Endometriosis and physical activity: A narrative review

Insights into endometriosis symptom trajectories and assessment of surgical intervention outcomes using longitudinal actigraphy

Endometriosis is a common, chronic condition associated with debilitating pain, fatigue, and heterogeneous symptom presentation. In this exploratory study, 68 participants with confirmed endometriosis were monitored for up to three 4-6-week smartwatch cycles. We collected daily self-reports of pain and fatigue as well as retrospective questionnaires assessing quality of life, and we extracted daily measures of physical activity (PA), sleep, and diurnal rhythms from wrist-worn actigraphy data. We found that daily PA was strongly negatively correlated with self-reported fatigue (repeated measures correlations R < - 0.3 ) and that participants with more severe or variable symptom trajectories displayed lower levels of PA, greater sleep disturbance, and more disrupted sleep and activity rhythms (Spearman's |R| > 0.3 ). Lastly, we found evidence of sleep and PA changes following surgery for endometriosis that reflected change in self-reported symptoms. Collectively, our findings suggest that passive data collection using wrist-worn wearables in endometriosis could facilitate individualized objective insights into symptom trajectories.

The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis

BACKGROUND

Endometriosis is a debilitating, chronic disease that affects approximately 10% of women of reproductive age worldwide. The most common symptom is chronic pelvic pain, which leads to a reduced quality of life and requires lifelong treatment. The current standard of care for endometriosis is pain management, which consists mainly of medical and surgical treatment. Appropriate physical activity (PA) and exercise can help manage both physical and psychological symptoms of chronic conditions. Consequently, this systematic review and meta-analysis was designed to assess the effectiveness and safety of PA and exercise in women with endometriosis.

METHODS

We searched the published literature in Pubmed, Medline, Embase, The Cochrane Library, and Web of Science. Randomized controlled trials (RCTs) were obtained to assess the effects of physical activity and exercise on women with endometriosis. The random or fixed effects model was used to analyze the data in meta-analysis. The results were expressed as weighted mean differences (WMD) and their corresponding 95% confidence intervals (CIs).

RESULTS

Six RCTs were identified in our systematic review, involving 251 patients. The results indicated that physical activity and exercise have a beneficial impact on quality of life, pain intensity, mental health, pelvic floor dysfunction, and bone density. However, due to the heterogeneity of the outcome measures and the incomplete reporting of the results in the studies included in this review, only a simple meta-analysis of two studies could be performed. The meta-analysis demonstrated that physical activity and exercise have a significant impact on the improvement of quality of life, particularly in the context of pain (P <0.0001), control and powerlessness (P <0.00001), and emotional well-being (P = 0.006).

CONCLUSION

The present review indicates that physical activity and exercise have beneficial effects on the treatment of symptoms associated with endometriosis, particularly in terms of improving quality of life and providing pain relief. Due to the limitation in the quality of involved studies and the short duration of treatment, more RCTs with high-quality, long-term duration are needed for further validation.

TRIAL REGISTRATION

Systematic review registration: Registration number: CRD 42024547551.

A Multimodal Approach to Symptomatic Endometriosis: A Proposed Algorithm for Clinical Management

Recent research has proven that peripheral (PS) and central sensitization (CS), mental health, and myofascial dysfunction all play a role, alongside nociception, in the genesis and in the perpetuation of endometriosis' symptoms. However, such components of pain are still largely ignored in clinical practice, although not considering such contributors may entail serious consequences on women's health, including the choice of unnecessary surgery and leaving the real causes of pain untreated. At the present time, we are facing a paradox by which 25-40% of women who undergo laparoscopic surgery for pelvic pain do not have an obvious diagnosis, while the percentage of women with endometriosis who have signs of CS, of depressive or anxiety disorders, or who have an increased pelvic muscle tone ammounts to 41-55%, 15-88% and 28-73%, respectively. Moving from the widely-accepted stepwise approach suggested for endometriosis management, which consists in the initial prescription of low-dose combined oral contraceptives (COCs) or of a progestin monotherapy, followed by GnRH analogues and, ultimately, by surgery, when COCs and progestins have proven ineffective or are not tolerated or contraindicated, we propose an integration of such model which takes into account the identification and the simultaneous treatment of all pain contributors. Our objective is to encourage physicians' awareness of the need of a multidisciplinary, multimodal approach to endometriosis-related pain, and ultimately to promote a reduction in the number of unnecessary surgeries.

Holistic approach to care for patients with endometriosis

PURPOSE OF REVIEW

Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis.

RECENT FINDINGS

Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration.

SUMMARY

Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.

Impact of lifestyle and dietary modifications for endometriosis development and symptom management

PURPOSE OF REVIEW

Management of endometriosis is often complex and poorly studied. Patients with endometriosis have interest in how their lifestyle may affect their diagnosis. Self-management and lifestyle changes are often used as adjunct therapy, but best practices are not concrete in treatment guidelines.

RECENT FINDINGS

Lifestyle impact on endometriosis and possible self-management treatment therapies are reviewed. Overall, there is a need for future studies in all topics. Data suggest a link between endocrine-disrupting chemicals (EDCs), particularly persistent EDCs, and endometriosis. More work is needed to isolate and quantify exposures and explore their connection to endometriosis in order to provide guidance for clinical practice recommendations. There is insufficient evidence to support a superior diet for management of endometriosis; however, the Mediterranean diet may have the most benefit without nutrition concerns. Exercise may be another tool to improve endometriosis symptoms, but once again data are limited and best type and frequency is not well studied. Best evidence supports body-mind practices such as yoga, although new evidence suggests benefit from a holistic combination of several types of exercises.

SUMMARY

Overall, data on lifestyle effects and associated therapies are limited. Future high-quality studies are needed to guide practice.

Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients

Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.