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NCT Number: NCT05091268

Effect of Physical Activity and Pain Education on Endometriosis-associated Pain

Endometriosis is a benign gynecological condition where the uterine endometrium is located outside the uterus. The condition affects up to 10% of women of fertile age and up to 70% of women with endometriosis have symptoms with severe pain during menstruation (dysmenorrhea), pain during intercourse (dyspareunia), and/or chronic pelvic pain. Current treatments are dictated by the primary symptom: pain and are limited to surgery and hormonal treatments with often short-lived effects. Advances in the understanding of the condition have expanded to focus on less invasive and non-pharmacological treatments. Systematic reviews and meta-analyses of observational studies have focused on the protective role of physical activity and exercise on the risk of developing endometriosis. The results from these studies have been inconclusive. However, the efficacy of physical activity and exercise on pain among women with endometriosis has not been tested in high-quality randomized controlled trials (RCT).

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This study is active but is not currently recruiting participants.

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Key information

Conditions

Endometriosis Behavior Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Genital Diseases Genital Diseases, Female Motor Activity Urogenital Diseases

Age range

18 year–45 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Akershus University Hospital

Lillestrøm, Nordbyhagen, 1478, Norway

About this study

Due to the complexity of the disease, international clinical guidelines recommend that the treatment of endometriosis-associated pain should come from a multimodal and multidisciplinary perspective. Numerous non-pharmacological treatments have been proposed to alleviate endometriosis-associated pain, such as physical activity. Physical activity was introduced as a factor in the treatment of endometriosis-associated pain over three decades ago, with the possible beneficial effect that physical activity stimulates anti-inflammatory properties that will impede the development of endometriosis and lower the pain. A recent systematic review and meta-analysis found one randomized controlled study that showed no effect of physical activity on endometriosis-associated pain. They concluded that the methodological quality of this study was low, and the need for future randomized controlled studies was warranted. We, therefore, aimed to study the effect of pain education and group-based physical activity versus pain education alone on women with endometriosis-associated pain.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Women of age 18-45 with signs of endometriosis on ultrasound and/or MRI and/or confirmed by laparoscopy with histology at Akershus University Hospital and Oslo University Hospital. Women may also be recruited through social media but must present with diagnosis of endometriosis.
  • genital-pelvic pain ≥4/10 as measured on a numeric rating scale.
  • able to understand and speak Norwegian language
  • able to meet at Akershus University Hospital for participation in the study
  • giving signed consent to participate.

Exclusion criteria

  • Intra-abdominal or vaginal surgery in the last six months
  • Patients who have received Botox over the past four months
  • Severe pathology (malignancy),cardiovascular conditions and immune system diseases diagnosed by specialist; pregnancy, as well as childbirth the last 12 months and breastfeeding; severe psychiatric disorders that demands or has demanded admission to the hospital; personality disorder diagnosed by specialist and recently started or recently adjusted ongoing hormonal therapy.
  • Participants should not have any disease or injury that could prevent them from participating in the intervention.
  • Participants will be encouraged not to start with any new treatment (non-pharmacological or pharmacological) during the four-month intervention period.
  • Participants who have recently undergone surgery and received Botox injections into the pelvic area can be referred but must wait 4-6 months before being included in the study. Women with planned surgery or Botox in the study period will be excluded.
  • Participants recently started or adjusting ongoing hormonal therapy must wait 3-6 months to be included in the study.

Treatment and study plan

Exercise

Behavioral

All participants will attend a four-hour pain education session including gynecologist, psychologist, sexologist, and physiotherapist at Akershus University Hospital.

The education will be held twice, with half of the participants at the time. The training group will then attend a 60 minutes weekly group training session led by a physiotherapist with specialist training in women's health over a period of four months. In addition, participants will perform a progressive home exercise program performed daily over the same period. The focus will be general strength training using own body weight and cardiovascular fitness (walking, low-impact aerobic exercise), stretching, and relaxation

Primary outcomes

  1. Endometriosis associated pain

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported pelvic and genital pain will include a pain body map and pain intensity scale (NRS). We will ask for average pain, worst pain, and conditional pain over the course of one month.

Secondary outcomes

  1. Level of physical activity

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported physical activity level will be measured using the International physical activity questionnaire-short form (IPAQ-SF). We will analyse MET values and categories of activity in addition to walking

  2. Pelvic floor muscle maximal contraction and resting tension

    Time frame: Measured at baseline and after 4 months

    Pelvic floor muscle maximal contraction and muscular endurance will be measured with manometer using a vaginal balloon catheter Camtech Sandvika Norge AS (cmH2O) will be assessed. This method has demonstrated good validity and reliability, by our research group.

    Resting tension and the ability to contract using surface electromyography (EMG) will be used with a vaginal probe (Quintet). We will also perform vaginal palpation to assess pain/tenderness and tone. (All women will be instructed on how to correctly perform a pelvic floor muscle contraction prior to assessment).

  3. Sexual function and sexual pain

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported assessment using the Female Sexual Function Index (FSFI). We will also use questions adapted from Sahlgrenska University Hospital related to sexual pain. Higher scores indicates more problems. range 0-36

  4. Depression and anxiety

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported assessment using Hopkins Symptom Check List (SCL-5). Hopkins Symptom Checklist (SCL-5) was used to evaluate psychological distress, a higher score (up to 20) indicating greater psychological distress. range 0-20

  5. Pain with urination

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported assessment of pain prior to, during or after urination (developed by urologists at Akershus University Hospital). Categories of answers. Alternatives will be yes/no. questions will also cover if the symptom increases during menstruation with alternatives yes, no, sometimes, always

  6. Bowel function

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported assessment of bowel function including pain and constipation using the Knowles-Eccersley-Scott-Symptom (KESS). Higher scores indicating more problems. range 0-39

  7. Health economy and related quality of life

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported assessment using health-related quality of life questionnaire (EQ5D). Higher scores indicating better health. Questions also include questions on health care utilisation with categories over the last 4 weeks. Three questions on quality of life will also be included measured on a scale (0-10).

  8. Fear of movement

    Time frame: Measured at baseline and after 4 months and 12 months

    Tampa scale measuring fair of movement. Fair avoidance with Tampa Scale for Kinesiophobia (TSK-13), which score ranges from 0 - 52, 4 subcategories, "subclinical" (score 13-22), "mild" (score 23-32) "moderate" (score 33-42) and "severe" (score 43-52).

  9. Pain with defecation

    Time frame: Measured at baseline and after 4 months and 12 months

    Electronically patient-reported assessment of pain prior to, during or after defecation (developed by urologists at Akershus University Hospital). Categories of answers. Alternatives will be yes/no. questions will also cover if the symptom increases during menstruation with alternatives yes, no, sometimes, always

  10. General pain

    Time frame: Measured at baseline and after 4 months and 12 months

    General pain will be assessed with a body map in addition to self-developed questions. Alternatives will be yes/no. questions will also cover if the symptom increases during menstruation with alternatives yes, no, sometimes, always

Other outcomes

  1. Body mass index

    Time frame: Measured at baseline

    Weight and height will be combined to report BMI in kg/m^2. Weight will be measures wearing underwear and height will be measured against a wall wearing no shoes or heavy clothing.

  2. Satisfaction and experience with physical activity and pain management

    Time frame: Measured after 4 months

    A qualitative interview with open ended questions to participants in both the intervention and control group that include satisfaction with participating and experience with physical exercise and pain management.

  3. Satisfaction and experience with physical activity and pain management

    Time frame: Measured after 4 months and 12 months

    Self-defined questions on satisfaction with participation in the project

Sponsors and collaborators

Lead sponsor

University Hospital, Akershus

Other

Collaborators

  • Fysiofondet
  • Kristiania University College
  • Oslo University Hospital

Registry information

Official study title

Effect of Physical Activity and Pain Education on Endometriosis-associated Pain A Randomizes Controlled Trial With a Multimodal Interdisciplinary Group Approach

Important dates

Study start
2022
Primary completion
2026
Study completion
2026
First posted
Oct 25, 2021
Registry last updated
Jul 30, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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