Chiropractic Care for Treated Endometriosis: Limited Role in Follow-Up
Chiropractic care has no established role in the evidence-based follow-up management of treated endometriosis, as current guidelines focus exclusively on medical imaging, hormonal therapies, and surgical interventions for symptom management and disease surveillance.
Evidence-Based Follow-Up Care
The established follow-up protocols for treated endometriosis do not include chiropractic interventions:
Standard Surveillance Approaches
MRI pelvis with and without IV contrast is the recommended imaging modality for patients with established postoperative endometriosis who develop new or ongoing symptoms 1.
Transvaginal ultrasound combined with transabdominal ultrasound serves as an alternative imaging option for monitoring disease recurrence 1.
Up to 44% of women experience symptom recurrence within one year after surgical treatment, necessitating close medical surveillance 2.
Medical Management for Persistent Symptoms
If the patient continues to experience endometriosis-related pain after gynecologic treatment:
NSAIDs should be the first-line treatment for immediate pain relief, used at appropriate doses and schedules 2.
GnRH agonists for at least three months provide significant pain relief for chronic pelvic pain, even without surgical confirmation of recurrence 2.
When using GnRH agonists long-term, add-back therapy should be implemented to reduce bone mineral loss without compromising pain relief efficacy 2.
Continuous oral contraceptive pills are as effective as GnRH agonists for pain control while causing fewer side effects 2.
Evidence-Based Physical Interventions
Physiotherapy (Not Chiropractic)
Recent evidence supports specific physiotherapy techniques, which differ fundamentally from chiropractic care:
Physiotherapy techniques are effective in reducing pain in women with endometriosis, with a mean difference of -1.97 on pain scales compared to non-physiotherapy techniques 3.
Locally applied physiotherapy techniques (such as pelvic floor physical therapy and electrotherapy) result in greater pain reduction than generally applied techniques 3.
Physiotherapy modalities including electrotherapy and laser devices showed the greatest reduction in pain levels among all interventions studied 3.
Why Chiropractic Care Is Not Recommended
Disease Characteristics
Endometriosis is now recognized as a chronic systemic inflammatory disease affecting metabolism, causing systemic inflammation, and altering gene expression in the brain—not a musculoskeletal condition amenable to spinal manipulation 4.
The disease affects approximately 190 million women globally and requires multimodal, interdisciplinary treatment approaches focused on hormonal, surgical, and targeted physical therapy interventions 5, 4.
Appropriate Referral Pathway
If the patient has persistent pelvic pain after gynecologic treatment, appropriate referrals include:
Return to gynecology for medical management optimization (hormonal therapies) 2.
Pelvic floor physical therapy (not chiropractic) for locally applied techniques 3.
Pain management specialists if conservative treatments fail 2.
Repeat imaging (MRI or ultrasound) to assess for disease recurrence 1.
Clinical Caveat
The significant social and psychological impact of endometriosis on women's quality of life, intimate relationships, and mental health requires comprehensive support beyond any single intervention 6. However, this support should come from evidence-based interdisciplinary teams including gynecology, pain management, mental health professionals, and specialized pelvic floor physical therapists—not chiropractors, as there is no evidence supporting chiropractic intervention for this condition.