Recovery takes weeks

After a laparoscopy (keyhole surgery) to diagnose endometriosis, recovery takes up to 10 days; after surgery to treat it, it can take 6 to 8 weeks to fully recover. Move around as much as you can, and do foot and leg exercises while you're resting.

Source 39

Gentle Pilates can help your recovery

Endometriosis UK says "gentle exercises, yoga or Pilates can be helpful to support your recovery". Follow your surgical team's timeline for core work and lifting: start with breathing, walking and gentle moves on your back, and add Pilates core work gradually (our suggestion). After a hysterectomy, our hysterectomy guide covers the stages.

Source 7

Treatment carries the evidenceStrong evidence

There's no cure, but painkillers, hormone treatments and sometimes surgery manage the symptoms. NICE suggests a short trial of paracetamol or an anti-inflammatory painkiller and hormonal treatment, and a 2025 review puts hormonal medicines first for people not trying to get pregnant.

Sources 13, 6, 40

Talking therapy helped tooEmerging evidence

In the largest trial of self-help, online CBT improved quality of life and pain.

Source 28

Where Pilates fits

Pilates is something you do alongside treatment, for movement, confidence and quality of life. It isn't a treatment for the disease, and it isn't a reason to stop or change any medicine.

Pelvic floor squeezes and constant bracing

With pelvic pain, pain with sex or trouble emptying, don't add squeezes or "lift your pelvic floor" cues: use the release, and let a pelvic health physiotherapist decide about strengthening. Keep deep tummy work at about 20% effort rather than bracing hard.

Sources 9, 16, 2

Curl-ups and roll-ups

The roll-up, teaser, criss-cross and chest lift can press on a tender or bloated tummy, and roll-ups kept pressure in the tummy high for longest in a lab study. Keep them for good days, or use the head-down hundred and dead bug heel taps (our suggestion).

Source 38

Face-down moves when you're bloated

The swan and swimming: a pillow under your tummy, or skip them.

Source 2

Long holds and harder classes on flare days

Do the breathing and stretches only, or rest.

Sources 2, 19

Call 999 or go to A&E (911 in the US)

If you have pelvic pain and any of these. Don't drive yourself to A&E.

• It's severe, getting worse, or it hurts to move or touch the area.
• You feel faint, dizzy or light-headed, or you pass out.
• You have pain in the tip of your shoulder.
• You have difficulty breathing.
• You have heavy bleeding from your vagina.
• You suddenly feel confused.

Source 34

Get help from NHS 111

If you have pelvic pain and any of these.

• You find it difficult to pee or poo, or there's blood in your pee or poo.
• You have unusual discharge or bleeding from your vagina, or pain when peeing.
• You have a very high temperature, or feel hot, cold or shivery.
• You're vomiting, have diarrhoea or feel sick.
• You are or may be pregnant.

Source 34

Urgent GP appointment or NHS 111

If pelvic or period pain is severe or worse than usual, and painkillers haven't helped.

Source 12

See a GP

• You think you might have endometriosis, or your symptoms affect your daily life, work or relationships.
• Treatment from a GP isn't helping.
• Pelvic pain or bloating that comes and goes or doesn't go away, losing weight without trying, or feeling full quickly.
• Periods that become more painful, heavier or irregular, period pain that stops your usual activities, pain during sex, or bleeding between periods or after sex.
• Heavy periods that affect your life: changing a pad or tampon every 1 to 2 hours, passing clots larger than about 2.5 cm, or bleeding through to your clothes.

Sources 13, 34, 12, 41

After keyhole surgery

Ask for an urgent GP appointment or call NHS 111 for a high temperature, severe or continuous vomiting, tummy pain that's getting worse, a bloated tummy, pain, swelling, bleeding, pus or redness around your wounds, pain and swelling in one leg, or more breathlessness than usual. Call 999 for a very fast heartbeat, chest pain or severe difficulty breathing.

Source 39

During Pilates

Stop a move that brings on sharp or worsening pelvic pain, and leave out pelvic floor squeezes, curl-ups or long holds if they bring on pain. Pain during or after pelvic floor exercises, or trouble emptying your bladder or bowel, is a reason to ask your GP about a pelvic health physiotherapist.

Sources 9, 2

"Exercise makes endometriosis worse"Mixed evidence

Trials of supervised exercise reported no harm and a small benefit. Some people do flare: in one survey, 15.9% of yoga or Pilates users self-reported side effects, mostly more pelvic pain, which is why Endometriosis UK says start small and allow a recovery day.

Sources 3, 19, 17, 11, 2

"Pilates strengthens your pelvic floor, and that eases endometriosis pain"Mixed evidence

Not shown. The pelvic floor is often tight with pelvic pain, pelvic floor exercises "may not be appropriate and could increase pain", and relaxation comes first.

Sources 8, 9, 10

"Exercise or upside-down poses on your period cause endometriosis"Emerging evidence

No study links exercise or going upside down with endometriosis. Blood flows back into the pelvis during periods in about 90% of women with open fallopian tubes, whether or not they have endometriosis.

Source 42

"Pilates balances your hormones"Mixed evidence

No trial has shown Pilates changes hormones or the disease, and the European guideline can't recommend exercise as a treatment.

Sources 1, 5

"You can't do core work with endometriosis"Mixed evidence

Endometriosis UK's own programme includes the hundred, bridges and deep tummy work, at a gentle effort and built up slowly.

Source 2

"Rest until the pain goes"Emerging evidence

On bad days, rest or very gentle movement is fine, but the trials and Endometriosis UK support building activity up gradually.

Sources 3, 2, 19