Acupuncture and moxibustion for endometriosis: A systematic review and analysis

This systematic review analyzed 15 randomized clinical studies involving 1,018 women with endometriosis to evaluate the efficacy of acupuncture and moxibustion in treating the symptoms of the disease. Endometriosis is a chronic inflammatory condition that causes intense pelvic pain, dysmenorrhea (menstrual cramps), and dyspareunia (pain during sexual intercourse), significantly affecting women's quality of life.

The researchers performed a comprehensive search of nine databases through April 2022, including studies conducted mainly in China, but also in Brazil, the United States, Austria, and Australia. Most studies (11 of 15) provided treatment for three months, mainly using manual acupuncture and moxibustion. The most frequently used acupuncture points were CV-4 Guanyuan, CV-3 Zhongji, SP-6 Sanyinjiao, and SP-10 Xuehai, points traditionally associated with the female reproductive system in traditional Chinese medicine.

The results showed promising evidence for the use of acupuncture in the treatment of endometriosis. Compared with sham acupuncture (placebo), manual acupuncture produced a significant reduction in the intensity of dysmenorrhea (2.40 points on the visual analog scale), pelvic pain (2.65 points), and dyspareunia (2.88 points). In addition, acupuncture proved effective in reducing the size of ovarian cysts (mean reduction of 3.88 cm) and in improving quality of life across multiple domains assessed by the EHP-30 questionnaire, including pain, personal control, emotional well-being, and social functioning.

When used as complementary therapy to conventional treatment, acupuncture showed superior benefits to drug treatment alone. Moxibustion, a technique that applies heat to specific points, also showed efficacy in reducing menstrual pain and improving symptoms when combined with conventional medications.

In terms of safety, the studies reported fewer adverse events in the groups that received acupuncture or moxibustion compared with control groups using medications. The side effects of acupuncture were minimal, occasionally including mild dizziness, small bruises, and minor moxibustion burns — all considered expected and low-risk events.

The limitations of this review include significant diversity among studies in terms of interventions, comparators, and outcome measures, preventing robust meta-analyses. Only five studies confirmed the diagnosis of endometriosis by laparoscopy (gold standard), and few studies performed long-term follow-up to assess the durability of effects.

The clinical implications suggest that acupuncture can be considered a safe complementary therapeutic option for women with endometriosis, especially those who experience significant side effects with conventional hormonal treatments or who seek integrated approaches to pain management. However, more high-quality studies with confirmed laparoscopic diagnosis and long-term follow-up are needed to establish definitive clinical guidelines on the use of acupuncture in endometriosis.