REVIEW QUESTION

Can regular exercise provide relief from dysmenorrhea in women of reproductive age?

TYPE OF REVIEW

A systematic review including a meta-analysis of 10 trials and 754 women.

RELEVANCE FOR NURSING

Dysmenorrhea refers to the cramps and pelvic pain associated with menstruation and can be primary or secondary. In primary dysmenorrhea, the pain is caused by hypersecretion of prostaglandins and increased uterine contractility and is not associated with changes in the pelvis. In secondary dysmenorrhea, the pain is caused by a reproductive organ disorder such as endometriosis or uterine fibroids.

Primary dysmenorrhea is prevalent in women younger than 25 years of age and is often associated with reduced quality of life and loss of productivity. Although the highest rates of dysmenorrhea prevalence are in adolescents, the estimated overall prevalence in women of reproductive age is between 45% and 93%. Many women do not seek medical treatment for dysmenorrhea and often use over-the-counter medications; it is important that nurses educate women on treatment options both medical and nonmedical.

CHARACTERISTICS OF THE EVIDENCE

The purpose of this review was to determine whether exercise is better than treatments such as nonsteroidal antiinflammatory drugs (NSAIDs), oral contraceptives, or no treatment in reducing the intensity of menstrual pain in women diagnosed with primary dysmenorrhea.

Inclusion criteria included trials of women 15 to 49 years of age who had suspected primary dysmenorrhea or self-reported pain during the majority of menstrual cycles in the past three months, and who had moderate-to-severe dysmenorrhea according to a validated pain scale. Trials were excluded if they included women with diagnosed secondary dysmenorrhea or dysmenorrhea from use of an intrauterine device.

The primary outcomes were menstrual pain intensity measured by a validated pain scale and adverse events such as injuries resulting from exercise. Secondary outcomes included use of an analgesic medication, restriction of activities of daily living, overall menstrual symptoms, time away from work or school, and measurements of quality of life via a validated tool.

The review focused on a meta-analysis that included 10 randomized controlled trials (RCTs) with a total of 754 women. Nine of the 10 studies compared exercise with no treatment, and one compared exercise with NSAIDs. For the primary outcome of menstrual pain intensity, exercise-both low intensity, such as stretching or yoga, and high intensity, such as dancing or aerobics-had a considerable and likely clinically significant effect on reducing pain intensity compared with no treatment (low quality evidence), but its effect compared with NSAIDs was uncertain (low quality evidence). Because of the low quality of the evidence, any differences in adverse event rates between exercise and no exercise could not be determined. No studies on exercise versus oral contraceptives were identified.

BEST PRACTICE RECOMMENDATIONS

Given the low quality of the evidence and limited number of RCTs exploring the primary outcomes, further RCTs are needed to provide the evidence necessary to make a firm recommendation. However, the evidence does suggest that regular exercise-at least three times per week for 45 to 60 minutes in most studies-may produce a clinically significant reduction in menstrual pain intensity. Moreover, as no differences in adverse event rates between exercise and no exercise were reported and as exercise is known to have health benefits, women should consider engaging in regular exercise to manage menstrual pain. The review reveals four areas requiring additional research: type of exercise intensity, affect on quality of life, affect on time taken from work or school, and exercise versus oral contraceptive outcomes.

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