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

Mike Armour, Caroline A Smith, Kylie A Steel, Freya Macmillan, Mike Armour, Caroline A Smith, Kylie A Steel, Freya Macmillan

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.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

MA and CS: As a medical research institute, National Institute of Complementary Medicine (NICM) receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute. This systematic review was not specifically supported by donor or sponsor funding to NICM.

KS: none known.

FM: none known.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Summary of risk of bias across studies
Fig. 3
Fig. 3
Risk of bias for individual studies
Fig. 4
Fig. 4
Pooled effects of acupressure, exercise and heat on overall menstrual pain
Fig. 5
Fig. 5
Comparison of the effect of acupressure or heat versus analgesic medication on menstrual pain intensity
Fig. 6
Fig. 6
Comparison of acupressure vs sham acupressure on menstrual pain intensity
Fig. 7
Fig. 7
Comparison of acupressure or exercise versus no treatment/usual care on menstrual pain intensity

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