Efficacy and safety of traditional Chinese medicine for endometriosis-related pain: a meta-analysis

OBJECTIVE: To systematically evaluate the efficacy and safety of Chinese herbal medicine (CHM) for endometriosis-associated pain (EAP). METHODS: Randomized controlled trials (RCTs) were retrieved from PubMed, Embase, and Cochrane Library up to July 2025. The intervention group received CHM alone, while controls received placebo, western medicine, or no treatment. Primary outcomes included pain relief measured by the visual analog scale (VAS) for dysmenorrhea, dyspareunia, and pelvic pain, as well as adverse reactions. Secondary outcomes were TNF-α and IL-6 levels. The risk of bias was assessed using Cochrane RoB 2.0, and data were analyzed using RevMan 5.4. RESULTS: Eleven RCTs (1401 participants) were included. CHM significantly reduced VAS scores for dysmenorrhea (SMD=-2.04, P=0.0484) and dyspareunia (SMD=-2.42, P=0.0031), although heterogeneity was high. No significant effect was observed on pelvic pain (SMD=-1.70, P=0.0793). CHM significantly decreased serum TNF-α (SMD=-0.85, P<0.0001) and IL-6 (SMD=-0.77, P0.05). CONCLUSION: CHM effectively relieves EAP-related dysmenorrhea and dyspareunia, and reduces TNF-α/IL-6, with acceptable safety. However, its effect on pelvic pain remains inconclusive. Further high-quality RCTs with standardized interventions are needed.