The Interplay Between Endometriosis, Athletic Performance, and Physical Activity: A Narrative Review on Symptom Management and Training Adaptations in Active Women

Abstract

Background: Endometriosis is a chronic, systemic inflammatory condition affecting 10% of women, characterized by chronic pelvic pain, "endo-fatigue" and myofascial hypertonia. In athletes, these symptoms compromise exercise tolerance and neuromuscular function, yet performance-limiting impacts remain under-researched. A critical gap exists regarding training adaptations in active women, as studies traditionally focus on sedentary cohorts.   Aim: This review evaluates the bi-directional relationship between endometriosis and athletic performance, synthesizing evidence-based strategies for tailored exercise and training load periodization.   Material and methods: PubMed and Scopus were searched using integrated clinical and exercise science terminology. Eligibility focused on peer-reviewed studies of active populations and physical activity interventions, using thematic narrative synthesis to integrate pathophysiology with performance metrics.   Results: Endometriosis induces objective neuromuscular deconditioning, specifically reduced isometric strength and compromised lumbopelvic control. Structured physical activity and pelvic floor rehabilitation act as anti-inflammatory modulators, reducing pain perception and fatigue while improving cardiorespiratory tolerance. Cycle-adjusted periodization, intensifying loads during peak estrogen phases and utilizing symptom-triggered modifications, maintains training adaptations without provoking flare-ups.   Conclusions: Endometriosis is a systemic performance constraint requiring interdisciplinary sports medicine care and proactive screening. Success requires flexible, symptom-aligned periodization and normalizing menstrual health in competitive sports. Individualized interventions are essential for the well-being and performance longevity of active women.