# Efficacy and Safety of Traditional Chinese Medicine Retention Enema for Endometriosis: A Systematic Review and Meta-Analysis

## TL;DR

This study reviews the effectiveness and safety of using herbal enemas from Traditional Chinese Medicine to treat endometriosis, finding some benefits but noting the need for better research.

## Contribution

The study provides the first systematic review and meta-analysis on the clinical efficacy and safety of herbal retention enema for endometriosis.

## Key findings

- Herbal retention enema showed greater overall clinical effectiveness compared to Western medical therapies.
- It demonstrated significant improvement in dysmenorrhea and a higher total effective rate than oral herbal medicine.
- No serious adverse events were reported, and systemic side effects were less frequent than hormonal therapies.

## Abstract

Background/Objectives: Herbal retention enema is widely used in Traditional Chinese Medicine for the management of endometriosis; however, its clinical efficacy and safety have not been systematically evaluated. Methods: Ten electronic databases were searched up to May 2025 to identify randomized controlled trials evaluating herbal retention enema as a standalone treatment for endometriosis. Primary outcomes included total effective rate and pain-related measures. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Nine randomized controlled trials involving 614 participants were included. Compared with Western medical therapies, herbal retention enema was associated with greater overall clinical effectiveness (OR = 2.87) and significant improvement in dysmenorrhea. When compared with oral herbal medicine, herbal retention enema demonstrated a higher total effective rate (OR = 7.13). A trend toward improved pregnancy outcomes was observed (p = 0.05). No serious adverse events related to herbal retention enema were reported, and systemic adverse effects were less frequent than with hormonal therapies. Conclusions: Herbal retention enema may represent a potential complementary option for symptom management in endometriosis; however, the certainty of evidence remains low due to important methodological limitations in the included trials. However, given methodological limitations and heterogeneity among studies, further high-quality randomized controlled trials with standardized outcomes and long-term follow-up are required.