Acupuncture for Endometriosis-Related Pain: What Does the Research Say?
What is Endometriosis?
Endometriosis is a chronic inflammatory condition characterised by the presence of endometrial-like tissue outside the uterus. It commonly causes pelvic pain, dysmenorrhoea (painful periods), fatigue, and reduced quality of life. Despite advances in medical and surgical management, many people continue to experience persistent pain or intolerable side effects, prompting growing interest in non-pharmacological and integrative approaches such as acupuncture.
Growing research interest in acupuncture
Over the past two decades, acupuncture has been increasingly studied for endometriosis-related pain. Multiple randomised controlled trials (RCTs), systematic reviews, and meta-analyses now provide insight into its potential role as an adjunctive therapy.
A major systematic review and meta-analysis published in Integrative Medicine Research analysed six RCTs involving more than 300 participants (Giese et al., 2023). The review found that acupuncture produced clinically meaningful reductions in pelvic pain, particularly menstrual pain, when compared with non-specific acupuncture or usual care. Importantly, the magnitude of pain reduction exceeded thresholds considered clinically important in pain research.
Similarly, an earlier meta-analysis in PLOS ONE reported that acupuncture was associated with significant improvements in dysmenorrhoea and overall pelvic pain, as well as reductions in analgesic use in some studies (Xu et al., 2017). Although methodological limitations were noted, the overall direction of evidence favoured acupuncture over control interventions.
Evidence from controlled clinical trials
High-quality clinical trials further support these findings. A large multicentre randomised, single-blind, placebo-controlled trial demonstrated that acupuncture significantly reduced menstrual pain intensity and pain duration during the treatment phase compared with sham acupuncture (Li et al., 2023). Participants also reported improvements in wellbeing and quality of life. However, benefits diminished after treatment ceased, suggesting that ongoing or maintenance treatment may be important for sustained outcomes.
Other trials, including sham-controlled studies in adolescents and young women, have shown improvements in pain-related quality of life, even when changes in pain intensity alone were modest (Wayne et al., 2014). This highlights the complex, multidimensional nature of endometriosis pain, which involves not only nociception but also central pain processing, emotional burden, and functional impairment.
How might acupuncture help endometriosis pain?
Endometriosis pain is increasingly understood as involving both peripheral inflammation and central sensitisation. Research suggests acupuncture may influence multiple pathways relevant to this process:
- Modulation of central and peripheral pain signalling
- Increased release of endogenous opioids
- Reduction of inflammatory mediators (e.g. prostaglandins, nerve growth factors)
- Regulation of autonomic nervous system activity
- Improved pelvic blood flow
These mechanisms are discussed across both clinical and mechanistic reviews, supporting biological plausibility for acupuncture’s analgesic effects (Giese et al., 2023).
Safety and tolerability
Across trials and reviews, acupuncture has demonstrated a favourable safety profile. Reported adverse events are generally mild and transient, such as temporary soreness, bruising, or lightheadedness (Xu et al., 2017; Giese et al., 2023). Serious adverse events are rare when treatment is provided by qualified practitioners.
Limitations of current evidence
While results are promising, authors consistently emphasise limitations within the current evidence base. These include small sample sizes, variation in acupuncture styles and treatment protocols, difficulties designing inert sham controls, and limited long-term follow-up. As a result, certainty of evidence is often rated as moderate to low, and individual responses to treatment vary.
Clinical implications
Taken together, current research suggests acupuncture may be a valuable adjunctive therapy for people with endometriosis-related pain, particularly menstrual and pelvic pain, when used as part of a multidisciplinary care approach. It is not a cure for endometriosis, but it may help reduce pain, improve quality of life, and decrease reliance on pain medication for some individuals.
Further high-quality trials are needed to clarify optimal treatment frequency, long-term benefits, and which patients are most likely to respond. Nevertheless, the existing evidence supports acupuncture as a reasonable, evidence-informed option for those seeking non-drug pain management strategies.
Reference list
Giese, N., Kwon, K. K., & Armour, M. (2023). Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative Medicine Research, 12(4), 101003. https://www.sciencedirect.com/science/article/pii/S2213422023000823 Li, P. S., Peng, X. M., Niu, X. X., Xu, L., Ng, E. H. Y., Wang, C. C., & Li, P. (2023). Efficacy of acupuncture for endometriosis-associated pain: A multicenter randomized single-blind placebo-controlled trial. Fertility and Sterility, 119(5), 825–834. https://www.fertstert.org/article/S0015-0282(23)00072-9/fulltext Wayne, P. M., Kerr, C. E., Schnyer, R. N., Legedza, A. T. R., Savetsky-German, J., Shields, M. H., … Conboy, L. A. (2014). Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: Results of a randomized sham-controlled trial. Journal of Pain Research, 7, 191–201. https://www.tandfonline.com/doi/full/10.2147/JPR.S55580 Xu, Y., Zhao, W., Li, T., Zhao, Y., Bu, H., & Song, S. (2017). Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLOS ONE, 12(10), e0186616. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186616