TREATMENT OF ENDOMETRIOSIS: AN UMBRELLA REVIEW OF SYSTEMATIC REVIEWS AND META-ANALYSES WITH ASSESSMENT OF EVIDENCE OVERLAP

Wojciech Żywiec, Alicja Dorota, Michał Dorota, Kacper Karaban, Nicole Maryniak, Jakub Rzeszutek
In: International Journal of Innovative Technologies in Social Science · 2026 · doi:10.31435/ijitss.1(49).2026.4981 · W7129041730
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This umbrella review synthesized evidence on endometriosis treatments, finding progestins and GnRH modulators effective for pain, while surgical excision reduced recurrence but affected ovarian reserve.

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This umbrella review synthesized 49 systematic reviews with quantitative meta-analyses (2019–2026) identified from PubMed, assessing methodological quality with AMSTAR 2 and quantifying overlap of shared primary studies using the corrected covered area (CCA). It found moderate-to-high overall methodological quality, with generally low evidence overlap but notable high overlap in selected domains, especially hormonal pretreatment before assisted reproductive technologies. Across therapeutic domains, progestins and gonadotropin-releasing hormone modulators consistently reduced endometriosis-related pain, while surgical excision of ovarian endometriomas reduced recurrence but impaired ovarian reserve and postoperative hormonal suppression reduced recurrence risk, with a caveat that interpretability is limited by redundancy and methodological heterogeneity. This paper is centrally about endometriosis — it evaluates evidence for endometriosis treatments using an umbrella-review framework that explicitly measures overlap among systematic review findings.

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Abstract

Background: Endometriosis is a chronic inflammatory disease associated with pain, infertility, and impaired quality of life. Numerous systematic reviews and meta-analyses have evaluated available treatments but overlapping evidence and methodological heterogeneity limit interpretability. Objective: To synthesize secondary evidence on endometriosis management using an umbrella review with explicit assessment of evidence overlap. Methods: Systematic reviews with quantitative meta-analyses published between 2019 and 2026 were identified through PubMed. Methodological quality was assessed using AMSTAR 2. Evidence was synthesized narratively across therapeutic domains and overlap of primary studies was quantified using the Corrected Covered Area (CCA). Results: Forty-nine systematic reviews were included. Overall, methodological quality was moderate to high. Evidence overlap was generally low but high in selected domains, particularly hormonal pretreatment before assisted reproductive technologies. Progestins and gonadotropin-releasing hormone modulators consistently reduce endometriosis-related pain. Surgical excision of ovarian endometriomas reduced recurrence but impaired ovarian reserve, while postoperative hormonal suppression reduced recurrence risk. Conclusions: This umbrella review supports selected hormonal and surgical strategies for endometriosis management while highlighting evidence redundancy and key knowledge gaps.
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Background

Endometriosis is a chronic inflammatory disease associated with pain, infertility, and impaired quality of life. Numerous systematic reviews and meta-analyses have evaluated available treatments but overlapping evidence and methodological heterogeneity limit interpretability.

Objective

To synthesize secondary evidence on endometriosis management using an umbrella review with explicit assessment of evidence overlap.

Methods

Systematic reviews with quantitative meta-analyses published between 2019 and 2026 were identified through PubMed. Methodological quality was assessed using AMSTAR 2. Evidence was synthesized narratively across therapeutic domains and overlap of primary studies was quantified using the Corrected Covered Area (CCA).

Results

Forty-nine systematic reviews were included. Overall, methodological quality was moderate to high. Evidence overlap was generally low but high in selected domains, particularly hormonal pretreatment before assisted reproductive technologies. Progestins and gonadotropin-releasing hormone modulators consistently reduce endometriosis-related pain. Surgical excision of ovarian endometriomas reduced recurrence but impaired ovarian reserve, while postoperative hormonal suppression reduced recurrence risk.

Conclusions

This umbrella review supports selected hormonal and surgical strategies for endometriosis management while highlighting evidence redundancy and key knowledge gaps.

References

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