Behavioural interventions for dysmenorrhoea

Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in the uterus (womb). When the pain is due to a recognised medical condition such as endometriosis it is called secondary dysmenorrhoea. When the pain is of unknown cause it is called primary dysmenorrhoea. Nonsteroidal anti-inflammatory drugs or the contraceptive pill have been used as treatment for period pain but more women are looking for non-drug therapies. Behavioural therapies assume that psychological (the mind) and environmental factors interact with, and influence, physical processes, for example stress might influence period pain. Behavioural therapies focus on both physical and psychological coping strategies for symptoms such as pain rather than focusing on medical solutions for any underlying causes of the symptoms. An example of a behavioural therapy is using relaxation to help a woman cope with painful period cramps. This review found that progressive muscle relaxation with or without imagery and relaxation may help with spasmodic (acute, cramping pain) symptoms of period pain. Also that pain management training and relaxation plus biofeedback may help with period pain in general. The results are not conclusive due to the small number of women in the trials and the poor methods used in some of the trials.

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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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 May 2009), Cochrane Central Register of Controlled Trials (CENTRAL on The Cochrane Library, Issue 2, 2009), MEDLINE (1966 to May 2009), EMBASE (1980 to May 2009), Social Sciences Index (1980 to May 2009), PsycINFO (1972 to May 2009) and CINAHL (1982 to May 2009) 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.

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