The non-pharmacological treatment of primary dysmenorrhea - efficiency and safety

Brygida Zapała, Aldona Ząber, Ewa Gacoń, Julita Zembala, Nikola SIEKIERKO, Jakub Kucharski, Maja ŻOŁNIEREK, Wiktoria KOTUSIEWICZ, Mateusz LEWANDOWSKI
In: Journal of Education, Health and Sport · 2023 · vol. 30(1) , pp. 79–86 · doi:10.12775/jehs.2023.30.01.007 · W4376600325
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Non-pharmacological treatments including TENS, acupuncture, heat, and exercise effectively reduce primary dysmenorrhea symptoms by lowering prostaglandins and other mechanisms with minimal side effects.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This paper reviews what is known about non-pharmacological treatments for primary dysmenorrhea, a common reproductive-age condition characterized by menstrual cramps without pelvic abnormalities, and describes their proposed mechanisms, efficacy, and safety. At a high level, it discusses modalities including TENS, acupuncture, continuous topical heat, exercise, and yoga, noting evidence that they can reduce symptoms and often have mild or rarely reported side effects. The authors attribute potential benefits largely to anti-inflammatory effects through prostaglandin reduction, alongside additional mechanisms such as endogenous opioid release (for TENS/acupuncture) and improved uterine blood flow reducing hypoxia (for heat, yoga, and acupuncture), while a key limitation is that the paper is a narrative overview rather than presenting new original clinical trial data. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Primary dysmenorrhea is the most common, though often underdiagnosed, gynecological disorder of women of reproductive age. The disease presents with painful abdominal cramps associated with menstrual bleeding in the absence of pelvic abnormalities. Symptoms are caused primarily by increased levels of prostaglandins produced by the endometrium, which provides hypercontraction of the uterine muscles, ischemia, and pain. Dysmenorrhea is usually treated pharmacologically with non-steroidal anti-inflammatory drugs or hormonal contraception. In particularly severe cases, surgical treatment is also possible. Nonetheless, an increasing amount of studies on non-pharmacological treatments have been published recently. Methods like Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture, continuous topical heat, or exercise and yoga seem to be effective in reducing the symptoms of primary dysmenorrhea. All have an anti-inflammatory effect by lowering prostaglandin levels, but they also contribute to reducing symptoms through other mechanisms. TENS elevates the pain threshold and, together with acupuncture, causes the release of endogenous opioids. Heat, yoga, and acupuncture also lead to increased blood flow in the uterus, reducing hypoxia. Their additional advantage is the low cost and ease of self-use, except for acupuncture, depending on the patient's needs. Side effects of non-pharmacological treatments are usually mild and rarely reported.
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The non-pharmacological treatment of primary dysmenorrhea - efficiency and safety DOI: https://doi.org/10.12775/JEHS.2023.30.01.007Keywords primary dysmenorrhea, dysmenorrhea, TENS, acupuncture, YogaAbstract Primary dysmenorrhea is the most common, though often underdiagnosed, gynecological disorder of women of reproductive age. The disease presents with painful abdominal cramps associated with menstrual bleeding in the absence of pelvic abnormalities. Symptoms are caused primarily by increased levels of prostaglandins produced by the endometrium, which provides hypercontraction of the uterine muscles, ischemia, and pain. Dysmenorrhea is usually treated pharmacologically with non-steroidal anti-inflammatory drugs or hormonal contraception. In particularly severe cases, surgical treatment is also possible. Nonetheless, an increasing amount of studies on non-pharmacological treatments have been published recently. Methods like Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture, continuous topical heat, or exercise and yoga seem to be effective in reducing the symptoms of primary dysmenorrhea. All have an anti-inflammatory effect by lowering prostaglandin levels, but they also contribute to reducing symptoms through other mechanisms. TENS elevates the pain threshold and, together with acupuncture, causes the release of endogenous opioids. Heat, yoga, and acupuncture also lead to increased blood flow in the uterus, reducing hypoxia. Their additional advantage is the low cost and ease of self-use, except for acupuncture, depending on the patient's needs. Side effects of non-pharmacological treatments are usually mild and rarely reported. References Margaret Burnett, Madeleine Lemyre. No. 345-Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2017; 39(7):585-595. doi: 10.1016/j.jogc.2016.12.023. Elizabeth Ferries-Rowe, Elizabeth Corey, Johanna S Archer. Primary Dysmenorrhea: Diagnosis and Therapy. Obstet Gynecol. 2020; 136(5):1047-1058. doi: 10.1097/AOG.0000000000004096 Stella Iacovides, Ingrid Avidon, Fiona C. Baker. What we know about primary dysmenorrhea today: a critical review. Human Reproduction Update. 2015; 21(6):762–778. doi:10.1093/humupd/dmv039 Guimarães I, Póvoa AM. Primary Dysmenorrhea: Assessment and Treatment. Rev Bras Ginecol Obstet. 2020; 42(8):501-507. doi:10.1055/s-0040-1712131 Rania Itani, Lama Soubra, Samar Karout, Deema Rahme, Lina Karout, Hani M J Khojah. Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean Journal of Family Medicine. 2022; 43(2):101-108. doi:10.4082/kjfm.21.0103 Arik MI, Kiloatar H, Aslan B, Icelli M. The effect of TENS for pain relief in women with primary dysmenorrhea: A systematic review and meta-analysis. Explore (NY). 2022; 18(1):108-113. doi: 10.1016/j.explore.2020.08.005. Maybin JA, Critchley HO. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update. 2015; 21(6):748–761. doi:10.1093/humupd/dmv038 Proctor M, Farquhar C, Stones W, He L, Zhu X, Brown J. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2002;1:CD002123. Michal Elboim-Gabyzon, Leonid Kalichman. Transcutaneous Electrical Nerve Stimulation (TENS) for Primary Dysmenorrhea: An Overview. Int J Womens Health. 2020; 8(12):1-10. doi: 10.2147/IJWH.S220523. Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS. The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine (Baltimore). 2018; 97(23):e1100. doi: 10.1097/MD.0000000000011007. Yu WY, Ma LX, Zhang Z, Mu JD, Sun TY, Tian Y, Qian X, Zhang YD. Acupuncture for Primary Dysmenorrhea: A Potential Mechanism from an Anti-Inflammatory Perspective. Evid Based Complement Alternat Med. 2021 Dec 3;2021:1907009. doi: 10.1155/2021/1907009. Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. Acupuncture for dysmenorrhoea. The Cochrane Database of Systematic Reviews. 2016; Issue 4. Art. No.: CD007854. doi: 10.1002/14651858.CD007854.pub3. Liu W, Wang CC, Lee KH, Ma X, Kang TL. Efficacy and Safety of Acupuncture and or Moxibustion for Managing Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Clin Nurs Res. 2022 Sep;31(7):1362-1375. doi: 10.1177/10547738221086984. Jo J, Lee SH. Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Sci Rep 2018 Nov 2;8(1):16252. doi: 10.1038/s41598-018-34303-z. Igwea SE, Tabansi-Ochuogu CS, Abaraogu UO. TENS and heat therapy for pain relief and quality of life improvement in individuals with primary dysmenorrhea: a systematic review. Complement Ther Clin Pract. 2016;24:86–91. doi: 10.1016/j.ctcp.2016.05.001 Kim SD. Yoga for menstrual pain in primary dysmenorrhea: A meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 2019 Aug;36:94-99. doi: 10.1016/j.ctcp.2019.06.006. McGovern CE, Cheung C. Yoga and quality of life in women with primary dysmenorrhea: a systematic review. J Midwifery Womens Health. 2018:63:470–82. doi: 10.1111/jmwh.12729 Brown J, Brown S. Exercise for dysmenorrhoea. The Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD004142. doi: 10.1002/14651858.CD004142.pub2. Downloads Published How to Cite Issue Section License Copyright (c) 2023 Brygida Zapała, Aldona Ząber, Ewa Gacoń, Julita Zembala, Nikola Siekierko, Jakub Kucharski, Maja Żołnierek, Wiktoria Kotusiewicz, Mateusz Mirosław Lewandowski This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. 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