Can Pelvic Floor Physical Therapy help with painful menstruation?

Laura is a 25-year-old female who survives on Ibuprofen for the first 2 days of her period due to excruciating cramps. Her cramps have been so painful that she had to call out sick from work a couple times over the past year. According to her gynecologist, “everything looks fine”, and she was offered birth control to manage symptoms; however, Laura would prefer to find alternative methods to help manage her painful periods instead of altering her hormones. After researching online, she made an appointment with a pelvic floor physical therapist to see if there were any treatments to reduce her painful cycles.

Primary dysmenorrhea is painful menstruation that does not have a specific cause. Secondary dysmenorrhea is the term for painful menstruation with a known cause like endometriosis. Approximately 60-90% of females have primary dysmenorrhea and is highest in women ages 16- 25 years old.1-2 The most supported cause of painful menstruation is that molecules called prostaglandins create narrowing of the uterine blood vessels and abnormal contraction of the uterus which can cause reduced blood flow and oxygen.2 They can also increase nerve sensitivity. Pain usually begins a few hours before or after menstrual bleeding and peaks around 24-48 hours. It typically subsides after 2-3 days.2 Painful menstruation can be very disruptive to daily activities and have a negative impact on quality of life.1 In fact, it is one of the leading causes of missed school and work. It can negatively impact psychological and social health.1

Systematic reviews look at the available research on a particular topic. Two reviews published in 2021 and 2023 looked at the impact of physical therapy on primary dysmenorrhea. Some of the

treatments that were researched included aerobic exercise, stretching, kinesio taping, aquatic therapy, acupressure, yoga, core stability, and education.

Overall, aerobic exercise, stretching, and core stability showed the greatest reduction in painful menstruation symptoms.1 Stretching the pelvis, abdomen, and groin are shown to be very effective at reducing pain. Interestingly, aerobic exercise appears to be more effective at pain reduction than stretching alone. Additionally, core exercises that included the back extensors, abdominal muscles, and pelvic floor muscles were found to be helpful to reduce pain as these movements improve circulation. Exercise has been found to reduce painful menstruation by increasing blood flow, increasing endorphins, and decreasing prostaglandins (remember these reduce blood flow to the uterus which cause muscle contractions during menstruation).1 Typically, exercise needs to be performed for about 45-60 minutes, 3 or more times per week over an 8–12-week timeframe for pain reduction.2

Yoga, kinesio taping, aquatic therapy and spinal manipulations (think adjustments) have also shown promise in reducing painful menstruation.1 Ideally, these would be used, if needed, in addition to aerobic activity, strengthening, and stretching to reduce pain.1 Heat therapy, TENS (transcutaneous electrical nerve stimulation), and massage, especially with aromatic oils, can also help to temporarily reduce pain.2

In addition to regular physical activity, other factors that can help reduce painful menstruation include: reducing stress and anxiety, self-care, good quality social relationships, and balanced nutrition. In fact, dysmenorrhea was found to be much more common in women who are dieting to lose weight. Other nutritional aspects that are helpful with reducing painful menstruation include foods high in magnesium to reduce muscle tension, foods rich in potassium to reduce menstrual bloating, and vitamin C to ensure good circulation.1

If you are struggling with painful menstruation and you are told that “everything looks normal”, please reach out to your local pelvic floor physical therapist! They will perform an individualized evaluation of your body and develop a plan of care to reduce pain, improve blood flow, and reduce your likelihood of missing work or other activities. Remember, consistency, especially with regards to physical activity, will be the most beneficial over time. It definitely helps to have a professional create a plan specifically for you!

Written by Jordan Schmidt, PT, DPT

References

1. Tremback-Ball, A., Hammond, E., Applegate, A., Caldwell, E., & Witmer, H. (2023). Effectiveness of Physical Therapy Interventions for Women With Dysmenorrhea: A Systematic Review. Journal of Womenʼs Health Physical Therapy, 47(1), 3-18.

2.

López-Liria, R., Torres-Álamo, L., Vega-Ramírez, F. A., García-Luengo, A. V., Aguilar-

Parra, J. M., Trigueros-Ramos, R., & Rocamora-Pérez, P. (2021). Efficacy of

Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-

Analysis. International journal of environmental research and public health, 18(15),