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

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

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

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

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

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.

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.

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.

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