Dismenorreia Primária e Mobilização.

Sem intervenção: CONTROL

Participants in the control group received no active treatment, exercise program, or physiotherapy intervention during the study period. They were instructed to continue their routine daily activities and not to initiate any new pharmacological or non-pharmacological treatment for dysmenorrhea symptoms during the study.

Comparador Ativo: FEMOB

Structured multimodal mobilization (FEMOB) is a manual therapy-based mobilization protocol consisting of temporomandibular, occipitosacral, and sacroiliac joint mobilizations, abdominal myofascial release, and kinesio taping.

Outro: FEMOB

FEMOB is a structured multimodal mobilization protocol consisting of temporomandibular, occipitosacral, and sacroiliac joint mobilizations, abdominal myofascial release, and kinesio taping.

Comparador Ativo: MOPEXE

Participants in the MOPEXE arm receive a 60-minute Pilates-based motor imagery-focused pelvic floor exercise program twice weekly for 12 weeks. Each session consists of 5 minutes of meditation, 10 minutes of progressive relaxation training using the Bernstein-Borkovec method, 5 minutes of diaphragmatic and pursed-lip breathing exercises, 35 minutes of motor imagery-focused pelvic floor exercises, and a final 5 minutes of meditation. Outcomes are assessed at baseline and after completion of the 12-week intervention period.

Outro: MOPEXE

MOPEXE is a Pilates-based motor imagery-focused pelvic floor exercise program. Each 60-minute session consists of 5 minutes of meditation, 10 minutes of progressive relaxation training using the Bernstein-Borkovec method, 5 minutes of diaphragmatic and pursed-lip breathing exercises, 35 minutes of motor imagery-focused pelvic floor exercises, and a final 5 minutes of meditation. Sessions are delivered twice weekly for 12 weeks.

Outro: Conventional treatment group

The conventional treatment arm receives TENS and hot pack application. TENS is administered with the Chattanooga Intelect Advanced Combo system at 100 Hz and 200 µs for 30 minutes using two channels and four electrodes placed over the lumbar and suprapubic regions. Hot pack application is applied to the lumbar and suprapubic regions for a total of 20 minutes.

Outro: Conventional Treatment group

The conventional treatment arm receives TENS and hot pack application. TENS is administered with the Chattanooga Intelect Advanced Combo system at 100 Hz and 200 µs for 30 minutes using two channels and four electrodes placed over the lumbar and suprapubic regions. Hot pack application is applied to the lumbar and suprapubic regions for 20 minutes.

Short-Form McGill Pain Questionnaire Total Pain Score

Pain intensity was assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ total pain score, calculated as the sum of sensory and affective pain descriptor scores, was defined as the primary outcome. Higher scores indicate greater pain severity.

Menstrual Attitude Questionnaire

The Turkish version of the Menstrual Attitude Scale (MBI) will be applied to determine the attitudes and behaviors of the participants during the menstrual period. Menstruation attitude scale includes 5 subtitles. These subheadings are;

1. Menstruation as a debilitating event
2. Menstruation as a bothersome event
3. Menstruation as a natural event
4. Ancipitation and prediction of the onset of menstruation
5. Denial of any effect of menstruation

Functional and Emotional Dysmenorrhea Scale

This is a 14-item, 5-point Likert-type scale used to measure dysmenorrhea functionally and emotionally. There are no reverse items in the scale. The scale was developed to provide functional and emotional measurement of dysmenorrhea. As the scores obtained from the scale increase, the extent to which patients are functionally and emotionally affected by dysmenorrhea also increases.

Menstrual Symptom Questionnaire

The scale consists of 22 items that inquire about menstrual symptoms and is scored on a five-point Likert scale, from never (1) to always (5). The scale, which consists of three sub-dimensions, is evaluated in the sub-dimension of 'Negative effects/somatic complaints' with items 1-13, the sub-dimension of 'Menstrual pain symptoms' with items 14-19, and the sub-dimension of 'Coping methods' with items 20-22. An increase in the mean score indicates an increase in the severity of menstrual symptoms related to the relevant sub-dimension.

The Menstrual Distress Questionnaire

This is a self-reported assessment tool designed to comprehensively evaluate the physical and emotional symptoms experienced by individuals during their menstrual period. The scale consists of 25 questions, each with 5 sub-items, covering common symptoms such as abdominal pain, headache, nausea, irritability, and mood swings. Each item is scored using a Likert-type rating system to determine the frequency or severity with which the participant experiences the relevant symptom. As the total score on the scale increases, the intensity of the symptoms experienced during menstruation and their negative impact on daily life also increase. In this context, high scores indicate increased symptom severity and decreased quality of life. The scale offers a holistic assessment by encompassing both the somatic and emotional dimensions of menstruation-related symptoms.