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Introduction: Endometriosis is a chronic gynecological condition characterized by ectopic growth of endometrial tissue, causing pelvic pain, dysmenorrhea, infertility, and reduced quality of life. Conventional treatments include hormonal therapy, analgesics, and surgical interventions, which often provide symptomatic relief but have limitations such as recurrence and side effects. Ayurveda conceptualizes endometriosis as a Vata-Kapha predominant disorder with involvement of Rakta and Artava dhatus, presenting with symptoms of pain, irregular bleeding, and infertility. Herbal formulations, Panchakarma therapies, and lifestyle modifications are traditionally employed to manage the condition. Methods: A systematic literature review was conducted using PubMed, Scopus, Web of Science, Google Scholar, and AYUSH Research Portal. Keywords included “Endometriosis,” “Ayurveda,” “Vata-Kapha disorders,” “Panchakarma,” “herbal therapy,” and “gynecological pain.” Classical Ayurvedic texts, preclinical studies, clinical trials, case reports, and systematic reviews published between 2000 and 2025 were included. Exclusion criteria encompassed non-peer-reviewed articles and studies lacking measurable outcomes. Data were synthesized thematically according to pathophysiology, symptomatology, and management strategies. Results: Ayurvedic management of endometriosis focuses on dosha balancing, Rakta purification, and uterine tonicity. Panchakarma interventions such as Virechana (therapeutic purgation) and Basti (medicated enema) target vitiated Vata and eliminate accumulated toxins. Herbal formulations including Ashokarishta, Dashamoola, Shatavari, and Punarnava show anti-inflammatory, analgesic, and hormonal modulatory properties. Clinical studies report significant reduction in pelvic pain, menstrual irregularities, and improvement in fertility outcomes with minimal adverse effects. Discussion: The integration of Ayurvedic principles and modern pharmacological understanding supports a holistic approach to endometriosis management. While preliminary evidence is promising, limitations include small sample sizes, heterogeneity of formulations, and lack of standardized protocols. Further multicentric randomized controlled trials and mechanistic studies are warranted to establish evidence-based guidelines. Conclusion: Ayurvedic management of endometriosis offers a complementary approach targeting symptom relief, dosha balance, and reproductive health. Evidence-based integration with conventional therapy could enhance therapeutic outcomes and reduce recurrence, promoting holistic reproductive well-being.

KEYWORDS: Ayurveda, endometriosis, gynecology, Panchakarma, herbal therapy