Endometriosis And Exercise
My Endometriosis: Management through Movement
One in 10 women suffers from endometriosis and unfortunately, I am part of that statistic. It is often described as a silent disease and with good reason; the number of times I have had to explain endometriosis to my friends and family are countless.
I usually refer to it as “the bastard disease” but for the sake of this article, Google directed me to The World Health Organisation that describes it as “a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility.”
It took 10 painful years for me before I was diagnosed with endometriosis. And when I say painful, I mean debilitating, excruciating, life-restricting kind of pain.
I started my period at age of 11. In my first month of secondary school, enough of an overwhelming time for anyone without the monthly fear of this new, foreign pain that riddled my body. By the age of 15, I had been rushed to hospital eight times.
It was another six years – 72 painful months – until I was diagnosed via laparoscopy at the age of 21. This is where a fibre optic instrument is inserted through the abdominal wall to view the abdomen. Any endometriosis visible is removed, until it grows back. Because in the majority of cases, it always grows back. After 6 operations, it seemed a hysterectomy is the only move I have left, and even this doesn’t guarantee a cure. I have had the Mirena coil for a little over a year and that has definitely helped a lot, but it’s not a long-term answer for me.
How do I feel about it? Disappointed to be honest. Disappointed that it has been nearly 20 years since my first diagnoses and still, there is only one medical procedure available to us. Disappointed that I have had to go to such extremes as forced, temporary menopause to try and (unsuccessfully) realign my body. Disappointed that for the majority of my life, I have had to deal with monthly bouts of pain that affect me to the point where I cannot live life. To anyone who knows me, the latter is probably one of the most difficult things to deal with. I love life.
These monthly attacks aren’t just period pains. It’s what I can only explain as the closest thing I will ever experience to labour. Ironic really considering that opportunity has been taken away from many of us thanks to this condition.
Because not only does endometriosis cause physical pain, it can also cause fertility problems for some unfortunate women, myself included. It’s not quite understood why, but the damage done to the ovaries and fallopian tubes play a part.
The mocking continues with the regular occurrence of a swollen belly that almost mimics the appearance of someone in their third trimester. The number of messages I regularly get on Instagram questioning or congratulating me on my “pregnancy” is astounding. People are not ill-meaning, I guess just ignorant. I suppose this is why I am sharing my story. Awareness of endometriosis is key, but it’s also scarce.
Theo and I went through the exhausting process of IVF a couple of years ago. I have actually never spoken about this publicly until today. In all honestly, it was a traumatising experience that I try not to dwell on.
After months of enduring the process of all the meds, the injecting and the worrying, we fell pregnant with twins. We felt the joy, the adrenalin, the desperation for everything to be okay that I assume most expecting parents feel. I felt pregnant and it felt right.
I started bleeding after six weeks. I lost the first baby that day. But we still had the hope of that second tiny foetus. All the tests continued to show I was pregnant, so we allowed ourselves to dream a little more.
Until three weeks later when I woke up in the middle of the night with excruciating pain, I knew immediately that it had gone. The trauma of having two miscarriages within a month was real. To date this is one of the most devastating things we have experienced. Theo and I have been through a lot in our 19 years together, and although the memory of that time will always be with us, it also strengthened our love even more. It also gave us both another perspective on how precious life is.
It was after my miscarriages that I decided that western medicine, as remarkable as it is, could not do much more for me. And although there are days where I have to take ibuprofen for the pain, I didn’t want to rely on that. I decided to turn to alternative practice. From acupuncture to Chinese medicine to detoxes and yoga.
I was - and am still – lucky enough to be supported by the amazing Marie Reynolds, an expert in advanced holistic wellbeing. Her motto is “The body is like a human novel, you just have to know how to read the chapters”. She helped me do exactly that. This taught me how to look at my body in a way I hadn’t before. The complexity of the female body is actually quite astonishing. She also made me realise how strong I am and how to better harness that strength.
I also stepped up physical exercise, which has been a game-changer for me. I’d like to think I am very strong, mentally. My mind works in an ‘I’m not going to let anything stop me’ kinda way. I think of that as my superpower. I have learned to translate that strength into exercise. It is a non-negotiable part of my life, and it helps me both physically and mentally.
This is where weight training and Aleem come in. I was recommended Aleem by my physio, Gemma. I had heard how important weight training was to women, so I thought why not? It has been – at the risk of sound dramatic – nothing less than life-changing. I now train four times a week alongside my beloved yoga with Roisin, and my swimming sessions. I can’t believe how strong I have become; I mean I’m lifting over 100kg! That’s the weight of a Panda don’t you know! Although I’d 100% prefer to be lifting one of those cuddly creatures over a cold metal bar. Who wouldn’t?
I’ve asked Aleem to write about his experience and advice from working with me. Please remember everyone is different and technique is vital, so do seek advice from a certified personal trainer before you start lifting. Has it stopped my pain? Well, no. But it has made me look at my body in a different way. It really is remarkable. And I feel great, probably the best I’ve ever felt, so I will be continuing my weight training and, as I’ve mentioned before, I won’t allow this disease stop me and I encourage anyone dealing with chronic pain to get moving, even just for a walk.
Over to the man himself…
Hi, my name is Aleem.
A little bit of background about me, I started training from a young age. Martial arts came first at only 8 years old, before moving on to rugby later on. I started weight training at the age of 16 and always included it in my training with the sports I was doing. Over the last 10 years my focus has been on strength training and competitive powerlifting, my best lifts being a 275kg squat, 165kg bench press and 280kg deadlift.
I have been a coach since 2014, and in 2016 I moved to London to study a BSc in Strength & Conditioning Science at St Mary’s University. I’m probably best known for coaching strength training, but as I really enjoy coaching people, I work with people with varying goals and backgrounds into helping them become the best version of themselves.
My passion for coaching has changed over the years. In the beginning I found something in weight training that I really enjoyed, and I would get asked for advice and found it rewarding to see people make progress. As I got older, I learned to appreciate how exercise, good nutrition and balancing your lifestyle benefits you mentally as well as physically. Being able to share my knowledge and experience with clients and watch them grow and develop as humans both inside and outside of the gym has been really fulfilling.
Insight 1: Technique First
Anyone who knows Lisa will tell she doesn’t do things by halves and she has energy! So coming into to every session the aim was to push Lisa, hit PBs where we could and make progress! However, the first thing we focused on was getting her technique and form consistent. Lisa was stronger than her form could maintain, so sometimes that would lead to pain or discomfort, so we emphasised technique and lighter loads in the beginning. As Lisa’s technique improved and she grew more confident, we progressively increased the weight or reps on exercises. To give some context here as an example, we started on deadlifts using dumbbells. I noticed that technique was inconsistent, so we reduced weight and used a light Les Mills training bar to practice the hip hinge movement. Then we gradually introduced weight with dumbbells, progressed load over weeks and when Lisa hit 20KG in each hand we began using the trap bar for deadlifts.
Insight 2: Managing Symptoms & Pain
There would be days when I would be coaching Lisa, and she would experience no pain or discomfort. On those sessions we could fully push her limits, aim for more reps or increased weight and smash PBs. On the flip side, there were also days when Lisa would have discomfort or an unsettled stomach, these days communication was key. If an exercise would cause further discomfort or pain, I would adjust it, take for example the hip thrust, this involves placing load directly on the hips, on a day where pain was already present, we would modify this to be body weight with a band. Finding an alternative or work-around is important. In some cases, we would push through pain, now massive disclaimer here, working through pain is not something I recommend except for in very specific circumstances. However, there is a difference between working through discomfort if an exercise is hard or working through pain and managing an injury or condition such as endometriosis. In this instance if pain was present, we would still train and I would monitor Lisa’s pain tolerance by asking after each set whether the pain was increasing or staying the same (anything higher than a 4/10 for pain and we would stop). One session to note was when we were working on deadlifts and Lisa requested to push heavier and through the pain, this was as much to push physically on the lift to achieve a PB as much as it was a mental battle to not let her condition hold her back. Safe to say Lisa won the battle, hit her PB, and felt elated.
Insight 3: Consistency, Recovery, Mindset
There’s a “gym culture” saying that maturing in the gym is when you don’t aim to hit a PB every workout but turn up every week consistently and chip away towards a PB. When we first started training, Lisa was hitting PBs left, right and centre. In the beginning of any programme it’s expected to see progress every session, but over time, it’s important to gradually build towards a new PB otherwise you will plateau. Recovery plays a big part here as Lisa was also consistent in her Yoga training as well as doing long hours for her job. So over time I made sure that our more demanding exercises were spread out across the week. If Lisa had a shoot the following day, I would prescribe lower body training allowing her arms to be recovered for work and train upper body the day after her shoot. This in turn matured the mindset and expectations of training. Don’t get me wrong, we still aim for PBs where we can, but now we play it smart with training. If energy is good and pain is low, we can push more. Days where there’s discomfort or pain is present, we ease off on the weight and focus on form, technique and reps.
Even though endometriosis is a painful condition that affects millions of women worldwide, there are ways to manage symptoms, and one of them is undoubtedly through strength training. For women with endometriosis, strength training can provide numerous health benefits, including improving bone density, reducing the risk of chronic disease, and improving mental health… not to mention helping with pain management.
Here's how strength training can help women with endometriosis:
Reduces inflammation: Endometriosis causes inflammation in the body, which can lead to pain and discomfort. Strength training has been shown to reduce inflammation by decreasing the production of pro-inflammatory cytokines.
Improves pain tolerance: Women with endometriosis often experience severe menstrual cramps, which can make it difficult to exercise. However, strength training has been shown to increase pain tolerance, allowing women to work through their discomfort.
Boosts mood: Endometriosis can take a toll on mental health, leading to anxiety and depression. Strength training has been shown to improve mood and reduce symptoms of anxiety and depression.
Increases strength and mobility: Women with endometriosis often experience muscle weakness and limited mobility due to pain and inflammation. Strength training can help improve muscle strength and mobility, making it easier to perform daily activities.
Improving Sleep: Endometriosis can disrupt sleep patterns, making it difficult to get a good night's sleep. Strength training can help to improve sleep quality and duration. It can increase the production of growth hormone, which is essential for repairing and restoring the body during sleep.
Increasing Energy: Fatigue is a common symptom of endometriosis. Strength training can help to increase energy levels by improving muscle strength and endurance. It can also help to improve cardiovascular fitness, which can increase stamina and endurance.
If you are looking to incorporate strength training into your routine to manage symptoms of endometriosis, it is important to start slow and gradually increase the intensity and duration of your workouts.
Here is an example program that you can follow, both at home or in the gym:
Warm-up:
5-10 minutes of light cardio (e.g., walking, cycling) to increase blood flow and warm up the muscles, followed by some gentle stretches for the muscles you will be working.
Home-based Exercises:
Squats: 3 sets of 8-12 reps. Start with bodyweight squats and progress to using dumbbells or a resistance band as you get stronger.
Lunges: 3 sets of 8-12 reps on each leg. Start with bodyweight lunges and progress to using dumbbells or a resistance band as you get stronger.
Deadlifts: 3 sets of 8-12 reps. Start with a bodyweight deadlift to ensure proper form then progress to dumbbells or resistance bands as you get stronger.
Push Ups: 3 sets of 10-12 reps. Start with modified push-ups (e.g., on your knees, against the sofa) if needed, and progress to full push-ups as you get stronger.
Rows: 3 sets of 10-12 reps. Use dumbbells or a resistance band to target the upper back muscles.
Gym-based Exercises:
Day 1
Squats: 3 sets of 8-12 reps. Start with bodyweight squats and progress to using dumbbells as you get stronger and then onto a barbell.
Lunges: 3 sets of 8-12 reps on each leg. Start with bodyweight lunges and progress to using dumbbells as you get stronger.
Chest Press: 3 sets of 8-12 reps. Start with the resistance machine and progress to using dumbbells as you get stronger and then onto a barbell.
Lat Pulldown/Pull Up: 3 sets of 8-12 reps (3-6 reps for pull ups). Start with with the lat pulldown machine and as you get stronger, progress onto the assisted pull up machine or band assisted pull up.
Cable Triceps Pushdown: 3 sets of 8-12 reps. As you get stronger try using a different handle attachment to the cable to keep the exercise challenging
Day 2
Deadlifts: 3 sets of 6-8 reps. Start with a bodyweight deadlift to ensure proper form then progress to dumbbells as you get stronger then eventually barbell deadlifts.
Overhead Press: 3 sets of 8-12 reps. Start with the resistance machine and progress to using dumbbells as you get stronger and then onto a barbell or smith machine.
Rows: 3 sets of 8-12 reps. Start with the resistance machine and progress to using dumbbells as you get stronger and then onto a barbell or smith machine.
Glute Bridge/Hip Thrust: 3 sets of 8-12 reps. Start with a bodyweight glute bridge, then progress onto a dumbbell or banded glute bridge. As you get stronger, progress onto a bodyweight hip thrust, then use dumbbells and finally a barbell.
Cable Biceps Curls: 3 sets of 8-12 reps. As you get stronger try using a different handle attachment to the cable to keep the exercise challenging or progress onto dumbbells.
Cool-Down:
5-10 minutes of light cardio (such as walking) followed by some gentle stretches for the muscles you worked.
It is important to listen to your body and adjust the intensity and duration of your workouts as needed. You may want to start with lighter weights and fewer sets/reps and gradually increase as you get stronger. It's also crucial to note that every woman with endometriosis is different, and what works for one person may not work for another. It's always a good idea to talk to a doctor or physical therapist before starting a new exercise program, especially if you have any medical conditions.
In conclusion, strength training can be a valuable tool for women with endometriosis to manage their symptoms and improve their overall health and wellbeing. By incorporating strength training exercises into your routine, you may experience less pain, improved mobility, and a better quality of life.
It has been a pleasure training with Lisa and as she mentions above, you’ll always feel better when you get moving.
Thanks Aleem, you’re the best!
I will finish this article by encouraging anyone who feels a little off within their own body not to ignore it. Do not be afraid to see a GP, push to see a gynaecologist or get on the waiting list. Be persistent because even though there is no cure as such, getting a diagnosis can be a huge relief. Life is for living and anything that threatens to hinder that needs to be investigated, diagnosed, treated and managed. Endometriosis may have won the battle but I am determine to win the war. There are tables to be danced on, friends to be hugged, planes to board and adventures to be had. Feel free to ask Aleem any questions in the comment section below.
Love,
Lisa x