March is Endometriosis Awareness Month. Nurse-Midwife and AFLP Pilates teacher Melissa Mazzarino has written about her personal journey of suffering endometriosis and how Pilates helped throughout her journey to gaining wellness. 
 
The Australian Institute of Health and Welfare report (2019) have reported that 1 in 9 women born between 1973-1978 have been diagnosed with endometriosis by age 40-44. In the year of 2016-2017, over 34,000 hospitalisations were associated with endometriosis. These statistics however do not reflect the impact on endometriosis on women’s day to day life including the experience of pain, heavy menstrual bleeding and chronic fatigue and lethargy. The chronic nature of these symptoms may detrimentally affect girls and women participation in school/university, work, social and physical activities. Mental health may be significantly affected which may have an impact on personal relationships. A recent Australian study (2023) that surveyed women, their romantic/sexual partners and family showed that there is a need for research to investigate the treatment and management of endometriosis. 

What is endometriosis? 

Endometriosis is a condition where tissue, similar to the lining of the uterus, starts to grow on other organs in the reproductive system (i.e., muscle layer of the uterus, ovaries, fallopian tubes. This tissue may also grow outside the reproductive system including the intestines, bladder, rectum and lung. The growth of tissue can cause pain during the menstrual cycle, and for some women, pain is experienced daily. Pain may be experienced during sex or when passing urine or a bowel motion. Some women may experience stomach bloating, causing discomfort and may have a negative impact on a woman’s self-body image. The cause for endometriosis is still unknown but it is suspected that the immune system and hormone factors (i.e., estrogen dependency) are linked to this condition. 

My personal journey of endometriosis 

Managing endometriosis and painful periods became a health priority in my life. My  menstrual period gradually became more painful over in my late twenties and early thirties. Initially the bleeding phase was the only time I experienced severe pain. In my early thirties I began to experience pain and fatigue 5 days before my menstruation and for another five days during the menstruation. In my early thirty years I assumed my painful periods was due to genetics as my mother and my grandmother had painful periods. During my mid-thirties, I required regular pain relief which included paracetamol and ibuprofen. However, regular ibuprofen started to cause gastritis (severe heart burn) and I needed to start other medication to treat gastrointestinal symptoms. My abdomen felt more and more bloated, and the inflammation started to radiate to my joints. At times I was emotional – other times experienced great sadness, which I believe affected my relationships. I felt nobody understood what I was going through. I started to gain weight as I wasn’t exercising as intensely. I grieved my fitness and my old body. My work as a midwife and my PhD studies were my number one priority – The little energy I had was focussed on my work and studies. 

How Pilates helped my endo symptoms 

When I was unwell with endometriosis, it was difficult to exercise intensely. This is when I started to focus on the Pilates principle of flow and rhythm of movement. I participated in repetitive, fluid-like, rhythmical exercise transitioning from one movement to another. The repetitive aspect helped to focussed on my breathwork which helped relieve tension from muscle guarding in response to pain. I participated in rocking movements, to stimulate the vestibular system to evoke a sense of relaxation and down regulate my nervous system. 

This practice helped me to ‘reset’ my mindset and I felt I re-gained energy from movement. This help me to continue to attend work as well and complete my studies.  

Medical physician input is necessary for endometriosis 

During my mid-thirties and early forties, I required surgical procedures to remove endometriosis and uterine polyps. At the age of 44, I was diagnosed with 5 fibroids. Initially I had a Mirena inserted (hormone releasing intrauterine device) to manage my periods, however the pain was persistent, and I also started to gain weight. I read ‘frantically’ about nutrition and herbs and for a short period, some symptoms would  lessen, however gradually the pain and fatigue would return. At this point, I was severely exhausted and in a lot of pain. In 2024, I made the decision that I wanted a hysterectomy (surgery that involves the removal of the uterus). This was a big decision and required counselling. I sought a second opinion from a gynaecologist, who actively listened to my concerns and gave me the information and support I needed to make an informed decision. 

Pilates for surgical preparation 

In preparation for my surgery Practiced Pilates before the surgery to get more core strength prepared for recovery. It was important to strengthen my shoulder girdle as I it helped to move up the bed or get into bed when I was trying avoid leaning forward through the surgical site. 
It will be one year on April 9 th since I had my surgery. I have been able to rehabilitate my lower core using Pilates. I have returned to running three times per week and regularly practicing strength-based Pilates. 

Endometriosis and Pilates exercise 

Although regular exercise has been proposed to be protective against inflammatory immune response and regulating hormone levels, currently there is no evidence that supports physical exercise for reducing the prevalence or relieving symptoms of endometriosis. One recent study investigating 198 women under the age of 30 with endometriosis showed that women who participated in physical activity including relaxing activities, activities with or without other participants showed that they were to cope better with anxiety and stress a hold a more positive physical self-concept. Further research studies are needed in physical activity for influencing women’s wellness where there is a diagnosis of endometriosis. 
  
Living with of endometriosis can be a difficult journey – Challenges including coping with pain, body composition changes and fertility considerations are deep and complex for any woman. Physical activity is important, however consideration to the type and pace of movement is important. The benefit of participating in Pilates in a studio setting, enables a woman to be asked the questions, “how does your body feel today?”. From here the Pilates teacher can work with women to tailor exercise that movement and comfort is enabled. 

Pilates exercise that embraces the principle of flow – fluid and coordinated movement may help to maintain muscle tone, down regulating the nervous system and reenergise vitality. 

Medical physician advice should always be sought for gynaecology-related concerns. 
  
Armour, M., Ciccia, D., Yazdani, A., Rombauts, L., Niekerk, L.V., Schubert, R. and Abbott, J. (2023),  Endometriosis research priorities in Australia. Aust N Z J Obstet Gynaecol, 63: 594-  598. https://doi.org/10.1111/ajo.13699 
Coquinos Samantha , Oboeuf Alexandre , Vitiello Damien (2025). Moving beyond pain: the  relationship between physical activity and physical self-concept among young women with  endometriosis. rontiers in Sports and Active Living. Vol 7. Available:  https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2025.1494460 
Omlin X, Crivelli F, Heinicke L, Zaunseder S, Achermann P, Riener R. Effect of Rocking Movements  on Respiration. PLoS One. 2016 Mar 8;11(3): e0150581. doi: 10.1371/journal.pone.0150581. PMID:  26954500; PMCID: PMC4783003.