When teaching or practicing yoga with endometriosis, one question often comes up:
Is it safe—or even wise—to practice inversions during menstruation?
It’s not a small detail. This single choice often reflects how we balance tradition and science, respect for the body and practice, philosophy and physiology.
In yoga communities, answers vary. Some teachers rely on tradition and energetic principles. Others refer to scientific research. And many of us, especially those living with endometriosis, draw on lived experience.
This article offers a cross-perspective: what traditional yoga says, what modern physiology shows, and what I’ve observed as a teacher working with women who live with endometriosis.
Key Takeaways
- Inversions in yoga place the pelvis and uterus above the heart, reversing the effect of gravity.
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Traditional yoga and Ayurveda advise avoiding inversions during menstruation, to respect Apana Vayu and the natural downward flow.
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Science shows menstrual flow is driven by uterine contractions, not gravity; retrograde menstruation alone does not cause endometriosis.
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Many women with endometriosis report increased pain, fatigue, or heavier flow after inversions.
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The most important skill for teachers is discernment: asking why this pose, for this student (or in my own practice), and at what moment.
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Personally, I favor a precautionary approach—avoiding inversions during menstruation and placing the student at the very heart of the practice
What counts as an inversion?
In yoga, an inversion is any posture that places the pelvis and uterus above the heart.
That can look like:
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Sarvangasana (Shoulderstand)
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Sirsasana (Headstand)
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Adho Mukha Svanasana (Downward-Facing Dog)
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Viparita Karani (Legs up the Wall)
Even though their intensity varies, all of these positions change the relationship between pelvis, diaphragm, uterus, and heart, reversing the effect of gravity.
Traditional wisdom: Apana Vayu and menstruation
In yogic philosophy, menstruation is governed by Apana Vayu, the downward-moving energy responsible for elimination.
Inversions flip this flow. That’s why many traditional teachers and schools discourage them during menstruation:
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Iyengar Yoga: All inversions are contraindicated while bleeding. The reasoning is energetic and philosophical: the uterine lining, like any waste, is meant to be released.
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Ashtanga Vinyasa Yoga: Practitioners traditionally pause their practice entirely for the first three days of menstruation (ladies’ holiday), as a mark of rest and respect for the natural cycle.
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Ayurveda: Menstruation is understood as a process of cleansing (mala). Interfering with it is seen as a potential source of imbalance or disease.
From this perspective, inversions during menstruation aren’t just a matter of comfort, they could disrupt long-term menstrual and reproductive health.
The practice means honoring the body’s rhythm and placing the student—not the pose—at the heart of yoga.
Physiology and endometriosis: what research says
Retrograde menstruation and inversions
For years, inversions were suspected of worsening or even causing retrograde menstruation (when blood flows backward into the fallopian tubes). Because retrograde menstruation has been linked to endometriosis, many worried that inversions were risky.
But research paints a more nuanced picture…
Nearly 90% of women experience retrograde menstruation, whether or not they practice inversions. Around 10% will develop endometriosis. Retrograde menstruation, therefore, is not considered a direct cause of the condition.
Specialists also remind us that menstrual flow is driven by uterine contractions, not gravity. Astronauts continue to menstruate “normally” in space. This suggests that menstrual flow depends on uterine contractions rather than body position or gravity.
Of course, uterine contractions do ensure the shedding of the endometrial lining during menstruation. Yet to reduce the reality to this single mechanism feels incomplete to me, and some interpretations deserve to be placed in a broader context.
The body is intelligent and does what it needs to do, even if that means intensifying menstrual cramps (unfortunately for us).
Beyond the mechanics
That said, simply stating “the uterus contracts, therefore it doesn’t matter” feels incomplete.
With endometriosis, the body is already working harder:
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Uterine contractions may be more intense and painful
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Lesions outside the uterus can also bleed, adding to the workload
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Normally, certain immune cells clear misplaced endometrial cells from the pelvic cavity. But in endometriosis, the immune system is often deregulated, inflamed, and overtaxed. Menstruation itself is already inflammatory and stressful
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Inflammation and fatigue are already higher than average
Why add another layer of effort by turning upside down?
What many of my yoga students with endometriosis often report
This is where science meets lived experience.
Many of my students (and myself) have noticed that after an inversion (or even after sitting long with pelvic compression), a heavier flow, sometimes with clots, occurs upon returning upright. Gravity still seems to play a role in supporting elimination.
Others share that inversions during menstruation intensify pain, cramps, or fatigue, at a moment when the body already feels drained.
Of course, experiences vary:
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Some women bleed lightly, others heavily
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Some have intense pain, others less so
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Some no longer menstruate due to hormonal treatment
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Symptoms can even shift from one cycle to the next
This is why blanket rules fall short.
Discernment invites us to pause and ask: why this pose, for this student (or for myself), and at this moment—rather than applying a one-size-fits-all answer.
Questions of discernment
Instead of following a fixed rule, we might invite discernment—pausing to ask a few simple yet meaningful questions that can guide our practice and teaching:
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Which inversion? A strong Headstand is not the same as a supported Viparita Karani.
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Why am I proposing it? Is there a clear intention (physiological, emotional, energetic) or just habit?
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Who is it for? Will this student, in this state (pain, fatigue, emotional load), truly benefit?
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When? During heavy bleeding? Or could this pose serve better outside menstruation?
These questions restore both teacher and practitioner with the freedom to adapt the practice to the context, rather than follow a rigid dogma. In this way, practice regains its essential role: to honor physiology, to respect lived experience, and to place the person—not the pathology—at the very heart of yoga.
So, should inversions be avoided with endometriosis?
There isn’t a one-sentence answer. Context matters.
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Tradition: They disrupt Apana Vayu and should be avoided during menstruation.
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Science: Uterine contractions, not gravity, drive flow. Retrograde menstruation alone doesn’t explain endometriosis.
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Experience: For many women with endometriosis, inversions feel counterintuitive, painful, or simply unnecessary at that moment.
In my personal and teaching approach, I choose the path of precaution:
I generally avoid inversions during menstruation, and instead I guide students toward what best supports their physiology, their lived experience, and their unique needs.
Because in the end, yoga here is not about dogma.
It’s about placing the person, not the condition, at the center of the practice.
To go further
Free Resources
- 5 Lessons and Insights from 10 Years of Teaching Yoga for Endometriosis.
- 5 Practical Ways to Support a Student with Endometriosis in Your Yoga Class — Starting Now, Even if You’re Not Yet Specialized
Go deeper with the course : 50-Hour Yoga Teacher Training – Yoga Therapy for Endometriosis
If you wish to deepen your knowledge and develop real confidence in supporting women with endometriosis, this training offers you:
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A holistic approach that weaves together science, yoga tradition, and women’s physiology
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Practical tools to design and guide classes, workshops, and 1:1 sessions
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An expertise that is science-informed, rooted in yoga tradition, and deeply human, always at the service of your (future) students.
References
- Belluck, P. (2016, April 21). Periods in Space Are Not That Different, Though a Bit More Complicated.
- Halme, J., Hammond, M., Hulka, J., Raj, S., & Talbert, L. Retrograde menstruation in healthy women and in patients with endometriosis.
- Wade, L. There’s No Reason to Skip Headstands During Your Period.
- https://www.inserm.fr/dossier/endometriose/
- https://www.nytimes.com/2019/06/13/well/turning-your-period-upside-down.html
FAQ
Are inversions safe for women with endometriosis?
Inversions are debated. Tradition advises against them during menstruation, science shows flow is driven by uterine contractions, and many women report increased pain or bleeding. The safest approach is to adapt to the individual’s needs.
Do inversions cause retrograde menstruation and endometriosis?
No. Around 90% of women experience retrograde flow whether or not they practice inversions, but only 10% develop endometriosis. Causes are multifactorial—genetic, hormonal, immune.
Should yoga teachers always avoid inversions with students who have endometriosis?
Not necessarily. It depends on the type of inversion, timing, the student’s symptoms, and their lived experience. A discernment-based approach is best.
What does Ayurveda say about inversions during menstruation?
Ayurveda views menstruation as an elimination process. Inversions are discouraged because they can obstruct Apana Vayu, the downward flow of energy.
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