Endometriosis is a gynecological condition affecting approximately 10-15% of women of reproductive age, characterized by the presence of endometrial tissue outside the uterine cavity. This pathology can cause debilitating chronic pelvic pain, severe dysmenorrhea (abdominal pain occurring during menstruation), dyspareunia (genital pain during sexual intercourse), and in many cases, fertility problems that significantly impact patients' quality of life.
Faced with the limitations and side effects of conventional pharmacological therapies, increasing numbers of women are turning to complementary approaches such as acupuncture, a millennial medical therapy from Traditional Chinese Medicine that is gaining scientific recognition for its effectiveness in treating chronic pain and inflammation.
The objective of this article is to analyze the available clinical evidence and explain how acupuncture can represent a valuable therapeutic support for women affected by endometriosis, offering a natural and safe approach to pain and inflammation management.
Endometriosis is characterized by the presence of endometrial glands and stroma in extrauterine sites, most commonly in the ovaries, fallopian tubes, pelvic peritoneum, and in more severe cases, adjacent organs such as the intestines and bladder.
During each menstrual cycle, ectopic endometriotic foci undergo the same hormonal changes as normal uterine endometrium, proliferating under estrogen influence and shedding during the menstrual phase. However, unlike normal endometrial tissue that is expelled through menstrual flow, blood from ectopic foci remains trapped in surrounding tissues, causing irritation, inflammation, and formation of scar adhesions.
Furthermore, endometriosis is associated with central nervous system sensitization phenomena, where normally non-painful stimuli are perceived as painful (allodynia) and painful stimuli are amplified (hyperalgesia), contributing to chronic pelvic pain development.
Acupuncture, one of the pillars of Traditional Chinese Medicine (TCM), is based on the theory, formulated over 3,000 years ago, that our health depends on an immaterial force (called vital energy or Qi by traditional physicians) that flows through specific channels on our body's surface, called Meridians. According to TCM, pain and disease derive from blockages or imbalances in Qi flow, and inserting thin needles at specific points along the meridians can restore physiological balance and promote healing.
From a Western medicine perspective, the physiological mechanisms of acupuncture underlying pain control have been extensively studied and involve various areas of our central and peripheral nervous systems. Acupuncture specifically stimulates the release of endogenous neurotransmitters such as endorphins, enkephalins, and serotonin, which have potent analgesic and anxiolytic effects.
Scientific research has provided convincing evidence that acupuncture can effectively reduce inflammation associated with endometriosis through several mechanisms of action.
Randomized controlled clinical studies have demonstrated that acupuncture can significantly reduce serum levels of inflammatory markers in women with endometriosis. A meta-analysis published in 2017 analyzed six clinical studies involving 332 patients and concluded that acupuncture was significantly more effective than placebo in reducing inflammation levels. Additionally, acupuncture can modulate the hypothalamic-pituitary-adrenal (HPA) axis, reducing cortisol levels and other stress hormones that can perpetuate chronic inflammation, and can also influence prostaglandin production, favoring the production of anti-inflammatory mediators.
Clinical evidence on acupuncture's effectiveness in treating endometriosis pain is increasingly numerous and encouraging. Several randomized controlled studies have demonstrated that acupuncture can significantly reduce pelvic pain intensity and improve quality of life in women affected by endometriosis.
A pilot study published in "Fertility and Sterility" in 2018 followed 67 women with endometriosis for 12 weeks, comparing real acupuncture with placebo acupuncture. Results showed a statistically significant reduction in VAS pain scores (Visual Analog Scale used to evaluate symptom intensity) in the group treated with real acupuncture.
Another significant research study, a 2019 Cochrane systematic review, analyzed 12 randomized clinical studies involving over 1,000 patients with endometriosis. The meta-analysis concluded that acupuncture was significantly more effective than standard pharmacological therapy in reducing dysmenorrhea and chronic pelvic pain, with an effect that persisted for at least 3 months after treatment completion.
The most effective treatment protocol generally involves acupuncture sessions lasting 25-30 minutes, with a frequency of 1-2 times per week for a period of 12-16 weeks. Manual needle stimulation is often combined with electroacupuncture to enhance the analgesic effect through endorphin release.
Optimal management of endometriosis-related inflammation requires an integrated approach that combines acupuncture with other therapeutic strategies, creating synergies that amplify the benefits of each individual intervention.
Nutrition represents a fundamental pillar of this approach. Epidemiological research has demonstrated that a diet rich in omega-3 fatty acids, antioxidants, and phytochemical compounds can significantly reduce systemic inflammation and pain associated with endometriosis.
Equally important is the reduction of refined sugars and high glycemic index foods, which can promote inflammation through insulin pathway activation and protein glycation. A low glycemic load diet has been shown to reduce inflammatory markers and improve endometriosis symptoms.
Regular physical activity, specifically 150 minutes per week of moderate activity such as yoga, brisk walking, and Chinese medical exercises like Qigong, can contribute significantly to reducing inflammation and pain.
Stress management techniques, including mindfulness meditation and deep breathing techniques, are essential since chronic stress can maintain inflammation, in addition to improving pain perception through modulation of brain areas involved in nociceptive processing.
Integrating acupuncture into this multidisciplinary approach creates a synergistic effect, as acupuncture stimulation can enhance the anti-inflammatory effects of diet and physical exercise, while improving adherence to other therapies through anxiety reduction and mood improvement.
For patients with severe endometriosis and intractable pain, a therapeutic approach combining different treatment modalities is necessary to achieve optimal symptom control.
Acupuncture can be enhanced through electroacupuncture use, which applies low-intensity electrical currents to needles to intensify stimulation.
TENS (Transcutaneous Electrical Nerve Stimulation) can also be used as complementary therapy to acupuncture, applying electrodes to the lumbosacral region and lower abdomen.
Local heat application through thermotherapy or moxa (stimulation of acupuncture points with heat) can improve pelvic circulation and reduce uterine smooth muscle contraction.
The use of adequate and controlled doses of micronutrients, such as vitamins and minerals, can significantly support pain management. Magnesium, for example, acts as a calcium antagonist reducing uterine smooth muscle contractility and has anti-inflammatory properties. Vitamin D, often deficient in women with endometriosis, modulates immune response and has anti-inflammatory effects.
Treatment regularity is crucial for therapeutic effectiveness. An intensive protocol involves biweekly acupuncture sessions for the first 4-6 weeks, followed by weekly treatments for 8-12 weeks, and subsequently monthly maintenance sessions.
Acupuncture is a safe therapy, free from side effects, risks, and contraindications, but it is essential that patients consult exclusively with qualified operators, specifically acupuncturists with recognized training.
A systematic review published in "Acupuncture in Medicine" in 2019 analyzed 12 clinical studies involving over 2,000 patients with gynecological pathologies treated with acupuncture. The incidence of adverse events was very low (1.2%), limited mainly to minor and transient effects such as small hematomas at insertion sites (0.8%), mild pain during needle insertion (0.3%), and occasional post-treatment fatigue sensation (0.1%).
Serious side effects are extremely rare when acupuncture is practiced according to international safety standards. Needle sterility is guaranteed by the exclusive use of sterile single-use needles, eliminating any risk of infection transmission.
An important aspect to emphasize is that acupuncture should not completely replace conventional medical therapies for endometriosis, but should be used as an integrated treatment in the overall therapeutic plan.
Women who are pregnant or trying to conceive should inform their acupuncturist of their condition, as some points are contraindicated during pregnancy. However, acupuncture can be particularly useful in the pre-conception period to optimize fertility and reduce pelvic inflammation.
Beyond direct pain and inflammation control, acupuncture offers a series of additional benefits that contribute significantly to improving quality of life for women with endometriosis.
Sleep quality improvement represents one of the most appreciated benefits by patients. Endometriosis is often associated with sleep disorders due to chronic pain, nighttime awakenings, and anticipatory anxiety. Acupuncture can modulate melatonin and serotonin production, neurotransmitters fundamental for sleep-wake cycle regulation. Polysomnographic studies have demonstrated that regular acupuncture improves deep sleep duration and reduces nighttime awakenings, with benefits that persist for weeks after treatment.
Management of anxiety and depression, frequently associated with endometriosis, represents another area of acupuncture effectiveness. Chronic pain can trigger a vicious cycle of anticipatory anxiety, reactive depression, and amplification of pain perception. Acupuncture, as extensively demonstrated in scientific literature, acts on this cycle by promoting a state of relaxation and psychological well-being.
A particularly relevant benefit is fertility support in Assisted Reproductive Technology (ART) pathways. Endometriosis is one of the main causes of female infertility, and acupuncture can improve success rates of assisted reproduction techniques through various mechanisms. Stimulation of specific points can improve uterine vascularization, optimize endometrial thickness, regulate reproductive hormones, and reduce stress related to fertility treatments.
A multicenter randomized study published in "Human Reproduction" demonstrated that peri-transfer acupuncture (before and after embryo transfer) increases pregnancy rates by 42% in women undergoing IVF/ICSI with endometriosis. The protocol involved specific treatments to improve embryo implantation and reduce uterine contractions.
Acupuncture can also contribute to irregular menstrual cycle regulation, often present in women with endometriosis.
An additional benefit is digestive function improvement, compromised in many women with intestinal endometriosis or pelvic adhesions. Acupuncture can stimulate intestinal motility, reduce abdominal bloating, and improve symptoms of irritable bowel syndrome often associated with endometriosis.
Finally, acupuncture can support the immune system, often compromised in women with endometriosis. The disease is characterized by immune response alterations, with hyperactivation of some inflammatory mechanisms and compromised immunological surveillance. Acupuncture can help rebalance immune response, reducing chronic inflammation and strengthening the body's natural defenses.
Acupuncture represents a precious and scientifically validated therapeutic resource for women facing the challenge of endometriosis. Clinical evidence accumulated in recent years clearly demonstrates that this ancient medical therapy can offer significant and lasting benefits in chronic pelvic pain management, inflammation reduction, and overall quality of life improvement.
Acupuncture's mechanisms of action, understood through modern neuroscientific research, explain how stimulation of specific points can modulate pain transmission, activate endogenous anti-inflammatory systems, and rebalance physiological functions compromised by the disease. Treatment safety, when practiced by qualified operators, makes it an accessible and well-tolerated therapeutic option.
The integrated approach combining acupuncture with lifestyle modifications, anti-inflammatory nutrition, and stress management offers patients a complete and customizable therapeutic pathway that can be adapted to specific individual needs and condition severity.
It is important to emphasize that acupuncture should be part of an integrated therapeutic project of integrative medicine, offering women with endometriosis an additional option to manage a complex and often debilitating condition. The decision to undertake an acupuncture pathway should always be discussed with one's gynecologist and entrusted to qualified professionals.