Effects of anti-inflammatory dietary supplements on pelvic pain in females with endometriosis: A GRADE-assessed systematic review and meta-analysis of RCTs

BACKGROUND: Endometriosis, the most perplexing gynecologic condition, impairs the quality of life because it is usually accompanied by persistent severe acyclic pelvic pain and infertility as its two main symptoms. The majority economic burden of endometriosis is due to infertility and pelvic pain. Therefore, alleviating pelvic pain in patients with endometriosis is a necessity. OBJECTIVES: The present systematic review and meta-analysis aimed to summarize evidence about the effects of anti-inflammatory dietary supplements on pelvic pain in females with endometriosis. SEARCH STRATEGY: PubMed, Scopus, and Web of Science as online databases were systematically searched by relevant keywords up to December 2023. SELECTION CRITERIA: Randomized controlled clinical trials (RCTs) with either a parallel or crossover design conducted in adults with endometriosis were selected. DATA COLLECTION AND ANALYSIS: Random effect analysis was used to run meta-analysis. Subgroup analyses were run to detect heterogeneity sources. Quality assessment was done by revised Cochrane Collaboration tool II. The certainty of evidence was evaluated by the GRADE tool. MAIN RESULTS: A significant decrease in pelvic pain following supplementation with anti-inflammatory dietary supplements was detected. Also, anti-inflammatory dietary supplements could significantly decline pelvic pain in patients with endometriosis when the age of the participants was ≥32 years, the duration of supplementation was >8 weeks, the type of intervention was anti-inflammatory vitamins, the stage of endometriosis of study participants was > II, and baseline body mass index (BMI) of the participants was >23 kg/m2. CONCLUSIONS: Use of anti-inflammatory dietary supplements in females with endometriosis results in a remarkable decrease in pelvic pain.