Comparative Effectiveness of Non-Pharmacological Interventions for Pain and Quality of Life in Women with Endometriosis: A Systematic Review and Network Meta-Analysis

Xiaojun Zheng,1,* Yu Wang,1,* Haiping Li,1 Juncha Zhang,1 Jun Liu,1 Xihui Zheng,1 Jie Zhang,1 Guangya Fan,1 Yi Sun,1 Bingxian Li,1 Jingyi Jiao,1 Guang Zuo,1 Xisheng Fan,1,2 Yanfen She1,2 1College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People’s Republic of China; 2Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xisheng Fan, College of Acupuncture-Moxibustion and Tuina & Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang City, Hebei Province, 050200, People’s Republic of China, Email [email protected] Yanfen She, College of Acupuncture-Moxibustion and Tuina & Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang City, Hebei Province, 050200, People’s Republic of China, Email [email protected]: Endometriosis is a chronic gynecological disorder characterized by pain and impaired quality of life (QoL). While pharmacological and surgical options exist, their limitations necessitate complementary strategies. The comparative effectiveness of non-pharmacological interventions remains uncertain.Objective: This network meta-analysis (NMA) aimed to evaluate and rank the efficacy of non-pharmacological therapies for pain and QoL in women with endometriosis.Methods: We systematically searched PubMed, Embase, CENTRAL, Web of Science, and CNKI from inception to August 31, 2025. Eligible randomized controlled trials (RCTs) compared structured non-pharmacological interventions—acupuncture (ACU), exercise (EXE), nutritional supplementation (NUT), physical therapy (PHY), or psychological interventions (PSY)—against conventional care (CON). Primary outcomes were pain (overall, pelvic, dysmenorrhea) and QoL; the secondary outcome was anxiety.Results: Thirty-three RCTs involving 2323 women were included. For overall pain, PHY (SMD = − 1.44), ACU (SMD = − 1.27), and PSY (SMD = − 1.22) were significantly superior to CON, with PHY ranking highest (SUCRA = 74.4%). ACU was most effective for pelvic pain (SMD = − 4.53; SUCRA = 99.1%), while PHY was optimal for dysmenorrhea (SMD = − 1.30; SUCRA = 82.3%). Both ACU (SMD = 4.09) and PHY (SMD = 4.18) significantly improved QoL compared to CON. No statistically significant differences were observed among interventions for anxiety.Conclusion: Non-pharmacological interventions, particularly PHY and ACU, provide significant benefits for pain and QoL in endometriosis, with subtype-specific advantages. These findings support their integration into multimodal management pathways.Keywords: endometriosis, non-pharmacological interventions, pain management, quality of life, network meta-analysis, randomized controlled trials