Dysmenorrhea

This post was written by Allison Ariail, PT, DPT, CLT-LANA, PRPC, BCB-PMD. You can catch Allison teaching the Pelvic Floor Level 1 course in May in Los Angeles.

Dysmenorrhea is the medical term used for painful menstruation. Symptoms usually begin 1 or 2 days before or the first day of menstruation and include headache, low back and thigh pain, abdominal pain, nausea and vomiting, diarrhea, and excessive fatigue. Sixty percent of women suffer from dysmenorrhea, with many of these women being incapacitated for up to 3 days each month due to symptoms. There are two types of dysmenorrhea. Primary dysmenorrhea is menstrual pain that is not caused from another disorder or disease. Secondary dysmenorrhea is menstrual pain that is due to a disorder in the pelvic organs including endometriosis, fibroids, adenomyosis, pelvic inflammatory disease, cervical stenosis, or infection. In the past, treatment approaches for primary dysmenorrhea have included the use of non-steroidal anti-inflammatories, hormonal contraceptives, vitamins, and acupuncture. There have not been many studies that look at how physical activity influences the degree of pain for women with primary Dysmenorrhea. However, clinical experience has shown me that some women who begin exercising regularly decrease their dysmenorrhea symptoms compared to what they previously experienced. So I have done a search to find some studies that address this matter.

A Cochrane review found only one study that used a control group. In this study, the experimental group participated in a 12-week walking or jogging program at 70-80% of heart rate range, 3 days a week for 30 minutes. Moos’ Menstrual Distress Inventory was used to measure outcomes. This was given pre-training, post-training, and during the premenstrual and inter-menstrual phases for the three hormonal cycles measured. There were significant lower scores on the Moos’ Menstrual Distress Inventory during the menstrual phase in the group that participated in exercise compared to the control group. Additionally, there was a negative linear trend in scores over the three observed cycles for the training group with no linear trend seen in the control group.1 So the exercise group lessoned the degree of their symptoms over the three months by participating in the walking program!

A study by Maceno de Araujo et al. looked at the severity of primary dysmenorrhea symptoms before and after participating in a two month Pilates exercise regimen 2 times per week for 60 minutes. Outcome measures used included visual analog scale and McGill Pain Questionnaire. Although this study did not use a control group and the number of participants was low (n=10), it did show significant changes in pain scores during menstruation when comparing little to no exercise to a regular exercise program of Pilates. Pain scores due to menstruation prior to the study were 7.89 ± 1.96, and dropped to 2.56 ± .56 with the exercise program!

I found these articles interesting and began to wonder how many women we as therapists could help by knowing this information! I do not think that we as pelvic heath therapists are reaching this population of patient diagnoses. Yes, starting an exercise regimen, especially a walking program, sounds easy to us as physical therapists or occupational therapists. However, it can be daunting to a woman who has not previously participated in any type of exercise program. Meeting with some of these women who suffer from primary dysmenorrhea and evaluating any musculoskeletal dysfunctions that are present, then prescribing an appropriate exercise routine that is individualized for that patient can help the patient stay committed to the program. In finding this information, I am excited to pass it along to my patients and future patients in hopes of improving their life and lessening their discomforts! Join me to discuss this topic as well as others related to the pelvic floor in Los Angeles at PF1!

1. Brown J, Brown S. Exercise for dysmenorrhea. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD004142. DOI: 10.1002/14651858.CD004142.pub2.

2. Macêdo de Araújo L; Nunes da Silva JM; Tavares Bastos W; Lima Venutra P. Pain improvement in women with primary dysmenorrhea treated with Pilates. Revista Dor. 2012; 13(2).