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Can Physiotherapy Help Primary Dysmenorrhea?

Pain associated with menstruation is known as dysmenorrhea, and more than half of women have pain related to their period for 1-2 days per month, according to The American College of Obstetricians and Gynecologists. Primary dysmenorrhea is related to menstruation, and often begins within a short period of time once menses occurs, whereas secondary dysmenorrhea is often related to a condition within the reproductive tract such as endometriosis or fibroids. In the medical office, a medical history, a pelvic exam, and possibly an ultrasound or laparoscopy will be completed. Treatment may include medications such as NSAIDs which target the prostaglandins that often lead to symptoms of dysmenorrhea, birth control pills, or surgeries.

A recent literature review asked if physiotherapy can help with symptoms of primary dysmenorrhea. Of the articles reviewed, 186 were chosen, and included a range of articles from descriptive, experimental studies to prospective, randomized controlled studies. A variety of interventions and approaches were included in the review, such as TENS, abdominal massage, acupuncture, cryotherapy and thermotherapy, connective tissue, Pilates, and belly dance. All of the approaches demonstrated some therapeutic benefit, either in response to the immediate application of the intervention, or up to a few months after the intervention was applied or instructed.

This literature review echoes a prior systematic review that evaluated the effectiveness and safety of acupressure, acupuncture, aspirin, behavioral interventions, oral contraceptives, and other supplements, procedures, and complementary and alternative medical interventions. Click here to view the full-text article. In that particular review, the authors reported the following:

- high-frequency TENS reduces pain (but less so than ibuprofen)
- acupressure may be as effective as ibuprofen
- topical heat may be as effective as ibuprofen and more effective than paracetamol

The bottom line from this research should be that we as pelvic rehabilitation providers need to help patients address pain and symptoms from dysmenorrhea. Clearly, there are many pathways to achieve symptom reduction, and some, such as TENS or topical heat, are easily carried out on an independent basis. How are you reaching adolescent girls who may develop primary dysmenorrhea? In clinical practice, talking with their parents, or reaching out at the community level to schools, churches, camps, gyms, or coaches may provide an opportunity to provide education and help. If you would like to learn more about myofascial release techniques for the abdomen and pelvis, check out the Myofascial Release for Pelvic Dysfunction continuing education course taking place next month in Illinois!

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Upcoming Continuing Education Courses

Pelvic Floor Level 2A - Grand Rapids, MI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
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Oncology of the Pelvic Floor Level 1 - Grand Junction, CO (Rescheduled)

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Genital Lymphedema

Apr 24, 2020

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Apr 24, 2020 - Apr 26, 2020
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Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Robert Wood Johnson Medical Associates

Athletes & Pelvic Rehabilitation - Minneapolis, MN (Rescheduled)

Apr 25, 2020 - Apr 26, 2020
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Sacral Nerve Manual Assessment and Treatment - Fairlawn, NJ (Rescheduled)

May 1, 2020 - May 3, 2020
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Pelvic Floor Level 1 - Fayetteville, AR

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Pelvic Floor Level 1 - Boise, ID (Rescheduled)

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Location: St Luke's Rehab Hospital

Pediatric Incontinence - Duluth, MN

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Location: Polinsky Medical Rehabilitation Center

Yoga for Pelvic Pain - Online Course

May 2, 2020 - May 3, 2020

Pregnancy Rehabilitation - Corvallis, OR

May 2, 2020 - May 3, 2020
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Coccydynia and Painful Sitting - Boston, MA

May 2, 2020 - May 3, 2020
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Pelvic Floor Level 1 - Bay Shore, NY (SOLD OUT)

May 11, 2020 - May 13, 2020
Location: Touro College: Bayshore

Pelvic Floor Level 2A - Crown Point, IN

May 15, 2020 - May 17, 2020
Location: Franciscan Health System