#261 : Nutrition Intervention in Endometriosis Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Endometriosis is a chronic disease that affects approximately 10% of reproductive-age women, and one of the primary symptoms is pain, which can significantly impact quality of life and productivity. This has resulted in substantial income loss for women across the world. Aims: This study aimed to systematically review the evidence of nutrition interventions for improving pain in endometriosis patients based on randomized controlled trials (RCTs) and to perform a meta-analysis of the risk difference in mean visual analogue scale (VAS) between the treatment group and control. Methods: A comprehensive search strategy was used in PubMed, Embase, Cochrane Library, and Scopus using the keywords endometriosis, diet, nutrition, and pain. Screening, full-text review, and risk assessment were performed by two independent reviewers, and risk assessment bias was conducted using Risk of Bias 2 (RoB2). Results: The search resulted in 1,084 records, and eight studies were included in the review. Most studies were concluded to have low risk of bias based on RoB2 assessment, with two studies with some concern and one study with high risk of bias according to missing outcome data in reports. A total of 225 cases and 245 controls, laparoscopically confirmed with endometriosis, were included in this review. Nutrition interventions included in this review were vitamin C, D, E, fish oils, and complementary diet therapy for 8-24 weeks. Meta-analysis using a random-effect model showed an 18% risk reduction in mean VAS in the treatment group compared to the control. Although this analysis found substantial heterogeneity within the study (I2=82.51%), this finding can be explained by subgroup analysis, in which fish oils showed a positive mean risk difference with a large confidence interval. Conclusions: This study found that nutrition interventions show promising effects in alleviating pain in endometriosis. However, further research, especially RCTs for comparing nutrition intervention and medical treatments in managing endometriosis pain, is still much needed. These findings highlight the importance of exploring alternative, non-pharmacological approaches in endometriosis management, which could potentially improve the quality of life for patients.