COMPARATIVE EFFICACY OF MEDICAL, SURGICAL, DIETARY, AND EMERGING THERAPIES IN THE MANAGEMENT OF ENDOMETRIOSIS-ASSOCIATED PAIN AND QUALITY OF LIFE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Endometriosis affects approximately 10% of reproductive-age women worldwide, manifesting as chronic pelvic pain, dysmenorrhea, dyspareunia, and diminished quality of life (QoL). Despite advances, no curative treatment exists, necessitating comparative evaluations of medical (hormonal), surgical, dietary, and emerging therapies. Objective: To systematically review and meta-analyze the comparative efficacy of these therapies on pain (VAS/NRS) and QoL (EHP-30, SF-36) outcomes. Methods: Following PRISMA 2020 guidelines, databases (PubMed, Scopus, Cochrane, Web of Science) were searched from 2019-2025 using MeSH terms including "endometriosis pain," "hormonal therapy," "surgical intervention," "dietary therapy," and "meta-analysis." RCTs, cohorts, and reviews (n≥20) were included. Risk of bias used RoB2; random-effects meta-analysis (RevMan 5.4) calculated SMD/MD (95% CI), I² for heterogeneity. Results: From 1,247 records, 45 studies were included. Surgery showed superior pain reduction (SMD -1.12, 95% CI -1.45 to -0.79; I²=68%) vs medical (SMD -0.61, 95% CI -0.77 to -0.45); dietary/complementary therapies yielded SMD -0.48 (95% CI -0.72 to -0.24). Combination approaches optimized QoL (MD -12.5 EHP-30 points). Conclusions: Surgery excels in sustained relief; hormonal therapies suit first-line use; dietary/emerging options enhance safety and adherence. Multidisciplinary integration addresses heterogeneity and gaps. Keywords: Endometriosis, pain management, meta-analysis, hormonal therapy, laparoscopy, dietary interventions, quality of life