Exercise for dysmenorrhoea.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 31538328 · doi:10.1002/14651858.CD004142.pub4
What was done
Authors conducted a Cochrane systematic review searching databases including CENTRAL, MEDLINE, Embase, PsycINFO, AMED, and CINAHL up to July 2019 for randomized controlled trials evaluating exercise in women with moderate-to-severe primary dysmenorrhoea. Crossover and cluster-randomized trials were excluded. Eligible comparisons were exercise versus no treatment, attention control, NSAIDs, or oral contraceptive pills. Primary outcomes were menstrual pain intensity and adverse events; secondary outcomes included overall menstrual symptoms, rescue analgesics, restriction of daily activities, work or school absenteeism, and quality of life. Evidence quality was assessed using GRADE.
What was found
A total of 12 trials with 854 women were included in the review, and 10 trials with 754 women were included in meta-analyses. Nine trials compared exercise (low-intensity such as yoga, stretching, and core strengthening, or high-intensity such as Zumba and aerobic training; no resistance training) with no treatment, and one trial compared exercise with NSAIDs (mefenamic acid). No trials compared exercise with attention control or oral contraceptives. - Exercise versus no treatment: Exercise reduced menstrual pain intensity (SMD -1.86, 95% CI -2.06 to -1.66; 9 RCTs, n = 632; I2 = 91%; low-quality evidence), equivalent to a 25 mm reduction on a 100 mm visual analogue scale. Evidence was very low quality for overall menstrual symptoms (MD -33.16, 95% CI -40.45 to -25.87; 1 RCT, n = 120), mental quality of life (MD 4.40, 95% CI 1.59 to 7.21; 1 RCT, n = 55), and physical quality of life (MD 3.40, 95% CI -1.68 to 8.48; 1 RCT, n = 55). Adverse event rates were uncertain, and daily activity restrictions or absenteeism were not reported. - Exercise versus NSAIDs: Very low-quality evidence from one RCT (n = 122) showed pain intensity MD -7.40 (95% CI -8.36 to -6.44), rescue analgesic use RR 1.77 (95% CI 1.21 to 2.60), and work or school absence RR 1.00 (95% CI 0.49 to 2.03).
Why it matters
Regular exercise 45 to 60 minutes at least three times weekly may offer a clinically meaningful, non-pharmacologic option for managing primary menstrual pain.
Limits
The evidence certainty was low to very low across all outcomes due to substantial heterogeneity (I2 = 91% for primary pain relief), methodological limitations, and small sample sizes. There were no studies evaluating resistance training, oral contraceptive comparators, or attention controls. Reporting was absent or minimal for adverse events, functional activity restrictions, persistence of benefits after cessation, and effects in women older than 25.
Cited by
- supports Physical activity can help alleviate menstrual symptoms such as cramps by increasing blood flow.