Endometriosis is a benign gynecological disease where the uterine endometrium is located outside the uterus (1). It is found in approximately 10 % of women in reproductive age (1). The condition is primarily associated with pain during menstruation (dysmenorrhea), pain during intercourse (dyspareunia) and chronic pelvic pain. Other frequently observed conditions include bleeding disorders, irritable bowel syndrome, painful bladder syndrome, abdominal pain, threatening miscarriage, fatigue and infertility (2).
On average, it takes eight years to diagnose endometriosis (3). During this period, musculoskeletal disorders secondary to endometriosis and psychological disorders may develop (4,5). This may lead to severe suffering for the affected women, reduced work- capacity and increased use of health-care services (4,6).
There is currently no cure for the disease and the treatment has primarily been aimed at surgically removing the endometrial tissue with varying results (7). Physical activity and exercise has been proposed as a possible option for prevention and treatment of the disease and associated symptoms, but so far the results are inconclusive (8). The theory behind this is that physical activity and exercise may trigger anti-inflammatory processes that will impede the development of endometriosis. International clinical guidelines recommend interdisciplinary, multimodal treatment approaches including physical activity and exercise and pain education (9). The efficacy of these recommendations has not been tested in randomized controlled trials (RCT) of high methodological and interventional quality.
The Norwegian Women ́s Public Health Association together with the Norwegian Endometriosis Association has highlighted the need to focus on research into the best management of patients with endometriosis-associated symptoms (dysmenorrhea, dyspareunia and chronic pelvic pain). This is also reflected in The Norwegian Women ́s Public Health Association ́s research strategy for 2018-2024 “Kvinnehelse – fra vugge til grav”. As part of the re-organization of the treatment offered at Akershus University Hospital, physiotherapy is being introduced as a central part of the treatment package. We aim to conduct a RCT to study the effect of group-based physical activity and exercise and pain education in patients with endometriosis-associated symptoms. This may be a potentially beneficial and cost-effective alternative for these women and the society at large.