Endometriosis is a painful chronic disease which is said to afflict about millions of women across the world. It occurs when the tissue that lines the uterus (endometrium) is found outside the uterus — usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus or any part of the body. This misplaced tissue grows during the menstrual cycle in the same way that the endometrium in the uterus does: each month the tissue builds up, breaks down, and sheds. Menstrual blood from the uterus flows out of the body through the vagina, but the blood and tissue shed in other parts of the body in women with endometriosis has no way of leaving the body. This results in internal bleeding; breakdown of the blood and tissue; and causes severe pain during and prior to menses, infertility, adhesions, and bowel problems.

The cause of endometriosis is unknown. There are different theories proposed to explain the cause of this disorder. These include, retrograde menstruation where the endometrial tissue goes and implants in the fallopian tubes or parts of the abdomen and its growth is promoted in response to the hormones. Another theory suggests a genetic cause. Some biologists think that endometriosis is caused by the remnants of endometrial tissue at places other then the uterus from the embryonic stage which
starts growing in response to the hormonal stimulus. Whatever be the cause, the disorder is progressive with the women suffering from intense pain as the disorder spreads. Painkillers, treatment with anti-hormones, surgical ablation are the commonly used methods to control the disease but each of these has their own limitations.

Yoga Rahasya, spoke to Dr. Geeta S. Iyengar, one of the foremost authorities on yoga for women, to express her views on the possible cause, prevention and principles behind the methods used to overcome this problem through yoga. Here is a synopsis of the discussion.
“In the olden days, women were asked to rest during menstruation. They were kept away from household chores and any other kind of strenuous activity so that their body got the much needed rest. This custom was not social ostracism as has been often understood but to give the woman time to recover from the physiological changes the body is undergoing. Of course, such practices are no longer prevalent and often not practically feasible.
However, it is important that the woman gets the needed rest. On these days, practitioners of yoga, should not be doing any intense asana practice. They should be doing sitting asanas such Virasana, Baddha Konasana, seated asanas such as Upavista Konasana, Supta Virasana and Supta Baddha Konasana; they can do Viparita Dandasana on a bench or even a chair keeping the legs apart; forward bending asanas and Setu Bandha Sarvangasana with a support. Under no circumstances should they perform any inverted asanas like Sirsasana or Sarvangasana. I believe that endometriosis is a result of retrograde menstruation and by doing inverted asanas during menstruation, one will be inviting these problems later in life.

One can perform the inverted asanas throughout the month but stop as soon as menstruation starts. The menstrual discharge is meant to be thrown out of the body and therefore at that phase in the woman’s life she should be doing asanas which facilitate this discharge. Therefore, asanas like Baddha Konasana, Upavistha Konasana, Supta Baddha Konasana are very important. Also, the forward bending
asanas provide physical and mental relief to the stressful situation that the body is facing.

You should not be doing the standing asanas also while menstruating. It is not that the standing asanas themselves are harmful because they are not against the gravitational flow of the menstrual discharge. The problems that occur is because one tends to grip the uterus during the standing asanas and that is what causes problems. You can perform standing asanas throughout the month, if you want to, but you should not attempt these on the days you are menstruating.

You must realise that a woman’s nature is related to her uterus. The moment the woman is exposed to any kind of physical, physiological, emotional or psychological stress, she tends to hold the uterus. Even if she is angry or in an aggressive mood, the uterus is gripped. This happens very naturally. So, you should not be doing anything that can lead to “holding” or “gripping” the uterus and only perform asanas which help release this grip. Thus, by practicing as advised above, one can prevent the occurrence of endometriosis later in life.

Immediately after cessation of menstruation, one should be including inverted asanas in their practice. The uterus which has been “working hard” during menstruation needs to be relaxed and this much needed relief is provided by the inverted asanas. Also, the inverted asanas act on the pituitary glands to stimulate them to start producing the hormones necessary for starting the growth of the ovaries and uterine lining in the new cycle.

People who are already suffering from endometriosis are made to perform asanas is such a manner that there is an opening, a “spreading out” action is created in the lower abdominal region. They should be performing Ardha Chandrasana with the support of a tressler. The sitting and supine variations of Baddha Konasana as well as Upavistha Konasana. It is important that they feel the lift in the pelvic region while performing these asanas. If that lift is not felt then they should be sitting on a bolster
or a few folded blankets so that they feel the lower abdominal region. Otherwise just doing these asanas as postures will not be beneficial. They can perform Viparita Dandasana on a bench with legs in Baddha Konasana. They are also recommended to perform inverted asanas (except when they are menstruating). Even while they are performing inverted asanas, the “opening” has to be created in the lower abdomen – uterine region. So, they should be doing rope Sirsasana with legs in Baddha Konasana, Baddha Konasana in Sirsasana and even Sarvangasana. So also, they should be spreading their
legs out in Halasana into Supta Konasana.

After attaining relief from the pain associated with endometriosis by doing the asanasas described above, the women have to do asanas which help in healing the remnant scars. This is brought about by making them perform asanas which “close” the pelvic region. So, in the inverted asanas such as Sirsasana and Sarvangasana, they are made to hold a brick between the thighs and the same is repeated even while they are doing Viparita Dandasana. Thus, they are made to perform the same asana first with an “opening” action and then with the “closing” actions.”

This gives you an idea on how to prevent endometriosis and the principles on which one needs to work in the different asanas to treat it.

Written by Geeta S Iyengar and reprinted from Yoga Rahasya with the permission of the Publisher.