Combined pelvic floor training and hormonal therapy for endometriosis pain recurrence: a propensity score-matched study

Vollständiger Abstract

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Background Endometriosis (EMS) causes debilitating pain and reduces quality of life. Whether pelvic floor muscle training (PFMT) provides independent, additive benefits beyond standard postoperative hormonal suppression remains unknown. Methods A retrospective cohort study was conducted on 446 women with surgically confirmed EMS between June 2022 and May 2024. Patients were categorized into five groups: PFMT-only ( n = 98), PFMT+long-term adjuvant progestogen (PFMT+LAP; n = 91), PFMT+combined oral contraceptives (PFMT+COC; n = 87), LAP-only ( n = 85), and COC-only ( n = 85). Propensity score matching (PSM) with 28 baseline covariates was applied to isolate the effects of PFMT. Primary outcomes included 12-month pain recurrence, health-related quality of life (EHP-30), and recurrence-free survival. Results After PSM, 12-month dysmenorrhea recurrence was significantly lower in combination groups compared to hormonal therapy alone: PFMT+LAP vs. LAP-only (36.5% vs. 75.0%; OR = 0.192; p = 0.0002) and PFMT+COC vs. COC-only (38.3% vs. 68.1%; OR = 0.291; p = 0.0072). Multivariable logistic regression confirmed PFMT as an independent protective factor against recurrence for dysmenorrhea, chronic pelvic pain, and dyspareunia (all p<0.005). No significant difference was found between LAP-only and COC-only groups (OR = 1.04; p = 0.914), indicating PFMT drove the incremental benefit. Linear mixed-effects modeling showed a significant time-group interaction for EHP-30 pain scores ( F = 39.14; p<0.001). Kaplan-Meier analysis demonstrated superior recurrence-free survival for combination regimens (log-rank p<0.001). Conclusion Pelvic floor muscle training combined with hormonal therapy significantly reduces pain recurrence and quality-of-life burden while extending recurrence-free survival compared to hormonal therapy alone. These findings suggest that PFMT may confer a clinically meaningful adjunctive benefit. However, given the retrospective, non-randomized design of this study, confirmation in prospective randomized controlled trials is warranted before routine integration into postoperative endometriosis management protocols can be recommended.