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. 2025 Jul 10:pnaf083.
doi: 10.1093/pm/pnaf083. Online ahead of print.

Physiotherapy for endometriosis-associated pelvic pain: A systematic review and meta-analysis

Gökçe Can  1 , Isabel Pinto Amorim das Virgens  1 , Boglárka Fehér  1   2 , Enikő Pálma Orbán  1   3 , Péter Fehérvári  1   4 , Ferenc Bánhidy  1   2 , Péter Hegyi  1   5   6 , Ágnes Andrea Mayer  1   3 , Nándor Ács  1   2
Affiliations

Physiotherapy for endometriosis-associated pelvic pain: A systematic review and meta-analysis

Gökçe Can et al. Pain Med. .

Abstract

Background: Endometriosis is a disease often associated with chronic pelvic pain (CPP). It affects around 190 million females of reproductive age globally.

Objectives: To investigate the effect of physiotherapy techniques (PTs) in relieving endometriosis-associated pain.

Methods: This systematic review and meta-analysis followed the PRISMA 2020 and Cochrane Handbook guidelines. The study protocol was followed and registered on PROSPERO (CRD42023474231).

Search strategy: A systematic search was conducted in three databases: PubMed, Embase, and Cochrane.

Selection criteria: We used the following PICO strategy: Population, women with endometriosis-associated pelvic pain (EAPP); intervention, physiotherapy techniques; comparator, non-physiotherapy techniques; outcome, pelvic pain changes. The article selection was conducted by two independent reviewers.

Data collection and analysis: Two authors extracted data independently from the eligible articles. For continuous outcomes, the mean difference (MD) in change scores between intervention and control groups was used as an effect size with a 95% confidence interval (CI). Within-group correlation of before- and after-treatment was assumed to be equal across groups and studies.

Results: Out of eight eligible studies identified in our selection, seven were included in the quantitative analysis. PTs were effective in reducing pain compared to non-PTs (MD -1.97, CI -2.99 to -0.95), and physiotherapy modalities (electrotherapy and laser devices) had the greatest reduction in pain levels (MD -2.03, CI -3.9 to -0.14) among all studies. Additionally, locally applied techniques resulted in greater pain reduction than the generally applied techniques.

Conclusion: Physiotherapy techniques are effective in reducing pain in women with endometriosis, especially when applied locally.

Keywords: Chronic pelvic pain; electrotherapy; endometriosis; exercise; manual therapy; physiotherapy; physiotherapy modalities.

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