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Meta-Analysis
. 2026 Jan 1;27(1):95-103.
doi: 10.1093/pm/pnaf083.

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
Meta-Analysis

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

Gökçe Can et al. Pain Med. .

Abstract

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

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

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

Setting: A systematic search was conducted in 3 databases: PubMed, Embase, and Cochrane.

Participants: We used the following PICO strategy: population, women with endometriosis-associated pelvic pain; intervention, PTs; comparator, non-PTs; outcome, pelvic pain changes. The article selection was conducted by 2 independent reviewers.

Main outcome(s) and measure(s): 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 8 eligible studies identified in our selection, 7 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 and relevance: 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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Figures

Figure 1.
Figure 1.
PRISMA 2020 flowchart representing the study selection process.
Figure 2.
Figure 2.
Pain change from baseline to the longest follow-up time.
Figure 3.
Figure 3.
Effect of intervention types on pain change from baseline to the longest follow-up time.
Figure 4.
Figure 4.
Effect of application sites on pain change from baseline to the longest follow-up time.
See this image and copyright information in PMC

References

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    1. World Health Organization. Endometriosis fact sheet. 2023. Accessed April 2024. https://www.who.int/news-room/fact-sheets/detail/endometriosis
    1. Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1-15. - PubMed
    1. Zondervan KT, Becker CM, Missmer SA, Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. 10.1056/NEJMra1810764 - DOI - PubMed