How Is the Quality and Quantity of Primary Dysmenorrhea Affected by Physical Exercises? A Study Among Iranian Students

Identified as painful cramps happening during menstruation, dysmenorrhea is defined as the most common gynecologic problem in women in different age groups and races and as the most common cyclic pain (1,2). In the absence of any specific pelvic disease, primary dysmenorrhea is one of the most frequent complaints of women which starts with the young girls’ first experience of the ovulatory cycles (3). There is a wide range of the prevalence of dysmenorrhea (16.8% to 81%) in different societies (1,2). Its prevalence increases with the rise of the age during adolescence (15-17 years) and extends to its highest level in 20-24 years, then it gradually lowers steadily (4,5). The prevalence of dysmenorrhea has been reported as 74%-84% (6) in Iran. It is assumed that symptoms of primary dysmenorrhea is caused by the elevated concentration of prostaglandin F2 (PGF2) leading to uterine contractions, and ischemia (7). There are many risk factors related to the dysmenorrhea including heavy menstrual loss, premenstrual symptoms, irregular menstrual cycles, age under 30 years, probable pelvic pain disease, menarche before 12 years, low body mass index (BMI), and sterilization (2). Family history may help distinguish primary from secondary dysmenorrhea. Dysmenorrhea may bring about physiological and mental problems in some women and reduce their active participation in the society (8). It negatively affects patient’s quality of life (2) and it is a risk factor for fibromyalgia (9). Data from few longitudinal studies showed that the rate of primary dysmenorrhea-related absence at school is 34%50% (10,11). The diagnosis of primary dysmenorrhea is based on clinical history and physical examination (2). There is a range of treatments for primary dysmenorrhea, each having some advantages and disadvantages (12). Some medical and non-medical treatments are useful and effective in controlling dysmenorrhea. Some of them inhibit prostaglandin and reduce stress level. They include nonsteroidal anti-inflammatory drugs (NSAID) and hormonal contraceptives (2). However, dysmenorrhea and individuals’ various responses to the different treatment methods including pharmacologic therapy, skin electrical stimulation, using topical heat, surgery, and various vitamins and minerals have been suggested in this regard (13). A number of theories exist regarding the regular activity which can be a method of choice for dysmenorrhea Abstract Objectives: This study intended to evaluate the effect of 3 exercise programs on reducing symptoms of primary dysmenorrhea among some Iranian school girls. Materials and Methods: This randomized clinical trial study was conducted on 70 students aged 15-18 years with primary dysmenorrhea. They were randomly assigned into 4 different groups: stretch group (n = 19), massage group (n = 19), combined group (n = 21), and control group (n = 19). To evaluate the effect, the treatment was applied as 8 weeks of physical activity, 3 sessions a week, twice a day, 10 minutes for massage group, 20 minutes for stretching group and 20 minutes for combination group and without exercise for control group on primary dysmenorrhea. Moreover, to measure the intensity and severity of pain McGill’s questionnaire were used. Results: The results revealed that performing a regular physical activity led to a significant reduction in the severity of dysmenorrhea pain (P < 0.05), Pain Rate Index (PRI ) (P < 0.05), visual analog scale (VAS) (P < 0.05), present pain intensity (PPI) and total pain according to McGill’s short form questionnaire (TP) (P < 0.05), and volume of bleeding (P < 0.05) in the 3 groups. Conclusion: The results of this study indicated that lifestyle modifications including some physical activities would decrease the quality and quantity of pain in primary dysmenorrhea such as duration and intensity of pain.