{"id":62,"date":"2025-05-21T08:55:18","date_gmt":"2025-05-20T22:55:18","guid":{"rendered":"https:\/\/escope.ages.com.au\/volume-01-2025\/?p=62"},"modified":"2026-02-13T10:17:15","modified_gmt":"2026-02-13T00:17:15","slug":"melatonin-for-pelvic-pain-in-endometriosis","status":"publish","type":"post","link":"https:\/\/escope.ages.com.au\/february-2026\/melatonin-for-pelvic-pain-in-endometriosis\/","title":{"rendered":"Journal Club – Melatonin for Pelvic Pain in Endometriosis"},"content":{"rendered":"\n

\n\t\t\tMelatonin for Pelvic Pain in Endometriosis: New Evidence from a Triple-Blind RCT\t<\/h1>\n\t\t\t\t

For patients living with endometriosis, persistent pelvic pain, central sensitisation, psychological distress, and infertility form a self-perpetuating cycle in which poor sleep both exacerbates pain and reduces overall quality of life. While clinicians are increasingly aware of this interaction, practical, low-risk interventions targeting sleep in endometriosis remain limited.<\/p>\n

A recently published triple-blind randomised controlled trial offers new insight into whether melatonin, a widely used, inexpensive, and often patient-initiated treatment, may indeed have a role in this space (1).<\/p>\n

\n\t\t\t\t\"table-01\"\n\t<\/figure>\n\t\t\t

Study overview<\/h3>\t\t\t\n\t\t\t\t

This single-centre, triple-blind, placebo-controlled RCT enrolled 80 infertile women aged 18-45 with laparoscopically confirmed endometriosis, persistent pelvic pain (VAS \u22654), and clinically significant sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] \u22655) (2). Participants were randomised to receive either slow release melatonin 5mg nightly vs placebo for two months.<\/p>\n

The primary outcome was change in global PSQI score.<\/p>\n

Secondary outcomes included individual PSQI domains and persistent pelvic pain severity.<\/p>\n

\n\t\t\t\t\"table-02\"\n\t<\/figure>\n\t\t\t

Key findings<\/h3>\t\t\t\n\t\t\t\t

Melatonin supplementation resulted in a statistically significant improvement in overall sleep quality compared with placebo. The mean reduction in PSQI score was 1.7 points, with a large effect size (p < 0.001, \u03b7\u00b2 = 0.20, Cohen’s d=1). However, this improvement did not reach the pre-defined threshold for minimal clinically important difference (3 points), raising the familiar but important distinction between statistical and clinical significance.<\/p>\n

Notably, melatonin demonstrated meaningful benefits in specific sleep domains. Participants experienced improvements in sleep duration, reduced sleep disturbance, shorter sleep latency, and decreased reliance on sleep medications. There was no significant effect on sleep efficiency, daytime dysfunction, or subjective sleep quality.<\/p>\n

Importantly for gynaecologists, melatonin was also associated with a statistically significant reduction in persistent pelvic pain, with a mean VAS reduction of 1.56 points and a large effect size (p < 0.001, \u03b7\u00b2 = 0.18, Cohen’s d = 0.93). While again narrowly missing the trial’s pre-specified threshold for clinical significance, this degree of pain reduction is comparable to that seen with many non-surgical adjunctive therapies in endometriosis.<\/p>\n

No significant adverse effects were reported over the two-month treatment period.<\/p>\n\t\t\t

Why this matters<\/h3>\t\t\t\n\t\t\t\t

This study reinforces several important concepts for endometriosis care:<\/p>\n

First, sleep disturbance deserves explicit assessment and management. It is not simply a secondary symptom but a modifiable contributor to pain amplification and reduced quality of life.<\/p>\n

Second, melatonin appears to exert effects beyond sedation alone. Experimental and clinical data suggest anti-inflammatory, anti-nociceptive, and neuromodulatory properties, with actions at both peripheral and central pain pathways. Interestingly, the analgesic effect observed in this trial may be at least partly independent of sleep improvement, supporting melatonin’s potential role as a pain-modifying adjunct.<\/p>\n

Third, patient driven use of ‘natural’ therapies is common in endometriosis. High-quality, placebo-controlled data allows clinicians to engage in more informed discussions about benefits, limitations, and expectations.<\/p>\n\t\t\t

Strengths and limitations<\/h3>\t\t\t\n\t\t\t\t

The strengths of this trial include its rigorous triple-blind design, laparoscopically confirmed diagnosis, and use of validated outcome measures. Adherence was carefully monitored, and the study was conducted in accordance with CONSORT guidelines.<\/p>\n

Limitations include its single-centre nature, relatively short follow-up, and reliance on self-reported sleep measures rather than objective assessments. Additionally, the study population consisted exclusively of infertile women with diagnosed sleep disorders, which may limit generalisability to the broader endometriosis population.<\/p>\n

Most importantly, while effect sizes were large, absolute changes often fell just short of pre-defined clinical significance thresholds, highlighting the need for careful<\/p>\n\t\t\t

So where to next?<\/h3>\t\t\t\n\t\t\t\t

Melatonin is unlikely to be a standalone solution for endometriosis-associated pain or sleep disturbance. However, this trial supports its consideration as a\u00a0low-risk adjunct\u00a0within a broader, multidisciplinary management strategy, particularly for women experiencing sleep disruption and seeking non-hormonal options.<\/p>\n

Future research should explore optimal dosing, longer-term outcomes, and whether specific subgroups (such as those with severe sleep latency or features of central sensitisation features) derive greater benefit.<\/p>\n

For now, the message is a nuanced: melatonin may not be a game-changer, but in a complex chronic condition where small, cumulative gains matter, and multi-disciplinary multi-system care is essential, it may have a place in individualised care.<\/p>\n\t\t\t

References<\/h3>\t\t\t\n\t\t\t\t
    \n
  1. Esmaeilzadeh S, Habibolahi F, Moher D, Basirat Z, Gholinia H, Golsorkhtabaramiri M, et al. Melatonin and sleep parameters in infertile women with endometriosis: first results from the triple-blind randomized controlled trial of administration of melatonin in chronic pelvic pain and sleep disturbance. PLoS One. 2025;20(4):e0321635.<\/li>\n
  2. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.<\/li>\n<\/ol>\n\t\t\t

    Author<\/h3>\t\t\t\n\t

    \"Dr<\/p>\nDr Jennifer Pontr\u00e9
    \nMBBS (hons) FRANZCOG (AGES) MRepMed CF
    \nAGES Board Member, Gynaecologist
    \nKEMH, Perth, Western Australia\n\n","protected":false},"excerpt":{"rendered":"

    A recently published triple-blind randomised controlled trial offers new insight into whether melatonin, a widely used, inexpensive, and often patient-initiated treatment, may indeed have a role in this space.<\/p>\n","protected":false},"author":1,"featured_media":72,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-62","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorised"],"acf":[],"_links":{"self":[{"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/posts\/62","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/comments?post=62"}],"version-history":[{"count":5,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/posts\/62\/revisions"}],"predecessor-version":[{"id":220,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/posts\/62\/revisions\/220"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/media\/72"}],"wp:attachment":[{"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/media?parent=62"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/categories?post=62"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/escope.ages.com.au\/february-2026\/wp-json\/wp\/v2\/tags?post=62"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}