Effectiveness of physical therapy techniques and methods in the management of endometriosis symptoms: A systematic review with meta-analysis.
Alba Mena-González, Raquel Leirós-Rodríguez, Pablo Hernandez-Lucas
Physical therapy interventions (massage, electrotherapy, acupuncture, exercise, education) showed significant reductions in dyspareunia and pelvic pain, plus quality-of-life gains, in women with endometriosis.
Evidence is moderate certainty but most included studies had high risk of bias.
Key findings
1Pooled analysis of five studies (327 participants) found statistically significant pain reduction: dyspareunia SMD 3.1 (95% CI 1.192 to 5.016), pelvic pain SMD 0.98 (95% CI 0.220 to 1.741), and overall pain SMD 1.27 (95% CI 0.56 to 1.98).
2A separate meta-analysis of five studies (460 participants) found a statistically significant quality-of-life improvement with SMD 1.52 (95% CI 0.76 to 2.27).
3GRADE rated the evidence as moderate for all three primary outcomes, but 81.8% of included studies were judged to have high or critical risk of bias.
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What it does not show
Only 11 studies were available, and most had small samples (ranging from 10 to 154 participants). The interventions were very different from one study to the next — different techniques, durations, session numbers, and combinations — making it impossible to isolate which component drives the benefit. 81.8% of included studies were rated high or critical risk of bias, largely due to lack of blinding of participants and personnel. Statistical heterogeneity was substantial in every meta-analysis (I² above 90%), meaning the pooled effect sizes carry wide uncertainty. Publication bias was suspected based on Egger's test for both pain and quality-of-life outcomes. Most studies did not report long-term outcomes or stratify by disease severity. Several studies combined physical therapy with pharmacological or psychological treatment, so the contribution of the physical therapy component alone cannot be separated.
Declared interests
The authors report no conflicts of interest and state the research received no specific grant from any public, commercial, or not-for-profit funding agency.
The easy way to misread this
Do not read the large pooled effect sizes (SMD 3.1 for dyspareunia, SMD 1.52 for quality of life) as proof that any one technique — TENS, massage, or acupuncture — is proven effective. The meta-analysis pooled studies using very different combinations of interventions, heterogeneity exceeded 90% in every analysis, and 81.8% of the included studies had high or critical risk of bias, so the true benefit of any single modality remains unknown.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →