Acupuncture monotherapy for endometriosis-related pain: A systematic review and meta-analysis

Background: This study evaluated the efficacy of acupuncture as a monotherapy for managing endometriosis-related pain (ERP) compared to non-acupuncture interventions. Methods: We systematically searched PubMed, EMBASE, Cochrane Library, CNKI, WANGFANG, and VIP databases from inception to March 1, 2025, for randomized controlled trials (RCTs) comparing acupuncture alone with non-acupuncture treatments in ERP patients. Included trials were assessed for methodological quality using the Cochrane risk-of-bias tool, and statistical analyses by RevMan 5.4. Results: Nine RCTs involving 535 patients were included. Meta-analysis revealed that acupuncture significantly reduced pain intensity, as measured by the visual analog scale (mean difference = −1.67, 95% confidence interval [CI]: −2.85 to −0.49, P = .006) and improved clinical response rates (odds ratio = 2.61, 95% CI: 1.38–4.95, P = .003). However, no significant differences were observed in serum CA125 levels (mean difference = −1.46, 95% CI: −20.69 to 17.76, P = .88) or overall effective rate (odds ratio = 2.18, 95% CI: 0.99–4.80, P = .05). Conclusion: Acupuncture may serve as an effective standalone therapy for ERP, particularly in pain relief and clinical response. However, due to heterogeneity and methodological limitations in the included studies, further large-scale, high-quality RCTs are warranted to validate these findings and establish long-term efficacy.