Doing Yoga with Endometriosis

Which poses are helpful and which should be avoided for women with endometriosis? I've heard that working the abdominals is not good. Should a woman with this condition should avoid Ashtanga?

By Esther Myers

—Adriana Braga, Brazil

Esther Myers' reply:
Endometriosis is a condition in which endometrial cells from the lining of the uterus migrate to different parts of the pelvis and to other organs. The cells continue to respond to monthly hormonal fluctuations, causing bleeding within the body, which can be extremely painful and can cause scar tissue to form. The scar tissue can itself be a source of significant discomfort. Conventional treatments vary from birth control pills to surgery to removing the tissue of the uterus, fallopian tubes, and ovaries.

The cause of endometriosis is unknown. One theory suggests that some menstrual blood flows backward from the uterus. This retrograde flow is very common, but in a woman with endometriosis, the stray cells are not destroyed. (That is why a woman with endometriosis should absolutely avoid inversions while she is menstruating.) Because endometrial cells respond to estrogen, there is also speculation that endometriosis is caused by excessive estrogen in the body

The amount and location of misplaced tissue varies tremendously from woman to woman and with each menstrual cycle, which makes it difficult to give a general answer to your questions. I suggest starting with very simple postures, building up slowly, and watching carefully for any aggravation or discomfort.

Start with relaxed abdominal breathing and poses like Supta Baddha Konasana (Reclined Bound Angle Pose) and Supta Virasana (Reclined Hero Pose) that gently open and stretch the abdomen and pelvis. Use these poses during times of pain, bloating, or discomfort. Then focus on seated poses that open and release the pelvis like Baddha Konasana (Bound Angle Pose) or Upavistha Konasana (Open Angle Pose). Salamba Sarvangasana (Shoulderstand) is particularly beneficial to women with endometriosis when they’re not menstruating, since it helps balance the endocrine system.

My experience with scar tissue in my abdomen from a hysterectomy is that backbends often feel wonderful at the time, but can cause cramping the next day. Start with small backbends like Bhujangasana (Cobra Pose) and Salabhasana (Locust Pose) and gradually work up to Dhanurasana (Bow Pose), Ustrasana (Camel Pose) and Urdhva Dhanurasana (Upward Bow Pose, Backbend, or Wheel) to see how much stretch the front body can tolerate.

Similarly, twists stretch the tissues and stimulate the liver, which can be beneficial for endometriosis. Certain twists may not be comfortable at certain times in a monthly cycle. Try starting with very open twists like Bharadvajasana (Bharadvaja's Twist), Marichyasana I (Marichi's Pose), or Parivrtta Janu Sirsasana (Revolved Head-to-Knee Pose). Gradually move into more intense twists like Ardha Matsyendrasana (Half Lord of the Fishes Pose) or Marichyasana III.

To strengthen the abdominal muscles, begin by lying on the back and focusing on drawing the navel toward the spine as you exhale. If there is no discomfort, gradually move into poses that require abdominal strength like Chaturanga Dandasana (Four-Limbed Staff Pose) or Paripurna Navasana (Full Boat Pose). While a woman with endometriosis may be able to do an Ashtanga or Power Yoga practice, I do not recommend this practice exclusively. It would be better to counterbalance a vigorous practice with poses that soften, relax, and open the pelvis.

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