{"paper_id":"95db6bfe-38df-4746-9c95-495a912a3f7c","body_text":"Abstract\nBackground\nIn women, chronic pelvic pain (CPP) is recurrent or constant pain in the pelvis, lower abdominal region, and female organs that persists for longer than 6 months. Exercise has been effective for other chronic pain conditions and could potentially be effective for CPP. The objective was to evaluate if exercise is more effective than no intervention, minimal intervention or usual care for improving pain and quality of life (QOL) in the short, medium, and long-term in women of reproductive age with ongoing CPP of gynaecological or urological origin. Short-term pain was the primary endpoint.\nMethods\nThis was a systematic review with meta-analysis. Four databases were searched. Title/abstract, full-text screening, data extraction and risk of bias assessment were conducted by two independent authors. Risk of bias was measured using the Cochrane risk of bias 2.0 tool. For pain, scales were converted to a standardised 0 to 10 scale, with a smallest clinically worthwhile effect of 1.5 points. For QOL, scales were converted to a Standardised Mean difference (SMD). Random effects meta-analyses were used, and GRADE syntheses were performed.\nResults\nWe identified 9319 records. Six studies (n = 333) were included. All studies were high risk of bias. Two studies included yoga as an exercise modality, while the remaining used multiple exercise types. Comparators included advice, medication, or usual care. For pain, the evidence was very uncertain that exercise was better than the comparator and the effect was clinically worthwhile in the short- (MD: -2.74, 95%CI: -3.70 to -1.78, 4 studies) and long-term (MD: -3.38, 95%CI: -4.80 to -1.96, 2 studies). For QOL, the evidence was very uncertain that exercise was better than the comparator in the short- (SMD: 0.64, 95%CI: 0.08 to 1.19, 3 studies) and long-term (SMD: 1.12, 95%CI: 0.36 to 1.89, n = 31, 1 study). No studies investigated medium-term pain or QOL.\nConclusion\nThe evidence was very uncertain for exercise on short-and long-term pain and QOL. Studies with low risk of bias are required to confirm these effects and to determine if any specific exercise modality is more effective.\nProtocol registration\nThe protocol was pre-registered in Open Science Framework on May 31st, 2024 (https://doi.org/10.17605/OSF.IO/FA3CR).\nAbbreviations\n- CENTRAL:\n-\nCochrane Central Register of Controlled Trials\n- CINAHL:\n-\nCumulative Index to Nursing and Allied Health Literature\n- CPP:\n-\nChronic Pelvic Pain\n- EHP-30:\n-\nEndometriosis Health Profile-30\n- EQ5D-5L:\n-\nEuroQol-5 Dimension, 5-Level questionnaire\n- GRADE:\n-\nGrading of Recommendations Assessment, Development and Evaluation\n- MD:\n-\nMean difference\n- NSAIDS:\n-\nNon-steroidal anti-inflammatory drugs\n- NR:\n-\nNot Reported\n- NRS:\n-\nNumerical Rating Scale\n- PEDro:\n-\nPhysiotherapy Evidence Database\n- PRISMA:\n-\nPreferred Reporting Items for Systematic Reviews and Meta-Analyses\n- QOL:\n-\nQuality of life\n- RCT:\n-\nRandomised Controlled trial\n- SD:\n-\nStandard Deviation\n- SF-36:\n-\n36-Item Short Form Health Survey\n- SMD:\n-\nStandardised Mean Difference\n- VAS:\n-\nVisual Analogue Scale\n- WHOQOL‑Bref:\n-\nWorld Health Organization Quality of Life - Bref\nAcknowledgements\nWe would like to thank the UTS information specialist (Kimberley Porteous) for helping create and revise the search.\nFunding\nThe author(s) received no financial support for the research, authorship, and/or publication of this article.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthics approval and consent to participate\nNon applicable.\nConsent for publication\nNon applicable.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.\nAbout this article\nCite this article\nSun, M., Warren, I., Hodgkinson, O. et al. Exercise for chronic pelvic pain in pre-menopausal women: a systematic review and meta-analysis. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04847-8\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-04847-8","source_license":"CC0","license_restricted":false}