Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis

Background: Despite advances in treatments for endometriosis, some symptoms persist owing to the chronic inflammation observed in this disease.

Objective: To identify resources, methods, and/or complementary treatments to alleviate the pain symptoms of endometriosis, and to identify adverse effects of treatments.

Search strategy: Lilacs, Scielo, PEDro, Scopus, Pubmed, CENTRAL Cochrane, Science Direct, and Google Scholar were searched for studies published in Portuguese, English, and Spanish to July 31, 2017, using the terms "physical therapy" OR "complementary treatment" AND "endometriosis".

Selection criteria: Randomized controlled trials relating to complementary pelvic pain treatment and adverse effects.

Data collection and analysis: Eight studies were identified; two studies were included in the meta-analysis.

Main results: The complementary interventions studied were acupuncture, exercise, electrotherapy, and yoga. All were inconclusive in affirming benefit, but demonstrated a positive trend in the treatment of symptoms of endometriosis. Meta-analysis of acupuncture showed a significant benefit in pain reduction as compared with placebo (P=0.007).

Conclusions: Numerous complementary treatments have been used to alleviate the symptoms of endometriosis, but only acupuncture has demonstrated a significant improvement in outcomes. Nevertheless, other approaches demonstrated positive trends toward improving symptoms; this should encourage investigators to design controlled studies to support their applicability.