Comparing Surgical, Acupuncture, and Exercise Interventions for Improving the Quality of Life in Women With Endometriosis: A Systematic Review

This systematic review analyzed the efficacy of three therapeutic approaches—surgical, acupuncture, and exercise—for improving quality of life in women with endometriosis, a chronic condition that affects about 10% of women of reproductive age globally. The researchers conducted a comprehensive search of five databases, following PRISMA guidelines, and identified 10 relevant studies (6 randomized clinical trials and 4 observational studies) involving 493 participants. The results of surgical interventions were particularly impressive. Laparoscopic excision of endometriotic lesions demonstrated substantial reductions in pain, with one study reporting a drop from 94.8% to 18.4% in the proportion of women with moderate/severe pain.

Pain scores on the visual analog scale decreased dramatically from 8 ± 2.11 to 0.47 ± 1.24. In addition, 93.1% of patients rated their quality of life as significantly improved after surgery. Acupuncture also showed promising results as a non-invasive approach. The studies demonstrated significant reductions in dysmenorrhea, with a 3.9-point decrease in pain scores.

For chronic pelvic pain, 66% of patients in the acupuncture group experienced improvement, compared with only 17% in the placebo group. Acupuncture also produced significant improvements in emotional well-being, measured by instruments such as the Beck Depression Inventory and mood profiles. The supervised exercise program, although represented by only one study, showed encouraging results. Participants experienced improvements with large effect sizes (d > 0.80) in quality of life, both immediately after the intervention and at one-year follow-up.

Exercise reduced dyspareunia and pain catastrophizing, in addition to increasing abdominal and back strength, improving lumbopelvic stability, and enhancing muscle architecture. The review methodology was rigorous, using appropriate quality assessment tools—the Cochrane Risk of Bias tool for randomized clinical trials and the Newcastle-Ottawa Scale for observational studies. Most studies demonstrated good methodologic quality, although some limitations were identified, including small sample sizes in some studies, lack of adequate blinding in certain interventions, and potential selection bias. The mechanisms by which these interventions exert their beneficial effects vary.

Surgery acts directly by removing ectopic endometriotic tissue, eliminating the source of inflammation and pain. Acupuncture may modulate pain perception through neurologic pathways, promoting the release of endorphins and other neurotransmitters. Exercise contributes through improved overall physical function, stress reduction, and strengthening of specific muscle groups that may be compromised by the condition. The clinical implications of these findings are significant.

For patients with severe endometriosis refractory to conservative treatments, laparoscopic surgery emerges as a highly effective option. For those who prefer non-invasive approaches or as adjunctive therapies, both acupuncture and structured exercise programs offer clinically relevant benefits. The complementary nature of these interventions suggests that multimodal approaches may be particularly beneficial. However, several limitations must be considered.

Heterogeneity in intervention protocols, measurement instruments, and follow-up periods made direct comparisons difficult. Some studies lacked adequate control groups, limiting causal inferences. In addition, the long-term sustainability of observed benefits requires further investigation, particularly for interventions such as acupuncture and exercise that may require ongoing maintenance.