Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review

J Physiother. 2014 Mar;60(1):13-21. doi: 10.1016/j.jphys.2013.12.003. Epub 2014 Apr 24.


Question: In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life?

Design: Systematic review of randomised trials with meta-analysis.

Participants: Women with primary dysmenorrhea.

Intervention: Any form of physiotherapy treatment.

Outcome measures: The primary outcome was menstrual pain intensity and the secondary outcome was quality of life.

Results: The search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0-10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0-10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life.

Conclusion: Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects.

Keywords: Dysmenorrhea; Physical therapy modalities; Primary dysmenorrhea; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acupressure
  • Acupuncture
  • Adolescent
  • Adult
  • Dysmenorrhea / therapy*
  • Electric Stimulation Therapy*
  • Female
  • Hot Temperature*
  • Humans
  • Outcome Assessment, Health Care
  • Physical Therapy Modalities*
  • Quality of Life
  • Treatment Outcome
  • Yoga*
  • Young Adult