---
title: "Endometriosis"
url: "https://acuiq.com/wiki/evidence/endometriosis"
updated: 2026-10-15
last_verified: 2026-10-15
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-15"
reading_minutes: 9
sources: 16
---

# Endometriosis

_What the Cochrane review, later meta-analyses, the sham-controlled trials and two guidelines report on acupuncture for endometriosis-associated pain._

Endometriosis is a condition in which tissue similar to the lining of the womb grows outside it, most often on the pelvic organs, and its commonest symptoms are painful periods (dysmenorrhoea), chronic pelvic pain and pain during sex (dyspareunia). The [2011 Cochrane review](https://doi.org/10.1002/14651858.CD007864.pub2) of acupuncture for pain in endometriosis found one trial that met its criteria and judged the evidence limited. Reviews published since 2017 pool between 6 and 42 trials and report lower pain scores with acupuncture, most of them against drugs or herbal medicine rather than a sham. In the two blinded sham-controlled trials, the differences in pain narrowed or disappeared over follow-up. This page reports what each source found and what each compared acupuncture with.

## The Cochrane review

The review, by Xiaoshu Zhu, Kate Hamilton and Ewan McNicol, searched English and Chinese databases to 2010 for randomised, blinded trials in women whose endometriosis had been confirmed by laparoscopy, the keyhole surgery that is the usual way to diagnose it. Of 24 studies of acupuncture for endometriosis, one trial, with 67 participants, met every criterion. It compared auricular (ear) acupuncture with Chinese herbal medicine. Dysmenorrhoea scores were 4.81 points lower with ear acupuncture on a 15-point scale taken from a Chinese guideline for research on new Chinese medicines, and 91.9% of the ear acupuncture group against 60% of the herbal group met the trial's definition of an effective result. The improvement rate differed only among women with severe dysmenorrhoea. No data were available on quality of life, pregnancy, adverse effects or recurrence. The authors called the evidence limited and asked for well-designed, double-blinded trials. The review has not been updated since 2011: the DOI registry holds no later version, and PubMed records no update or withdrawal.

## Later reviews

The reviews below differ in what they let in. Some pool trials against sham acupuncture, some against hormonal drugs or Chinese herbal medicine, and some count acupuncture added to drugs. A standardised mean difference (SMD) or Hedges' g expresses an effect in standard deviations rather than scale points, so trials that used different pain scales can be pooled.

| Review | Searched to | Trials (participants) | Comparisons | What it reported |
| --- | --- | --- | --- | --- |
| [Xu and colleagues, 2017](https://doi.org/10.1371/journal.pone.0186616) | December 2016 | 10 (589) | Mostly drugs and herbal medicine; one placebo-controlled pilot | Pain 1.36 points lower on a 0 to 10 scale than in control groups; arms of 8 to 36 patients |
| [Wang and colleagues, 2023](https://doi.org/10.1016/j.ctim.2023.102963) | April 2022 | 15 (1,018) | Sham, conventional drugs, acupuncture added to drugs | Comparisons and outcomes too varied to pool; against sham, single studies reported lower period, pelvic and intercourse pain |
| [Giese and colleagues, 2023](https://doi.org/10.1016/j.imr.2023.101003) | March 2023 | 6 (331) | Non-specific (sham) acupuncture; usual care | Against sham, lower overall pelvic pain (g 1.54, 3 trials, 231 people) and period pain (g 1.67, 1 trial, 106 people); against usual care, lower period pain in 1 trial of 19 people |
| [Chen and colleagues, 2024](https://doi.org/10.1007/s00404-024-07675-z) | December 2022 | 14 (793) | Placebo, Chinese herbal medicine, Western drugs, pooled together | Lower pain severity (SMD −1.10) and lower serum CA-125, a blood marker raised in endometriosis |
| [Yang and colleagues, 2025](https://doi.org/10.1097/MD.0000000000044005) | March 2025 | 9 (535) | Acupuncture alone against any treatment without acupuncture | Pain 1.67 points lower on a visual analogue scale; no difference in CA-125 |

Only the review by Nicola Giese, Kwan Kyung Kwon and Mike Armour rated its evidence with GRADE, the standard system for grading how far a body of evidence can be trusted. It rated the sham comparison for overall pelvic pain low, the single sham-controlled trial of period pain moderate, and the usual-care comparison very low. The review by Wang and colleagues graded its single-study sham results moderate to high and concluded that the evidence on the overall effectiveness of acupuncture and moxibustion for endometriosis was insufficient. Chen and colleagues, and Yang and colleagues, both name the design and quality of the included trials as limits on their findings.

Two network meta-analyses rank acupuncture-related methods against each other through shared comparators. [Li and colleagues (2024)](https://doi.org/10.2147/JPR.S488343) included 42 trials and 3,635 participants across six methods, and ranked acupoint catgut embedding, in which absorbable thread is left under the skin at a point, first for lowering pain. [Su and colleagues (2025)](https://doi.org/10.1007/s00404-025-07979-8) included 23 trials and 1,545 patients of acupuncture-related methods combined with drugs, and ranked ear electroacupuncture first for overall symptoms. Both report their results against drug treatment rather than against a sham, and both called for higher-quality trials.

## Trials that shaped the evidence

A [2008 trial](https://doi.org/10.1016/j.jpag.2007.07.008) by Peter Wayne and colleagues in Boston randomised 18 young women aged 13 to 22 with laparoscopically diagnosed endometriosis to Japanese-style acupuncture or a sham, 16 treatments over eight weeks. Its pain outcome was pelvic pain outside periods and intercourse. After four weeks that pain had fallen by an average 4.8 points on an 11-point scale in the acupuncture group (9 women) against 1.4 points in the sham group (5 women). Pain in the acupuncture group stayed lower through six months, but after four weeks the difference between the groups was no longer statistically significant. The trial was designed to test whether a larger one was feasible.

A [2010 Austrian crossover trial](https://doi.org/10.1016/j.ejogrb.2010.06.023) by Katharina Rubi-Klein and colleagues gave 101 women aged 20 to 40 two series of 10 sessions, each over five weeks, on top of their conventional treatment. One group received acupuncture at specific points first and non-specific acupuncture second; the other received them in the reverse order, with at least two menstrual cycles between the series. Of the 83 women who finished, the group given specific points first reported significantly lower pain after the first series, and the other group only after crossing over.

The largest sham-controlled trial is a 2023 multicentre trial by Li and colleagues at four hospitals in Jiangxi and Hainan provinces, China. It randomised 106 women aged 20 to 40 to acupuncture or sham acupuncture, three 30-minute sessions a week for 12 weeks, starting a week before each expected period, then followed them for 12 more weeks. Its [published protocol](https://doi.org/10.1186/s13063-018-2684-6) names five points, [`CV04`](/points/cv04) (Guanyuan), [`SP06`](/points/sp06) (Sanyinjiao), [`LV03`](/points/lv03) (Taichong), [`KD06`](/points/kd06) (Zhaohai) and [`ST30`](/points/st30) (Qichong), against a sham of shallow needles on the shoulder and upper arm away from any acupuncture point, without stimulation. At 12 weeks the acupuncture group reported a greater fall in dysmenorrhoea scores, shorter periods of pain, and greater improvement in mood and quality-of-life scores. By week 24 the differences in period pain and questionnaire scores were gone. Pelvic pain outside periods and pain during sex did not differ between the groups, and the trial recorded no serious adverse events.

A [2021 Australian feasibility trial](https://doi.org/10.1089/acm.2021.0004) by Mike Armour and colleagues in Sydney compared 16 sessions over eight weeks plus usual care with usual care alone. Of 29 eligible women, 19 completed it: 14% withdrew from the acupuncture group and 53% from usual care. Median period and non-period pain fell by about 2 points in the acupuncture group only, and adverse events, mostly mild, occurred in 6.7%. The authors concluded that usual care alone was not an acceptable control for a larger trial.

## What guidance says

The European Society of Human Reproduction and Embryology (ESHRE) [endometriosis guideline](https://doi.org/10.1093/hropen/hoac009), issued on 2 February 2022 and, on ESHRE's guideline page, still its latest version, asks clinicians to discuss non-medical strategies for quality of life and psychological well-being. It makes no recommendation for any specific non-medical intervention, acupuncture, electrotherapy and Chinese medicine among them, because their potential benefits and harms are unclear. It reaches the same conclusion for fertility.

NICE's guideline NG73, Endometriosis: diagnosis and management, was published in September 2017 and last updated in November 2024, when its diagnosis recommendations were revised. Under non-pharmacological management it has one recommendation, unchanged since 2017: to advise women that the available evidence does not support traditional Chinese medicine, other Chinese herbal medicines or supplements for treating endometriosis. It does not mention acupuncture. Clinical guidelines sets out what other guideline bodies say, condition by condition.

## What the reviews could not settle

Most pooled trials compared acupuncture with drugs or herbal medicine, and many were small and unblinded, so they cannot separate the effect of needling from the attention and expectation that come with a course of treatment. The sham-controlled evidence rests on a handful of trials, and the largest found its differences gone 12 weeks after treatment stopped. Sham acupuncture explains why no sham is inert. The reviews had too few comparable trials to say which points, styles or numbers of sessions matter, and the largest sham-controlled trial found no difference in pain during sex. The Cochrane review found no trial data on quality of life, adverse effects or recurrence, and Wang and colleagues still judged the evidence on overall effectiveness insufficient in 2023.

[Period pain](/wiki/evidence/period-pain) reports the evidence for primary dysmenorrhoea, where no underlying disease is found; [Chronic pain](/wiki/evidence/chronic-pain) covers the individual patient data meta-analyses across chronic pain conditions; and Uterine fibroids and [Polycystic ovary syndrome](/wiki/evidence/polycystic-ovary-syndrome) report the trials in two other gynaecological conditions. AcuiQ’s [endometriosis page](/symptoms/endometriosis) lists the protocols individual studies prescribed, each with its citation, and Reading a protocol explains each field of an entry.

### Sources

1. Zhu X, Hamilton KD, McNicol ED, Acupuncture for pain in endometriosis, Cochrane Database of Systematic Reviews 2011 — https://doi.org/10.1002/14651858.CD007864.pub2
2. Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S, Effects of acupuncture for the treatment of endometriosis-related pain: a systematic review and meta-analysis, PLoS One 2017 — https://doi.org/10.1371/journal.pone.0186616
3. Wang Y, Coyle ME, Hong M, He S, Zhang AL, Guo X, Lu C, Xue CCL, Liang X, Acupuncture and moxibustion for endometriosis: a systematic review and analysis, Complementary Therapies in Medicine 2023 — https://doi.org/10.1016/j.ctim.2023.102963
4. Giese N, Kwon KK, Armour M, Acupuncture for endometriosis: a systematic review and meta-analysis, Integrative Medicine Research 2023 — https://doi.org/10.1016/j.imr.2023.101003
5. Chen C, Li X, Lu S, Yang J, Liu Y, Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis, Archives of Gynecology and Obstetrics 2024 — https://doi.org/10.1007/s00404-024-07675-z
6. Yang F, Wang L, Wang YW, Chu LC, Acupuncture monotherapy for endometriosis-related pain: a systematic review and meta-analysis, Medicine (Baltimore) 2025 — https://doi.org/10.1097/MD.0000000000044005
7. Li H, Wang X, Wang Y, et al., Acupuncture and related therapies for endometriosis: a network meta-analysis of randomized controlled trials, Journal of Pain Research 2024 — https://doi.org/10.2147/JPR.S488343
8. Su Y, Ji R, Zheng X, et al., Efficacy and safety of acupuncture-related therapies in symptomatic endometriosis: a systematic review and network meta-analysis, Archives of Gynecology and Obstetrics 2025 — https://doi.org/10.1007/s00404-025-07979-8
9. Wayne PM, Kerr CE, Schnyer RN, et al., Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial, Journal of Pediatric and Adolescent Gynecology 2008 — https://doi.org/10.1016/j.jpag.2007.07.008
10. Rubi-Klein K, Kucera-Sliutz E, Nissel H, Bijak M, Stockenhuber D, Fink M, Wolkenstein E, Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial, European Journal of Obstetrics and Gynecology and Reproductive Biology 2010 — https://doi.org/10.1016/j.ejogrb.2010.06.023
11. Li PS, Peng XM, Niu XX, Xu L, Ng EHY, Wang CC, Dai JF, Lu J, Liang RN, Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial, Fertility and Sterility 2023 — https://doi.org/10.1016/j.fertnstert.2023.01.034
12. Liang R, Li P, Peng X, et al., Efficacy of acupuncture on pelvic pain in patients with endometriosis: study protocol for a randomized, single-blind, multi-center, placebo-controlled trial, Trials 2018 — https://doi.org/10.1186/s13063-018-2684-6
13. Armour M, Cave AE, Schabrun SM, Steiner GZ, Zhu X, Song J, Abbott J, Smith CA, Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: a randomized controlled feasibility study, Journal of Alternative and Complementary Medicine 2021 — https://doi.org/10.1089/acm.2021.0004
14. Becker CM, Bokor A, Heikinheimo O, et al., ESHRE guideline: endometriosis, Human Reproduction Open 2022 — https://doi.org/10.1093/hropen/hoac009
15. ESHRE, Endometriosis guideline, European Society of Human Reproduction and Embryology, issued 2 February 2022 — https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
16. NICE guideline NG73, Endometriosis: diagnosis and management, National Institute for Health and Care Excellence, published September 2017, last updated November 2024 — https://www.nice.org.uk/guidance/ng73/chapter/Recommendations