Efectos del ejercicio terapéutico sobre el dolor pélvico en mujeres con endometriosis: revisión sistemática y metaanálisis

Introduction: Endometriosis is a chronic gynecological condition characterized by pelvic pain, dysmenorrhea, and functional impairment. Although conventional treatments provide partial symptom relief, clinical limitations persist. Therapeutic exercise has emerged as an effective complementary intervention. Objective: To systematically evaluate the effect of therapeutic exercise and supervised physical interventions on pelvic pain in women with endometriosis. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar (1995–May 2025), including controlled trials, pre-post studies, and observational designs with objective pain assessment. Meta-analysis was performed using a random-effects model (Hedges' g), heterogeneity analysis (I²), and publication bias assessment (Egger’s test). Results: A total of 2,721 records were identified. After applying inclusion criteria, 7 studies were analyzed, of which 5 provided quantitative data (N = 226). The overall effect size was Hedges' g = -1.73 (95% CI: -2.42 to -1.04), indicating a significant reduction in pain. Heterogeneity was moderate to high (I² = 62.8%). Subgroup analysis showed greater benefits for supervised exercise (g = -2.90), manual therapy/hydrotherapy (g = -2.00), yoga (g = -1.56), and somatosensory psychotherapy (g = -1.17), while digital interventions showed smaller effects (g = -0.50). No publication bias was detected (Egger p = 0.73). Conclusions: Supervised therapeutic exercise significantly reduces pelvic pain in women with endometriosis, with multicomponent face-to-face interventions showing the greatest clinical efficacy.