{"paper_id":"2046e60c-e80c-4494-84ac-297395488ccb","body_text":"Subscribe to RSS\nDOI: 10.1055/a-2815-3976\nPhysiotherapie bei Endometriose assoziierten Unterleibsschmerzen: eine systematische Übersichtsarbeit und Metaanalyse\nArticle in several languages: deutsch | EnglishAbstract\nBackground\nEndometriosis is a chronic inflammatory gynaecological disease characterised by the ectopic growth of tissue similar to the mucous membrane of the uterus (endometrium) and affects around 10 percent of women of childbearing age worldwide [1] [2] [3]. Endometriosis is often associated with chronic abdominal pain, dysmenorrhoea, dyspareunia, infertility and a significantly reduced quality of life [1] [2] [3] [4]. Although drug treatments such as NSAIDs and analgesics are often prescribed for endometriosis-associated abdominal pain, their long-term use is often limited due to side effects and contraindications [1] [3] [5] [6] [7] [8]. Physiotherapeutic interventions could offer an alternative and act as a potential pain-reducing intervention, but their role in endometriosis has not yet been sufficiently investigated.\nObjective\nTo date, there is no meta-analysis that deals exclusively with physiotherapeutic interventions for endometriosis-related abdominal pain. Therefore, the review and meta-analysis aims to evaluate the effectiveness of different physiotherapy techniques in relieving abdominal pain in women with endometriosis.\nMethods\nThe review was written according to the PRISMA 2020 guidelines, it was methodologically based on the Cochrane Handbook and it was registered in PROSPERO.\nThe literature search was conducted in PubMed, Embase and the Cochrane Library up to November 2023 without restrictions regarding language or publication date. The search terms in the search strategy included “endometriosis” in combination with terms such as physiotherapy, exercise therapy, rehabilitation, movement, electrotherapy, TENS, electrostimulation, laser therapy, manual therapy, manipulation, massage, ultrasound therapy, trigger point therapy, hydrotherapy and balneotherapy.\nStudies were included when they examined women with diagnosed endometriosis and endometriosis-related abdominal pain who were treated with physiotherapy. The pain intensity had to have been recorded both before and after the intervention using a 0–10-point scale (e. g. VAS or NRS) or an equivalent validated pain scale. Studies were excluded if they did not investigate physiotherapy or unconventional interventions such as yoga, Pilates or acupuncture, included populations without endometriosis-related abdominal pain, were animal or in vitro studies, did not record pain as an outcome or used non-comparable pain scales.\nThe interventions were categorised into 3 groups: Physiotherapeutic modalities: Electrotherapy procedures (TENS, NMES, transcranial direct current stimulation, laser therapy), exercise therapy: structured or supervised exercise programmes and manual therapy: manual techniques such as Thiele massage or soft tissue and joint techniques.\nThe bias potential was assessed independently by 2 reviewers using the Cochrane RoB 2 tool and the ROBINS-I tool. The evidence was assessed using the GRADE approach. The statistical analysis was carried out in R. The random-effects model was selected for the meta-analysis.\nThe mean differences with 95 % confidence intervals were calculated on the basis of the change in values between the control and intervention groups. If these were not specified, they were derived from the data before and after treatment.\nHeterogeneity was assessed using the Cochranʼs Q test and the I² statistic.\nResults\nOf 9828 researched studies, 8 (7 randomised controlled trials and 1 retrospective study) with a total of 433 participants met the inclusion criteria. Seven studies were included in the meta-analysis.\nOverall, physiotherapy interventions significantly reduced pelvic pain compared to control interventions, with an average reduction of around 2 points on a pain scale of 0–10 (MD -1.97; 95 % CI -2.99−-0.95).\nAmong the 3 intervention categories, physical measures, including TENS, transcranial electrotherapy and laser therapy, showed the greatest effect (pain intensity MD -2.03; 95 % CI -3.9−-0.14). Laser therapy led to a marked reduction in pain (MD -3.25; 95 % CI -4.96−-1.53). The side effects reported were minimal and only occurred in conjunction with electrotherapy. Manual therapy (e. g. soft tissue and joint techniques, Thiele massage) led to clinically significant but statistically insignificant effects (pain intensity MD -2.09; 95 % CI -15.84−11.67). Exercise therapy also reduced pain, albeit to a lesser extent (pain intensity MD -1.13; 95 % CI -3.94−1.68), although only limited data were available.\nMeasures categorised as local application were more effective than measures categorised as general application (pain intensity MD -2.26; 95 % CI -3.28−-1.24).\nThe overall risk of bias was moderate, and the quality of evidence was rated as low according to GRADE.\nConclusion\nThis systematic review and meta-analysis provides the first evidence that physiotherapy techniques are effective in relieving pelvic pain in women with endometriosis, particularly when the interventions are applied locally. Despite methodological limitations, the results speak in favour of considering physiotherapy as a valuable component of pain treatment for patients with endometriosis. Implementation of the results in clinical practice should take into account the low level of evidence.\nPublication History\nArticle published online:\n29 May 2026\n© 2026. Thieme. All rights reserved.\nGeorg Thieme Verlag KG\nOswald-Hesse-Straße 50, 70469 Stuttgart, Germany\n-\nLiteratur\n- 1 Becker CM, Bokor A, Heikinheimo O. et al. ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open 2022; 2022 (02) hoac009\n- 2 National Guideline Alliance (UK), Hrsg. Endometriosis: Diagnosis and Management. National Institute for Health and Care Excellence (NICE); 2017. Accessed January 18, 2026 at: www.nice.org.uk/guidance/ng73\n- 3 World Health Organization, Hrsg. Endometriosis fact sheet. WHO 2023. Accessed April 2024.. Accessed January 18, 2026 at: www.who.int/news-room/fact-sheets/detail/endometriosis\n- 4 Abril-Coello R, Correyero-Leon M, Ceballos-Laita L. et al. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: a systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 162: 233-243\n- 5 Bedaiwy MA, Alfaraj S, Yong P. et al. New developments in the medical treatment of endometriosis. Fertil Steril 2017; 107: 555-565\n- 6 Stratton P, Berkley KJ. Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update 2011; 17: 327-346\n- 7 National Health Service (NHS), Hrsg. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). NHS; 2022. Accessed January 18, 2026 at: www.nhs.uk/conditions/nsaids/\n- 8 Ghlichloo I, Gerriets V. Nonsteroidal anti-inflammatory drugs (NSAIDs). Treasure Island (FL): StatPearls Publishing; 2026.\n- 9 World Physiotherapy, Hrsg. Policy Statement: Description of Physiotherapy. World Physiotherapy; 2023.. Accessed January 18, 2026 at: https://world.physio/policy/ps-descriptionPT","source_license":"CC0","license_restricted":false}