Effects of exercise participation on menstrual pain and symptoms

Associations between psychological distress in adolescence and menstrual symptoms across life: Longitudinal evidence from the 1970 British Cohort Study

PURPOSE

This study aimed to investigate the association between psychological distress (PD) at age 16 and menstrual symptoms experienced across women's life.

METHODS

Up to 2584 females from the 1970 British Cohort Study, a study of individuals born within one week in 1970, were included. PD at age 16 was measured with the 12-item General Health Questionnaire. Three categories were derived: low PD (<11), moderate PD (11-15), and severe PD (>15). Five menstrual health symptoms were self-reported at each age (16, 30 and 42 years). Binomial logistic regressions examined associations between PD at age 16 and each individual symptom, adjusted for age of menarche, sleep and appetite problems, physical activity levels and socioeconomic position.

RESULTS

The most prevalent symptoms were "pain" (61 %), "painful period" (10 %) and "heavy period" (33 %) at ages 16, 30 and 42, respectively. At age 16, those with severe PD were more likely to experience depression (OR: 2.92; 95% CI: 2.31, 3.70)), irritability (1.67; 1.33, 2.11), menstrual pain (1.34; 1.01, 1.80), and headaches (1.29; 1.02, 1.63). A weak association was found between severe PD at age 16 and pre-menstrual tension at age 30 (1.72; 1.01, 2.83). At age 42, those with severe PD at age 16 were more likely to experience pre-menstrual tension (1.89; 1.46, 2.44), painful periods (1.64; 1.27, 2.11), and heavy periods (1.28; 1.00, 1.62).

DISCUSSION

Menstruating females with higher levels of PD in adolescence have an increased risk of menstrual symptoms across adolescence, early and mid-adulthood. Our findings suggest the need to consider early-life psychological interventions to improve women's menstrual experiences across their reproductive years.

The Association of Menstruation and Leisure-Time Physical Activity among Korean Female University Students: A Preliminary Study

An active lifestyle elicits many health benefits. This study’s aim is to understand the actual of leisure time physical activity (LTPA) of female university students in Korea who are experiencing stress due to, e.g., study and employment. LTPA is the degree of exercise participation in leisure time; it is cardiovascular and strength-based behavior occurring within recreation, exercise or sport and provides a positive effect on life satisfaction and psychological well-being. LTPA has been recommended as a method of reducing menstrual symptom severity. However, a lack of evidence exists to support a clear relationship between LTPA and menstruation in female university students. Health consciousness (HC) refers to the degree of interest in one’s health, and Korean female university students pay considerable attention to their body shape, diet habits, and LTPA. This study investigated female university students (K University in Gangwon-do, D University in Busan, and U University in Ulsan) in three metropolitan cities in Korea. Specifically, after seeking cooperation from the person in charge of each university, the purpose of this study was explained. In addition, after promising to provide coffee coupons to students who wish to respond to the survey, cooperation was sought in recruiting research subjects through the person in charge of each university. In addition, a total of 36 surveys that did not have contents filled in fully or gave inconsistent answers were excluded among all survey participants. Chi-square test, t-test and univariate one-way ANOVA, and Pearson’s correlation coefficient analysis were performed for between groups (HC, LTPA, intention to participate in LTPA). The LTPA results in relation to the menstruation patterns of Korean female college students are shown. First, there were no significant differences between menstruation (regular vs. irregular) and general LTPA during non-menstrual time periods (χ2 = 5.828, p < 0.212). However, female university students with regular menstruation patterns had higher LTPA after menstruation compared to female university students with irregular menstruation. Second, there were significant differences in the relationships among HC (p = 0.000), amount of LTPA (p = 0.002), and intention to perform LTPA (p = 0.002), according to the menstruation patterns (regular vs. irregular) of Korean female university students. In other words, those with regular menstruation patterns showed higher HC, amount of LTPA and intention to participate in LTPA than those with irregular menstruations. Third, there were significant differences in the relationship among HC (p = 0.000), amount of LTPA (p = 0.000), and intention to participate in LTPA (p = 0.000) according to LTPA of Korean female university students. Causation cannot be inferred from correlational studies. Therefore, female university students ultimately have different HC and participation in LTPA depending on menstruation regularity.

Development and Validation of a Menstruation-Related Activity Restriction Questionnaire among Adolescent Girls in Urban Resettlement Colonies of Delhi

Introduction:

Menstruation, a physiological phenomenon, till date is associated with myths, taboos, and malpractices. These interfere with the emotional, physical, and mental health of adolescent girls. This study attempts to draft a validated questionnaire to measure menstruation-related activity restriction.

Objective:

The objective was to study activities restricted during menstruation among adolescent girls residing in urban resettlement colonies of Delhi and to develop and validate a questionnaire for menstruation-related activity restriction.

Materials and Methods:

A community-based cross-sectional study was conducted among adolescent girls residing in urban resettlement colonies of Delhi during 2019. A multistage random sampling technique was used to select 1100 girls across four districts of Delhi. A 15-item questionnaire was developed by an expert committee and validated with principal component analysis (PCA).

Results:

In total, 1100 adolescent girls were included in the study whose mean age was 15.8 (±2.1) years. School/college/work was missed due to menstruation in 60% of the adolescent girls, 66% were not comfortable during menstruation, and 92% were restricted from entering religious places. In exploratory factor analysis using PCA, 6 principal components were identified which had eigenvalues more than 1.

Conclusion:

Religious restrictions during menstruation (94%) were highly prevalent among adolescent girls, followed by restriction of routine activity (69%) and work/academically related activity (60%). Construct validity has identified a six-factor structure for the menstruation-related activity restriction questionnaire. This was identified as a valid and internally consistent tool to assess activities restricted during menstruation among Indian adolescent girls.

Exercise for dysmenorrhoea

BACKGROUND

Exercise has a number of health benefits and has been recommended as a treatment for primary dysmenorrhoea (period pain), but the evidence for its effectiveness on primary dysmenorrhoea is unclear. This review examined the available evidence supporting the use of exercise to treat primary dysmenorrhoea.

OBJECTIVES

To evaluate the effectiveness and safety of exercise for women with primary dysmenorrhoea.

SEARCH METHODS

We searched the Cochrane Gynaecology and Fertility specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED and CINAHL (from inception to July 2019). We searched two clinical trial databases (inception to March 2019) and handsearched reference lists and previous systematic reviews.

SELECTION CRITERIA

We included studies if they randomised women with moderate-to-severe primary dysmenorrhoea to receive exercise versus no treatment, attention control, non-steroidal anti-inflammatory drugs (NSAIDs) or the oral contraceptive pill. Cross-over studies and cluster-randomised trials were not eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the studies, assessed eligible studies for risk of bias, and extracted data from each study. We contacted study authors for missing information. We assessed the quality of the evidence using GRADE. Our primary outcomes were menstrual pain intensity and adverse events. Secondary outcomes included overall menstrual symptoms, usage of rescue analgesic medication, restriction of daily life activities, absence from work or school and quality of life.

MAIN RESULTS

We included a total of 12 trials with 854 women in the review, with 10 trials and 754 women in the meta-analysis. Nine of the 10 studies compared exercise with no treatment, and one study compared exercise with NSAIDs. No studies compared exercise with attention control or with the oral contraceptive pill. Studies used low-intensity exercise (stretching, core strengthening or yoga) or high-intensity exercise (Zumba or aerobic training); none of the included studies used resistance training.Exercise versus no treatmentExercise may have a large effect on reducing menstrual pain intensity compared to no exercise (standard mean difference (SMD) -1.86, 95% confidence interval (CI) -2.06 to -1.66; 9 randomised controlled trials (RCTs), n = 632; I²= 91%; low-quality evidence). This SMD corresponds to a 25 mm reduction on a 100 mm visual analogue scale (VAS) and is likely to be clinically significant. We are uncertain if there is any difference in adverse event rates between exercise and no treatment.We are uncertain if exercise reduces overall menstrual symptoms (as measured by the Moos Menstrual Distress Questionnaire (MMDQ)), such as back pain or fatigue compared to no treatment (mean difference (MD) -33.16, 95% CI -40.45 to -25.87; 1 RCT, n = 120; very low-quality evidence), or improves mental quality of life (MD 4.40, 95% CI 1.59 to 7.21; 1 RCT, n = 55; very low-quality evidence) or physical quality of life (as measured by the 12-Item Short Form Health Survey (SF-12)) compared to no exercise (MD 3.40, 95% CI -1.68 to 8.48; 1 RCT, n = 55; very low-quality evidence) when compared to no treatment. No studies reported on any changes in restriction of daily life activities or on absence from work or school.Exercise versus NSAIDsWe are uncertain if exercise, when compared with mefenamic acid, reduced menstrual pain intensity (MD -7.40, 95% CI -8.36 to -6.44; 1 RCT, n = 122; very low-quality evidence), use of rescue analgesic medication (risk ratio (RR) 1.77, 95% CI 1.21 to 2.60; 1 RCT, n = 122; very low-quality evidence) or absence from work or school (RR 1.00, 95% CI 0.49 to 2.03; 1 RCT, n = 122; very low-quality evidence). None of the included studies reported on adverse events, overall menstrual symptoms, restriction of daily life activities or quality of life.

AUTHORS' CONCLUSIONS

The current low-quality evidence suggests that exercise, performed for about 45 to 60 minutes each time, three times per week or more, regardless of intensity, may provide a clinically significant reduction in menstrual pain intensity of around 25 mm on a 100 mm VAS. All studies used exercise regularly throughout the month, with some studies asking women not to exercise during menstruation. Given the overall health benefits of exercise, and the relatively low risk of side effects reported in the general population, women may consider using exercise, either alone or in conjunction with other modalities, such as NSAIDs, to manage menstrual pain. It is unclear if the benefits of exercise persist after regular exercise has stopped or if they are similar in women over the age of 25. Further research is required, using validated outcome measures, adequate blinding and suitable comparator groups reflecting current best practice or accounting for the extra attention given during exercise.

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

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.

Association of primary dysmenorrhea with anthropometrical and socio-economic factors in Polish university students

AIMS

To examine the prevalence and factors correlated with primary dysmenorrhea in young female subjects.

METHODS

Cross-sectional research was conducted among 1305 female university students aged 19-25 years. The following measurements were taken: height, body mass, waist circumference, hip circumference, the length of index and ring finger. A questionnaire was used to obtain information on menstrual pains, the characteristics of the menstrual cycles (regularity, duration), the number of the days of menstrual bleeding, age at menarche, overall health and socio-economic status of the subjects.

RESULTS

The prevalence of primary dysmenorrhea (PD) in the group was 64.85%, of which 69.60% reported mild pain, and 30.40% moderate and severe pain. PD occurs more frequently both in women with excess and insufficient level of abdominal adiposity. PD occurred more frequently in women who experience first menstruation at earlier age than in women with average and late age at menarche. The prevalence of PD grew along with mother's education and fell along with father's education. Painful menstruations occurred most commonly in women from large families. The impact of the age at menarche and the presence of abnormal body mass and abnormal level of abdominal adiposity on the prevalence of painful menstruation was also confirmed by the results of logistic regression analysis. The risk of PD is the highest in women whose finger 4 is longer than finger 2.

CONCLUSION

The results suggest that healthy body mass and lack of abdominal obesity may reduce the risk of PD.

Prevalence of menstrual pain in relation to the reproductive life history of women from the Mayan rural community

BACKGROUND

The prevalence of menstrual pain in Western societies is relatively high and has been shown to be related to many factors (e.g. age, menarche age, parity, menstrual cycle regularity, cigarette smoking, dietary habits). However, less data are available for traditional societies, within which there are, presumably, not as many potentially disturbing factors that could influence menstrual symptoms as in Western societies.

AIM

The study seeks to determine the prevalence of dysmenorrhoea, and the factors related to menstrual pains in women with natural fertility (i.e. without hormonal forms of contraception).

SUBJECTS AND METHODS

177 non-smoking women between 18 and 45 years of age living in one Mayan village (Yaxcaba, Yucatan, Mexico) were the subjects of this study. The method of logistic regression was used with the dichotomous dependent variable being the presence or absence of menstrual pain together with such independent variables as age, age at menarche, number of pregnancies, age when giving birth to the first child, the weight at interview and BMI.

RESULTS

The general prevalence of the menstrual pains was 28%. There was only one variable influencing dysmenorrhoea, namely the age at which women give birth to their first children. Those mothers who gave birth to their first child at an earlier age (at mean age of 19.4 vs 21.1 years) had a lower prevalence of dysmenorrhoea.

CONCLUSION

In the studied traditional society the main factor related to menstrual pain was the age at which woman first gave birth. It is hypothesized that an earlier start to reproductive life in some way decreases the sensitivity of the uterus to prostaglandins.

EFFECTS OF QI-THERAPY ON PREMENSTRUAL SYNDROME

This study investigated the effects of Qi-therapy (nine sessions over two menstrual cycles) on pain and other symptoms in women with premenstrual syndrome (PMS). Forty-six women who were attending college were randomly allocated to receive Qi-therapy (Qi-therapy group: n = 23) or placed on a waiting list as controls (n = 22: 1 dropped out). Qi-therapy had a significant effect on pain and water retention. In addition, there were significant short-term effects on pain, mental depression, and anxiety. These results suggested that Qi-therapy might be useful as a nursing intervention for women who suffer from PMS to maintain or restore a balance of Qi.

Exercise and primary dysmenorrhoea : a comprehensive and critical review of the literature

Primary dysmenorrhoea (PD) is chronic, cyclic, pelvic, spasmodic pain associated with menstruation in the absence of identifiable pathology and is typically known as menstrual cramps or period pain. PD is the most common gynaecological disorder in menstruating women. Despite treatments being available for PD, relatively few women consult a clinician about their symptoms, preferring not to use treatment, or to self-treat using non-pharmacological or over-the-counter interventions. The notion that exercise is effective in preventing and treating symptoms has prevailed for many years and led to the promotion of anecdotal belief that exercise is beneficial. Behavioural interventions such as exercise may not only reduce dysmenorrhoea, but also eliminate or reduce the need for medication to control menstrual cramps and other associated symptoms. With emphasis on data from experimental studies, this report seeks to review the available evidence regarding the role of exercise in the management of PD and menstruation-related symptomatology. Using key search terms, online bibliographical databases were searched from the beginning of each database to 1 April 2007. Despite the widespread belief that exercise can reduce PD, empirical support is limited. Evidence from observational studies was mixed. Several observational studies reported that physical activity/exercise was associated with reduced prevalence of dysmenorrhoea, although numerous other studies found no significant association between outcomes. Evidence from controlled trials suggests that exercise can reduce PD and associated symptoms, but these have been small and of low methodological quality. There are, however, several plausible mechanisms by which exercise might be effective in the management of PD. A large randomized controlled trial is required before women and clinicians are advised that exercise is likely to be effective in reducing PD and related menstrual symptoms.

Suburban sprawl and physical and mental health

OBJECTIVE

To study the association between objective measures of suburban sprawl and chronic medical conditions and mental health disorders in the USA.

METHODS

Cross-sectional analysis of survey data merged with objective measures of suburban sprawl. Outcomes are self-reported medical conditions, mental health disorders and health-related quality of life.

RESULTS

Sprawl significantly predicts chronic medical conditions and health-related quality of life, but not mental health disorders. An increase in sprawl from one standard deviation less to one standard deviation more than average implies 96 more chronic medical problems per 1000 residents, which is approximately similar to an aging of the population of 4 years.

CONCLUSIONS

A robust association between sprawl and physical (but not mental) health suggests that suburban design may be an important new avenue for health promotion and disease prevention.

Menstrual Pain Intensity, Coping, and Disability: The Role of Pain Catastrophizing

OBJECTIVE

Menstrual pain or primary dysmenorrhea has not received much attention in the field of pain research. Little is understood about the effects menstrual pain has on the women who experience it. No studies to date have examined the cognitive factors related to the perceived intensity and coping of menstrual pain. To investigate these areas further, this study examined the associations between pain catastrophizing and how women perceive and cope with menstrual pain.

DESIGN

A prospective and retrospective between-subjects study.

PARTICIPANTS

Ninety-three undergraduate women, with a regular menstrual period and no preexisting pain disorder (e.g., endometriosis) that affects menstrual pain, were classified into high or low pain catastrophizing groups.

OUTCOME MEASURES

Participants completed several self-reported questionnaires assessing pain catastrophizing, menstrual pain intensity, coping, and disability.

RESULTS

High pain catastrophizers, in comparison with low pain catastrophizers, reported greater menstrual pain intensities, greater affective menstrual pain intensity, greater variability in the use of pain coping strategies, lower perceived effectiveness of over-the-counter medications and nonmedical pain coping strategies, and greater disability.

CONCLUSIONS

The results extend our knowledge about the associations between pain catastrophizing and menstrual pain, reemphasize that pain experience is best viewed as a multidimensional construct, and have implications for the management of menstrual pain.

The effects of a multi-modal intervention trial of light, exercise, and vitamins on women's mood

The purpose of this study was to test the efficacy of a tri-modal intervention (LEVITY) to improve women's mood. This eight-week randomized experiment with a placebo-control group targeted women with symptoms of mild to moderate depression. Women in the intervention group were instructed to take a brisk 20-minute outdoor walk at target heart rate of 60% of maximum heart rate, to increase light exposure throughout the day and to take a specific vitamin regimen. Women in the control group took a daily placebo vitamin. The sample consisted of 112 women ages 19-78 who reported mild to moderate depressive symptoms. They were in otherwise good health and were not currently taking any mood-altering medication. Pre- and post-intervention assessment utilized live measures of mood: Center for Epidemiology Studies Depression Scale, Profile of Mood States, Depression-Happiness Scale, Rosenberg Self-Esteem Scale, and the General Well-Being Schedule. Analysis of covariance indicated that the intervention was effective in improving women's overall mood, self-esteem, and general sense of well-being and in decreasing symptoms on two measures of depression. Of particular note, the data from all five outcome measures supported the efficacy of the intervention. In addition, a high level of adherence to the intervention protocol was observed with two-thirds of the women reporting 100% adherence. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for mild-to-moderately depressed women who prefer a self-directed approach or who have difficulties with the cost or side-effects of medication or psychotherapy.