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Grand Rounds

Cochrane Review: Is Exercise an Effective Treatment for Primary Dysmenorrhea?

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BACKGROUND AND PURPOSE:

  • In this Cochrane review, Armour et al. (Cochrane Database of Systematic Reviews, 2019) evaluated the effectiveness and safety of exercise for primary dysmenorrhea

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • Cochrane Gynaecology and Fertility specialized register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED and CINAHL (from inception to July 2019)
    • Two clinical trial databases (ClinicalTrials.gov and WHO Trials Registry) and hand-searched reference lists and previous systematic reviews
  • Inclusion criteria
    • RCTs that included women with moderate-to-severe primary dysmenorrhea, randomized to exercise vs
      • No treatment | Attention control (“amount of time spent and attention received from the research team are matched to the intervention group, e.g. a lecture series on self-care for period pain”) | NSAIDs| OCPs
  • Exercise definition: “Physical activity characterized by using planned and structured repetitive movements to increase or maintain physical fitness”
    • Most studies included asked women to exercise three times per week, for about 45 to 60 minutes, throughout the month
  • Data synthesis and analysis
    • Two reviewers independently selected the studies, assessed bias, and extracted data
    • Study authors were contacted for missing information
    • GRADE criteria used for study quality assessment
  • Primary outcomes
    • Menstrual pain intensity
    • Adverse events
  • Secondary outcomes
    • Overall menstrual symptoms | Usage of rescue analgesic medications | Restriction of daily life activities | Absence from work or school and quality of life

RESULTS:

  • Meta-analysis: 10 trials 754 women
    • 9 of the 10 studies compared exercise with no treatment, and 1 study compared exercise with NSAIDs
    • No studies compared exercise with attention control or with the oral contraceptive pill
  • Studies used low-intensity exercise (stretching, core strengthening or yoga) or high-intensity exercise (Zumba or aerobic training)
    • None of the included studies used resistance training

Exercise vs No Treatment

  • Exercise may have a ‘large’ effect on reducing menstrual pain intensity compared to no exercise (low- quality evidence)
    • Standard mean difference (SMD) -1.86 (95% CI -2.06 to -1.66; n = 632)
    • Clinically significant difference (Corresponds to a 25 mm reduction on a 100 mm visual analogue scale [VAS])
  • Adverse events: Uncertain if there is any difference in adverse events between treatment and control
  • For other outcomes, uncertain if exercise is of benefit for the following due to very low-quality evidence
    • Overall menstrual symptoms (e.g., back pain or fatigue)
    • Improvement in mental quality of life
    • Improvement in physical quality of life
  • No studies reported on changes in daily life activities or absence from work/school

Exercise vs NSAIDs

  • Uncertain if exercise, when compared with mefenamic acid, was of benefit due to very low-quality evidence for the following
    • Menstrual pain intensity
    • Use of rescue analgesic medication
    • Absence from work or school
  • Studies did not report
    • Adverse events | Overall menstrual symptoms | Restriction of daily life activities | Quality of life

CONCLUSION:

  • Exercise may relieve pain intensity associated with dysmenorrhea
    • Reduction is likely clinically significant
  • Unclear whether exercising for less time or less frequently would have the same effect as that described in most studies (45 to 60 minutes, 3 times per week)
  • Insufficient evidence to determine if exercise provides benefit vs NSAIDs

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Learn More – Primary Sources:

Exercise for dysmenorrhea

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Related ObG Topics:

ACOG Guidance on Evaluation and Management of Endometriosis and Dysmenorrhea in Adolescents
Can Heat Treat Dysmenorrhea?
Can Exercise Alleviate Primary Dysmenorrhea?
Can Self-Acupressure Apps Relieve Dysmenorrhea?

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