Effectiveness of physical therapy techniques and methods in the management of endometriosis symptoms: A systematic review with meta-analysis

Background Endometriosis is a benign and chronic disease characterized by inflammation of the endometrial tissue outside the uterus. Numerous physical therapy interventions have been studied to alleviate the related symptoms. Objective To evaluate the effectiveness of different physical therapy methods and techniques in improving the symptoms triggered by endometriosis. Methods Systematic review of articles exclusively including women with endometriosis, quantitative studies, and interventions that included some form of physical therapy techniques. Difference in mean differences and their 95% confidence interval were calculated. The I² statistic was used to determine the degree of heterogeneity, and the GRADE approach was used to assess the certainty of the evidence. Results The interventions analyzed included manual therapy, education, electrotherapy, exercise, relaxation techniques, and acupuncture. Dyspareunia (p = 0.001; I2 = 95.6%) and pelvic pain (p = 0.012; I2 = 90.1%) were significantly reduced. Quality of life was significantly increased (p < 0.001; I2 = 94.9%). The certainty of the evidence obtained was moderate. Conclusion Massage therapy combined with perineal stretching, electrotherapy, acupuncture, exercise, and patient education are effective in improving chronic pelvic pain, dyspareunia, dysmenorrhea, non-menstrual pain, the basic and modular domains of quality of life, mental and physical health, and functional well-being in endometriosis. Healthcare professionals must recognize the importance of evaluating each case individually and tailoring treatments to the specific needs of each patient. © 2026 The Author(s).