Exercise improves chronic pelvic pain in women but the evidence is low quality. A systematic review and meta-analysis

The aim of this review is to determine if exercise is more effective than no intervention, usual intervention or other interventions for improving short-term pain (primary aim) and quality of life (secondary aim) in women of reproductive age with pelvic related pain of gynaecological or urological origin. 

This systematic review and meta-analysis was conducted following the PRISMA 2020 guidelines and the protocol is published on open science framework (https://osf.io/fa3cr). We searched MEDLINE, EMBASE, CENTRAL and PEDro for randomised trials. We performed title and abstract screening and full text screening using Covidence. Quality assessment was performed using the PEDro scale with PEDro scores of 6 being defined as low quality. Screening, data extraction and quality assessment were performed by independent reviewers in consultation with a third reviewer for disagreements. Random effects meta-analyses were used to combine studies for each outcome. For pain, VAS and NRS scales were converted to a common 0 to 10 scale. For QOL, studies used different outcome measures, and standardised mean difference (SMD) were calculated. The smallest clinically worthwhile effect was 1.5 points for pain and an SMD of 0.3 for QOL.

The search was conducted in June 2024. We identified 9319 records and screened 7057 records after deduplication. Six studies (from seven records) were included. 50% of identified articles included women diagnosed with chronic pelvic pain (CPP), while the remaining 50% were diagnosed with conditions associated with CPP. Twenty-five percent of studies included yoga as an exercise modality, while the remaining used multiple exercise types (such as Mensendieck somatocognitive therapy, aerobic-, strength- and core-exercises). The comparators included advice, medication, or usual (non-exercise) care. For pain, exercise was significantly better than the comparator and the effect was clinically worthwhile (mean difference: -2.7, 95% CI: -3.7 to -1.8, I² = 66%, n = 180, 4 studies). For QOL, exercise was significantly better than the comparator and the effect may or may not be clinically worthwhile (SMD: 0.79, 95%CI: 0.03 to 1.54, I² = 80%, n = 169, 3 studies). Four out of six studies were low-quality.

Exercise is a promising intervention for women with chronic pelvic pain for short term pain and QOL. As 4/6 studies were low quality, more high-quality studies are required to increase the certainty of the estimates. Further studies are also required to determine if any specific exercise type is better.

Exercise can be trialed in combination with standard medical practice for women with chronic pelvic pain but it may or may not improve short-term pain and QOL.