Does Physical Exercise Lower Endometriosis Risk? Systematic Review Insights Original paper

What was reviewed?

This systematic review assessed the relationship between physical exercise and endometriosis, specifically examining whether exercise influences the prevalence or symptom improvement of endometriosis. The authors conducted a comprehensive search of English-language studies in PubMed from 1985 to 2012 using terms related to endometriosis and physical exercise. Only original observational or experimental studies that included laparoscopy-confirmed endometriosis and directly addressed the association between exercise and disease prevalence or outcomes were included. Out of 935 articles identified, just six met the inclusion criteria. The review synthesized evidence from these studies to evaluate if regular physical activity acts as a protective factor against the development or progression of endometriosis, as well as to consider whether pain related to endometriosis limits women’s ability to exercise.

Who was reviewed?

The review focused on women of reproductive age, primarily those with laparoscopically diagnosed endometriosis. The included studies were case-control or cohort studies, with varying sample sizes and demographic characteristics. The control groups consisted of women without endometriosis, as well as subgroups with or without infertility. The studies examined both women who engaged in regular physical activity and those who did not, enabling an exploration of potential associations between exercise habits and endometriosis risk or symptomatology.

Most important findings

Across the six studies included, findings regarding the relationship between physical exercise and endometriosis risk or symptom improvement were inconclusive and sometimes contradictory. Some studies indicated a potential protective effect of regular, vigorous physical activity, with reduced endometriosis risk observed among women who exercised more than 2–4 hours per week or engaged in higher-intensity activities. For example, one study found a 65% risk reduction in women with regular exercise, while another noted a 76% lower risk of endometrioma among those performing frequent, high-intensity exercise. However, these effects did not reach statistical significance in all studies, and the possibility of reverse causation—whereby women with endometriosis reduce activity due to pelvic pain—was raised. Notably, the review did not identify any controlled trials or studies specifically evaluating the direct impact of exercise on endometriosis symptoms or disease progression. Microbiome-related mechanisms were not directly addressed in the included studies, but the review highlighted that exercise may confer anti-inflammatory and antioxidant benefits, which are relevant given the inflammatory and oxidative stress components of endometriosis pathophysiology.

Key implications

The review underscores a significant gap in the literature regarding the effects of physical exercise on endometriosis prevention and management. Although some observational data suggest a possible inverse relationship between regular, vigorous exercise and endometriosis risk, the evidence is limited, and causality cannot be established. Importantly, no studies directly evaluated the impact of exercise on microbiome changes in endometriosis, nor did they consistently account for confounding variables or symptom-driven activity reduction. The authors call for well-designed, randomized controlled trials with standardized exercise protocols and validated outcome measures to clarify whether exercise can be recommended as a preventive or therapeutic intervention for endometriosis. Given the disease’s inflammatory and oxidative stress components, future research should also explore the interaction between exercise, systemic inflammation, and the reproductive tract microbiome.