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Meta-Analysis
. 2007 Jul 18;2007(3):CD002248.
doi: 10.1002/14651858.CD002248.pub3.

Behavioural interventions for primary and secondary dysmenorrhoea

M L Proctor, P A Murphy, H M Pattison, J Suckling, C M Farquhar
Meta-Analysis

Behavioural interventions for primary and secondary dysmenorrhoea

M L Proctor et al. Cochrane Database Syst Rev. .

Abstract

Background: Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological condition with considerable morbidity. The behavioural approach assumes that psychological and environmental factors interact with, and influence, physiological processes. Behavioural interventions for dysmenorrhoea may include both physical and cognitive procedures and focus on both physical and psychological coping strategies for dysmenorrhoeic symptoms rather than modification of any underlying organic pathology.

Objectives: To determine the effectiveness of any behavioural interventions for the treatment of primary or secondary dysmenorrhoea when compared to each other, placebo, no treatment, or conventional medical treatments for example non-steroidal anti-inflammatory drugs (NSAIDs).

Search strategy: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched April 2005), Cochrane Central Register of Controlled Trials (CENTRAL on The Cochrane Library, Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1980 to April 2005), Social Sciences Index (1980 to April 2005), PsycINFO (1972 to April 2005) and CINAHL (1982 to April 2005) and reference lists of articles.

Selection criteria: Randomised controlled trials comparing behavioural interventions with placebo or other interventions in women with dysmenorrhoea.

Data collection and analysis: Two authors independently assessed trial quality and extracted data.

Main results: Five trials involving 213 women were included. Behavioural intervention vs control: One trial of pain management training reported reduction in pain and symptoms compared to a control. Three trials of relaxation compared to control reported varied results, two trials showed no difference in symptom severity scores however one trial reported relaxation was effective for reducing symptoms in menstrual sufferers with spasmodic symptoms. Two trials reported less restriction in daily activities following treatment with either relaxation of pain management training compared to a control. One trial also reported less time absent from school following treatment wit pain management training compared to a control. Behavioural intervention vs other behavioural interventions: Three trials showed no difference between behavioural interventions for the outcome of improvement in symptoms. One trial showed that relaxation resulted in a decrease in the need for resting time compared to the relaxation and imagery.

Authors' conclusions: There is some evidence from five RCTs that behavioural interventions may be effective for dysmenorrhoea however results should be viewed with caution as they varied greatly between trials due to inconsistency in the reporting of data, small trial size, poor methodological quality and age of the trials.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.2
1.2. Analysis
Comparison 1 Behavioural intervention versus control, Outcome 2 Improvement in symptoms ‐ measured by Symptom Severity Scale.
1.5
1.5. Analysis
Comparison 1 Behavioural intervention versus control, Outcome 5 Absence from work or school ‐ continuous data (minutes of lost time).
2.1
2.1. Analysis
Comparison 2 Behavioural intervention vs other behavioural intervention, Outcome 1 Improvement in symptoms ‐ measured by Symptom Severity Scale.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD002248.pub2

References

References to studies included in this review

Amodei 1987 {published data only}
    1. Amodei N, Nelson RO, Jarrett RB, Sigmon S. Psychological treatments of dysmenorrhea: differential effectiveness for spasmodics and congestives. Journal of Behavior Therapy & Experimental Psychiatry 1987;18(2):95‐103. - PubMed
Bennink 1982 {published data only}
    1. Bennink CD, Hulst LL, Benthem JA. The effects of EMG biofeedback and relaxation training on primary dysmenorrhea. Journal of Behavioral Medicine 1982;5:329‐41. - PubMed
Chesney 1975 {published data only}
    1. Chesney MA, Tasto DL. The effectiveness of behavior modification with spasmodic and congestive dysmenorrhea. Behaviour Research & Therapy 1975;13:245‐23. - PubMed
Hart 1981 {published data only}
    1. Hart AD, Mathisen KS, Prater JS. A comparison of skin temperature and EMG training for primary dysmenorrhea. Biofeedback & Self Regulation 1981;6(3):367‐73. - PubMed
Quillen 1982 {published data only}
    1. Quillen MA, Denney DR. Self‐control of dysmenorrheic symptoms through pain management training. Journal of Behavior Therapy and Experimental Psychiatry 1982;13:123‐30. - PubMed

References to studies excluded from this review

Hubbell 1949 {published data only}
    1. Hubbell M. Specific and non‐specific exercises for the relief of dysmenorrhea. Research Quarterly 1949;20:378‐86. - PubMed
Israel 1985 {published data only}
    1. Israel R, Sutton M, O' Brien K. Effects of aerobic training on primary dysmenorrhea symptomatology in college females. Journal of Alternative and Complementary Medicine 1985;33:241‐4. - PubMed
Lundquist 1947 {published data only}
    1. Lundquist C. Use of the Billig exercise for dysmenorrhea for college women. Research Quarterly 1947;18:44‐53. - PubMed
Mathur 1986 {published data only}
    1. Mathur CN, Sharma M, Likhari P. Progressive muscle relaxation in the treatment of dysmenorrhoea. Indian Journal of Clinical Psychology 1986;13:69‐70.
Pearce 1982 {published data only}
    1. Pearce S, Knight CK, Beard RW. Pelvic pain: A common gynaecological problem. Journal of Psychosomatic Obstetrics and Gynaecology 1982;1:12‐7.
Peters1991 {published data only}
    1. Peters A, Dorst E, Jellis B, Zurren E, Hermans J, Trimbos J. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstetrics & Gynecology 1991;77:740‐4. - PubMed
Sigmon 1988 {published data only}
    1. Sigmon ST, Nelson RO. The effectiveness of activity scheduling and relaxation training in the treatment of spasmodic dysmenorrhea. Journal of Behavioral Medicine 1988;11:483‐95. - PubMed
Van Zak 1994 {published data only}
    1. Van Zak, D. Biofeedback treatments for premenstrual and premenstrual affective syndromes. International Journal of Psychosomatics 1994;41:53‐59. - PubMed

Additional references

Andersch 1982
    1. Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. American Journal of Obstetrics & Gynecology 1982;144:655‐60. - PubMed
Bolton 2003
    1. Bolton P, Mar C, O'Connor V. Exercise for primary dysmenorrhoea (Protocol). Cochrane Database of Systematic Reviews 2003, Issue 2.
Bradley 1998
    1. Bradley LA, Alberts KR. Psychological and behavioral approaches to pain management for patients with rheumatic disease. Rheumatic Diseases Clinics of North Amenrica 1998;25(1):215‐32. - PubMed
Campbell 1997
    1. Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Archives of Pediatrics & Adolescent Medicine 1997;151:905‐13. - PubMed
Dawood 1984
    1. Dawood MY. Ibuprofen and dysmenorrhea. American Journal of Medicine 1984;77(1A):87‐94. - PubMed
Dawood 1985
    1. Dawood YM. Dysmenorrhea. Pain and Analgesia 1985;1:20.
Dawood 1988
    1. Dawood MY. Nonsteroidal anti‐inflammatory drugs and changing attitudes towards dysmenorrhea. American Journal of Medicine 1988;84(5A):23‐9. - PubMed
Dawood 1990
    1. Dawood MY. Dysmenorrhea. Clinical Obstetrics and Gynecology 1990;33(1):168‐78. - PubMed
Denny 1981
    1. Denny DR, Gerrard M. Behavioral treatments of primary dysmenorrhea: A review. Behavioral Research and Therapy 1981;19:303‐12. - PubMed
Harlow 1996
    1. Harlow SD, Park M. A longitudinal study of risk factors for the occurence, duration, and severity of menstrual cramps in a cohort of college women. British Journal of Obstetrics & Gynaecology 1996;103:1134‐42. - PubMed
Henzl 1985
    1. Henzl MR. Dysmenorrhea: Achievements and challenge. Sexual Medicine Today 1985;9:8‐12.
Jeffcoate 1975
    1. Jeffcoate N. Principles of Gynaecology. 4th Edition. London: Butterworth, 1975.
Klein 1981
    1. Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics 1981;68(5):661‐4. - PubMed
Lewis 1983
    1. Lewis RJ, Wasserman E, Denny NW, Gerrad M. The etiology and treatment of primary dysmenorrhoea: A review. Clinical Psychology Review 1983;3:371‐89.
Lichten 1987
    1. Lichten EM, Bombard J. Surgical treatment of primary dysmenorrhea with laparoscopic uterine nerve ablation. Journal of Reproductive Medicine 1987;32:37‐41. - PubMed
Marini 1978
    1. Marini DC. The relationship of stress arousal and stress prone personality traits to menstrual distress. Dissertation Abstracts International 1978;39B:3577.
NIH Panel 1996
    1. NIH Panel. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996;276(4):313‐8. - PubMed
Pedron‐Neuvo 1998
    1. Pedron Neuvo N, Gonzalez‐Unzaga LN, Celis‐Carrillo R, Reynoso‐Isla M, Torre‐Romeral L. Incidence of dysmenorrhoea and associated symptoms in women aged 12‐24 years. Ginecologia y Obstetricia de Mexico 1998;66:492‐4. - PubMed
Robinson 1992
    1. Robinson JC, Plichta S, Weisman CS, Nathanson CA, Ensminger M. Dysmenorrhoea and the use of oral contraceptives in adolescent women attending a family planning clinic. American Journal of Obstetrics & Gynecology 1992;166:578‐83. - PubMed
Rosenwaks 1980
    1. Rosenwaks Z, Seegar‐Jones G. Menstrual pain: its origin and pathogensis. Journal of Reproductive Medicine 1980;25(4 Suppl):207‐12. - PubMed
Siegel 1979
    1. Siegel JM, Johnson JH, Sarason IG. Life changes and menstrual discomfort. Journal of Human Stress 1979;5:41‐6. - PubMed
Stromberg 1984
    1. Stromberg P, Akerlund M, Forsling ML, Granstrom E, Kindahl H. Vasopressin and prostaglandins in premenstrual pain and primary dysmenorrhea. Acta Obstetricia et Gynecologica Scandinavica 1984;63(6):533‐8. - PubMed
Syrjala 1995
    1. Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive‐behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain 1995;63(2):189‐98. - PubMed
Webster 1979
    1. Webster SK, Martin HJ, Uchalik D, Gannon L. The menstrual symptom questionnaire and spasmodic/congestive dysmenorrhoea. Journal of Behavioral Medicine 1979;2:1‐20. - PubMed
Ylikorkala 1978
    1. Ylikorkala O, Dawood MY. New concepts in dysmenorrhea. American Journal of Obstetrics & Gynecology 1978;130:833‐47. - PubMed
Zondervan 1998
    1. Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. The prevalence of chronic pelvic pain in the United Kingdom: a systematic review. British Journal of Obstetrics & Gynaecology 1998;105(1):93‐9. - PubMed