The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis

Abstract

Background: Menstrual pain is very common amongst young women. Despite the significant impact that menstrual pain has on academic attendance and performance, social activities and quality of life, most young women do not seek medical treatment but prefer to use self-care; commonly OTC analgesic medications and rest. Many women do not get significant pain relief from these methods, therefore other low cost, easy to learn self-care methods may be a valuable approach to management. This review and meta-analysis examines the evidence for participant lead self-care techniques.

Methods: A search of Medline, PsychINFO, Google Scholar and CINAHL was carried out in September 2017.

Results: Twenty-three trials including 2302 women were eligible and included in the meta-analysis. Studies examined self-delivered acupressure, exercise and heat as interventions. Risk of bias was unclear for many domains. All interventions showed a reduction in menstrual pain symptoms; exercise (g = 2.16, 95% CI 0.97 to 3.35) showed the largest effect size, with heat (g = 0.73, 95% CI 0.06 to 1.40) and acupressure (g = 0.56, 95% CI 0.10 to 1.03) showing more moderate effect sizes. Exercise (g = 0.48, 95% CI 0.12 to 0.83) and heat (g = 0.48, 95% CI 0.10 to 0.87), were more effective than analgesics in reducing pain intensity, whereas acupressure was significantly less effective (g = - 0.76, 95% CI -1.37 to - 0.15).

Conclusion: Exercise showed large effects, while acupressure and heat showed moderate effects in reducing menstrual pain compared to no treatment. Both exercise and heat are potential alternatives to analgesic medication. However, difficulties in controlling for non-specific effects, along with potential for bias, may influence study findings.

Keywords: Acupressure; Exercise; Heat; Period pain; Self-care.

Fig. 1

PRISMA flow diagram

Fig. 2

Summary of risk of bias across studies

Fig. 3

Risk of bias for individual studies

Fig. 4

Pooled effects of acupressure, exercise and heat on overall menstrual pain

Fig. 5

Comparison of the effect of acupressure or heat versus analgesic medication on menstrual pain intensity

Fig. 6

Comparison of acupressure vs sham acupressure on menstrual pain intensity

Fig. 7

Comparison of acupressure or exercise versus no treatment/usual care on menstrual pain intensity