BACKGROUND: This study evaluated the efficacy of acupuncture as a monotherapy for managing endometriosis-related pain (ERP) compared to non-acupuncture interventions. METHODS: We systematically searched PubMed, EMBASE, Cochrane Library, CNKI, WANGFANG, and VIP databases from inception to March 1, 2025, for randomized controlled trials (RCTs) comparing acupuncture alone with non-acupuncture treatments in ERP patients. Included trials were assessed for methodological quality using the Cochrane risk-of-bias tool, and statistical analyses by RevMan 5.4. RESULTS: Nine RCTs involving 535 patients were included. Meta-analysis revealed that acupuncture significantly reduced pain intensity, as measured by the visual analog scale (mean difference -1.67, 95% confidence interval (CI) -2.85 to -0.49, p = 0.006) and improved clinical response rates (odds ratio 2.61, 95% CI 1.38 to 4.95, p = 0.003). However, no significant differences were observed in serum CA125 levels (mean difference -1.46, 95% CI -20.69 to 17.76, p = 0.88) or overall effective rate (odds ratio 2.18, 95% CI 0.99 to 4.80, p = 0.05). CONCLUSION: Acupuncture may serve as an effective standalone therapy for ERP, particularly in pain relief and clinical response. However, due to heterogeneity and methodological limitations in the included studies, further large-scale, high-quality RCTs are warranted to validate these findings and establish long-term efficacy.

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