World Applied Sciences Journal 17 (10): 1246-1252, 2012
© IDOSI Publications, 2012
Corresponding Author: Noorbakhsh Mahvash, College of Physical Education and Sport Sciences,
Islamic Azad University, Karaj Branch, Iran, POST: 17- Shenasa Street, Valye Asr Ave, Tehran, Iran.
Tel: +021-22058101, Cell: +09166148819, E-mail: firstname.lastname@example.org.
The Effect of Physical Activity on Primary Dysmenorrhea
of Female University Students
Noorbakhsh Mahvash, Alijani Eidy, Kohandel Mehdi,
1 1 1
Mehdizadeh Toorzani Zahra, Mirfaizi Mani and Hojat Shahla
2 2 1
College of Physical Education and Sport Sciences, Islamic Azad University - Karaj Branch, Iran
Department of Midwifery, Islamic Azad University - Karaj Branch, Iran
Abstract: Primary dysmenorrhea is one of the most common complains and gynecological problem worldwide
among young females. Findings claimed that exercise may positively affect this problem. Therefore, the main
purpose of this study was to examine the effect of 8 weeks physical activity on primary dysmenorrhea of female
students. Based on McGill’s questionnaire 50 students having moderate to severe primary dysmenorrhea took
part in this study and randomly were divided into experimental (N=25) and control (N=25) groups. The
experimental group participated in a physical activity program for 8 weeks, 3 sessions a week and 90 minutes
per session. The results revealed that performing a regular physical activity significantly reduced type of drugs
consumed (p# 0.08), number of drugs consumed (p# 0.01), volume of bleeding (p# 0.002), rate of bleeding (p#
0.005), length of menstruation pain (p# 0.001) and total and present pain intensity (p# 0.01, p#0.05) in
experimental group when comparing with control group or when comparing pre and post-test findings of
experimental group. Overalls, the results of this study indicated that participating in physical activity program
is likely an approach to reduce the detrimental effect of primary dysmenorrhea symptoms in young females.
Key words: Physical Activity % Primary Dysmenorrhea % University Students
INTRODUCTION next day. Dysmenorrhea pains are felt in lower abdomin
In the past two decades, the relation betweenpercentage of cases, girls may experience systematic
physical activity and menstrual disorders includingsymptoms such as backache, nausea, vomiting, diarrhea,
primary dysmenorrhea has significantly been studied.fatigue and headache . With severe pain, the suffers
Research findings have indicated that exercise can affectmay be absent from school or work for one or two days 
menstruation in many ways including inducingand it could have negative impact on academic, social and
amenorrhea in athletes and it may decrease symptoms ofsports activities of young girls .
premenstrual syndrome and dysmenorrhea . PrimaryAlthough primary dysmenorrhea is not a real threat
dysmenorrhea or painful menstruation, in absence of anyof life, but can impact on the quality of female life and in
specific pelvic diseases, is one of the most commoncase of severity it may lead to disability and inefficiency
complaints of women and is also the most common[8, 9]. On the other hand, dysmenorrhea can cause
gynecological problem worldwide [2, 3]. Primarypsychological problems in some of the females resulting
dysmenorrhea begins when young girls first experiencein their loneliness and inactive participation in different
the ovulatory cycles and its prevalence increases duringsocial activities . The detrimental impact of
adolescence (15-17 years) and reaches to its highest in 20- dysmenorrhea on the lives of women has been considered
24 years and decreases progressively thereafter [4, 5]. In by most of the researchers in this area. In many countries,
primary dysmenorrhea pain begins few hours before orprimary dysmenorrhea is the leading cause of recurrent
after the onset of menstruation and lasts for 24-48 hours.short-term school and work absenteeism in young girls
The pain is more in the first day and rarely continues toand women [7, 11]. Data from few longitudinal studies
and may radiate into inner parts of thighs. In a high
World Appl. Sci. J., 17 (10): 1246-1252, 2012
showed that the absenteeism from school due to primaryIn spite of the fact that many findings
dysmenorrhea is 34 to 50 percent [12, 13]. Indeed, as
reported by many studies, there is a considerable cost to
both the individual and society as a result of
It is believed that symptoms of primary dysmenorrhea
stem from raised concentrations of prostaglandins F2"
(PGF2") resulting in uterine contractions and ischemia
. One likely mechanism for increasing prostaglandins
is that, during premenstrual phase, progesterone
decreases which results in the synthesis of
prostaglandins in endometrial cells by membrane
phospholipids. This process is supported by the ability of
prostaglandin synthesis inhibitors in pain relief. As these
inhibitors only provide pain relief in 70% to 75% of
women, other factors may also be involved . The
results of studies carried out in North America, China,
Australia, Turkey and Iran have shown that the
prevalence of primary dysmenorrhea and percentage of
women involved are different from society to society [15-
19]. Based on findings of these and other studies,
dysmenorrhea is one of the most important health issues
of young girls which must be considered because many
researchers claimed that primary dysmenorrhea affects
between 50 to 90% of general population [7, 13, 20- 25].
Due to its importance, different treatments including
medical and non-medical treatment such as taking non-
steroidal anti-Inflammatory drugs (NSAIDS), herbal,
dietary therapies, yoga, meditation and acupuncture have
been used to reduce the effects of dysmenorrhea [18, 21,
Although these treatments are generally thought to
reduce the discomfort associated with dysmenorrhea, it is
believed that participation in regular physical activity is
another positive way of dysmenorrhea treatment by which
it may diminish the symptoms of dysmenorrhea in
exercising young girls and women. Shavandi et al. (2009)
studied the effect of 8 weeks isometric exercise on primary
dysmenorrhea and reported that intensity and duration of
pain-induced by primary dysmenorrhea are reduced and
less medicine is taken, but it has no effect on the amount
of bleeding . Shahrjerdi and Sheikh Hoseini (2010)
reported that the severity and length of pain due to
primary dysmenorrhea in young girls following 8 weeks
stretching exercises are diminished and they take
significantly less medicine . However, a number of
studies have shown a correlation between life stress and
gynecological symptoms. Similarly, women who train
intensively have been found to experience fewer
symptoms than women who take part in physical activities
occasionally or not taking part at all .
support the positive effect of physical activities on
primary dysmenorrhea few studies results showed no
effect of physical activities on primary dysmenorrhea
Due to the fact that dysmenorrhea has been treated
successfully with stress reduction techniques [33, 34],
physical activities and exercise are widely accepted as
a means of moderating stress and stress- related
symptoms. Exercise is known to cause the release of
endorphins hormones in brain that raise the pain
threshold and is shown to improve mood of
exercising subjects. However, because of high
prevalence of primary dysmenorrhea in different
societies and the potential benefits of exercise found
in treating dysmenorrhea and also existence of few
studies which claimed that physical activity has no
effect on primary dysmenorrhea the purpose of this
study was to investigate the effects of physical activities
on primary dysmenorrhea of Iranian female university
MATERIALS AND METHODS
All single and non-athlete female university students
from Islamic Azad University-Karaj Branch aged 23.34 ±
2.35 years who enrolled in Physical Education Courses of
the first semester of academic year of 2010-2011 (N=256)
as research population took part in this semi-experimental
study. Using Mc Gill’s questionnaire , 50 students
with moderate to severe primary dysmenorrhea were
selected as samples and based on their menstrual history
and data obtained from this questionnaire, were randomly
divided into experimental (N=25) and control (N=25)
groups. After obtaining ethical clearance from
University’s committee for research on human subjects all
subjects participated in an introductory session. Purposes
and methods of study were explained. Thereafter, all
subjects completed the different parts of questionnaire. In
the first part of the questionnaire demographic
characteristics regarding age, mass body index and
university subject were assessed. In the second part of
the questionnaire menstrual characteristics including type
and number of drugs consumed, volume (quality and
quantity) and rate of bleeding and onset of menstruation
and length of menstruation pain were evaluated. In the
third part, female students were asked to quantify their
menstrual characteristics including pain intensity by Pain
Rate Index (PRI), Visual Analog Scale (VAS) and Present
Pain Intensity (PPI) and total pain according to Mc Gill’s
World Appl. Sci. J., 17 (10): 1246-1252, 2012
short form questionnaire. Total pain score is equal to thePhysical Activities-Induced Changes in Primary
total scores obtained from all dimensions of pain. FinalDysmenorrhea Symptoms: When comparing different
scores calculated from the third part of questionnaire were types of drugs consumed by experimental and control
from 0 to 60; from 0 to 45 was considered for PRI, from 0 group, significant difference was found between two
to 10 was considered for VAS and from 0 to 5 wasgroups (p=0.057). In pre-test Ibuprofen as a drug was
considered for PPI. The reliability of McGill questionnaire used by most subjects in both groups. But when
was confirmed (r = 0.93). comparing the findings of post-test after 8 weeks of
Physical Activity Protocol: Experimental group took part experimental group (p=0.08) and type of drug consumed
in training program for 8 weeks, 3 sessions a week, 90was changed from Ibuprofen to Acetaminophen in
minutes in a session in two cycles under supervision ofexperimental group without change in control group
Physical Education experts. Control group only took part(Table 2).
in ordinary class which was one session a week. PhysicalWhen comparing the volume of bleeding in both
activity program included 5-10 minutes warm up, 30-45groups no significant difference was found in pre-test
minutes progressive stretching exercises specified for(p=0.1) but a significant decrease was seen in post-test
pelvic region, 10-15 minutes stretching exercises usingcomparing experimental and control groups (p=0.002)
partner, 10-15 minutes resistant exercises focusing on hip (Table 2).
girdle muscles and 5-10 minutes cool down. At the end of In relation to the onset of menstruation pain, the
program, the questionnaires were completed by subjectsfindings showed no significant differences between two
as post- test by both groups. Subjects in control groupgroups in pre-test (p=0.43) and post-test (p=0.27)
were requested not to take part in any regular exercise(Table 2).
program except their one university session up to the endWhen comparing the number of drugs consumed by
of the study. both groups, there were no significant differences
To check the normality of data Kolmogorov-Smirnov between experimental and control groups in pre-test
test was used in order to analyze the findings . Chi-(p=0.754) and post-test (p=0.175) (Table 3).
square and independent and dependent t-test atBut comparing number of drugs used by experimental
significant level of P#0.05 were also used. group in pre and post-test, significant difference was
RESULTS When comparing the rate of bleeding based on the
Demographic Characteristics of Subjects: As shown in experimental and control groups was found (p=0.005)
Table 1, there were no significant differences in the(Table 3).The findings also showed a significant
demographic characteristics between subjects of thedifference between pre and post-test of experimental
experimental and control groups. group (p=0.05) (Table 4).
physical activities, no significant difference was found in
found (p=0.01) (Table 4).
number of pads used, a significant difference between
Table 1: Comparison of characteristics between experimental and control groups
Variables Experimental Group N=25 Control Group P-value N=25 W
Age (years, Mean±SD) 22.84 ± 1.79 23.8 4 ± 2.91 p> 0.05
Weight (Kg, Mean±SD) 56.39 ± 9.05 60.63 ± 9.27 p> 0.05
Height (Cm, Mean±SD) 169.26 ± 5.53 163.86 ± 4.64 p> 0.05
Body Mass Index (K g/m², Mean±SD) 22.07 ± 3.61 22.64 ± 3.37 p>0.05
Age at onset of menstruation (years, Mean±SD) 13.43 ± 1.8 12.77 ± 1.47 p> 0.05
Length of menstruation cycle (days, Mean±SD) 6.78 ± 1.27 5.86 ± 1.28 p> 0.05
Length of menstruation phase (days, Mean±SD) 25.87 ± 3.68 26.54 ± 3.93 p> 0.05
Table 2: Comparison of primary dysmenorrhea characteristics between experimental and control groups based on Chi-square analysis
Variables K² df p-value
Type of drugs consumption Pre-test 2.9 40.57
Post-test 8.1 40.08
Volume of bleeding (quality) Pre-test 4.604 20.10
Post-test 15.21 30.002
Onset of menstruation pain Pre-test 2.74 30.43
Post-test 3.85 30.27
World Appl. Sci. J., 17 (10): 1246-1252, 2012
Table 3: Comparison of primary dysmenorrhea characteristics of experimental and control groups based on independent t-test analysis
Variables Mean Diff. df tp-value
Number of drugs consumed Pre-test 0.16 48 0.315 0.754
Post-test 0.73 48 1.315 0.175
Rate of bleeding Pre-test 0.96 48 1.58 0.12
Post-test 1.92 48 4.18 0.005
Length of menstruation pain Pre-test 0.17 48 -0.39 0.69
Post-test 1.74 48 3.28 0.001
Volume of bleeding(quantity) Pre-test 0.18 48 0.33 0. 75
Post-test 0.50 48 -0.35 0.72
Table 4: Comparison of primary dysmenorrhea characteristics between pre and post-test of experimental group based on dependent t-test analysis
Variables Mean diff. df tp-value
Number of drugs consumed 1.040 24 2.68 0.01
Rate of bleeding 0.84 24 3.05 0.005
Length of menstruation pain(days) 0.6 24 2.05 0.05
Volume of bleeding(quantity/CC) 2 24 2.87 0.008
Table 5: Comparison of primary dysmenorrheal pain between experimental and control groups assessed by Mc Gill’s questionnaire based on independent
Variables Mean diff. df tp-value
Pain Rate Index (PRI) -6.56 48 -6.56 0.01
Visual Analog Scale(VAS) -0.84 48 -1.97 0.05
Present Pain Intensity (PPI) -1.04 48 -4.9 0.05
Total Pain 8.37 48 -9.21 0.01
When comparing the length of menstruation pain itThe results of the study also showed that the total
was found that this item is significantly decreased inamount of pain reduction was significantly more in
experimental group (p=0.05) (Table 4). experimental group (p=0.01) in comparison with control
The results also showed that the differencegroup (Table 5).
between the length of menstruation pain of
experimental and control groups was significant (p=0.001) DISCUSSION AND CONCLUSION
When comparing the volume of bleeding, there was The main findings of this study indicated that
no significant difference between data of control group in physical activity had a positive impact on the most of
pre and post-test (p=0.22), but this difference wasprimary dysmenorrhea symptoms in such a way that type
significant in experimental group (p=0.008) (Table 4).of drugs consumption changed from Ibuprofen to
When the findings of two groups regarding the volume of Acetaminophen (p#0.05). Volume and rate of bleeding
bleeding was compared, no significant difference wasdecreased (p#0.002, p#0.05). Length of menstruation pain
observed (p=0.72) (Table 3). reduced (p#0.05), number of drugs consumed reduced,
In regard to Pain Rate Index (PRI), the findingsbut not significantly and finally Pain Rate Index and Total
showed no significant difference in pre and post-test ofand Present Pain Intensity reduced (p#0.01, p#0.05).
control group (p=0.14), but this difference was significant Regarding type of drugs used by subjects prior to
comparing pre and post-test of experimental groupstudy, it was found that experimental group participating
(p=0.01). PRI was also significantly different betweenin physical activity protocol replaced Acetaminophen
experimental and control groups (p=0.01) (Table 5). with Ibuprofen which is a strong pain relief meaning that
Findings from Visual Analog Scale (VAS) and thephysical activity resulted in more tolerable menstruation
Present Pain Intensity (PPI) which assess the total andthereafter. This finding is in line with Thirza et al. .
present intensity of pain, showed that significantDue to the fact that painful menstruation may limit
reduction was found between experimental and controlsocial activities and may also lead to school missing
groups (p=0.05) in both cases in favor of experimental[15, 17, 18, 21, 37] young girls try to use strong drugs
group (Table 5). such as Ibuprofen to prevent these problems.
World Appl. Sci. J., 17 (10): 1246-1252, 2012
Our findings also showed that the number of drugsnumber of studies have failed to find any relation between
consumed by experimental group decreased comparingintensity of primary dysmenorrhea pain and physical
pre and post-test data. This result is in agreement withactivity [31, 32], other studies such as Smith et al. ,
Shavandi et al. , Abbaspour et al.  and Shahrjerdi Iorno et al. , Abbaspour et al. , Shahrjerdi and
and Sheikh Hoseini . The reasons for this reductionSheikh Hoseini  and Izzo and Labriola  support our
might be due to that when menstruation is veryresults. One possible mechanism explaining the positive
painful, the suffers use more drugs and prefer to take anti- effect of physical activity on intensity of primary
inflammatory type such as Ibuprophen or other strongdysmenorrhea pain is associated with stress. It has been
drugs. accepted that exercise is used as a mean of moderating
When volume of bleeding was studied, our resultsstress. Menstrual pain may be resulted from increased
indicated that volume of bleeding was significantlycontraction of uterine muscle which is innervated by the
lowered in post- exercise group. In addition to thesympathetic nervous system. Stress is supposed to
evidence that experimental group had lower volume ofincrease the sympathetic activity which may lead to the
bleeding after 8 weeks of physical activity, it is suggested increase of menstrual pain by enhancing the intensity of
that physical activity might reduce, in some degree, theuterine contraction. So, due to the fact that exercise
magnitude of bleeding, because it may lead to a betterreduce and moderate stress, the sympathetic activity
hormonal balance. On the other hand, evidence showsmay be decreased. Thereby, intensity of menstrual pain
that anti diuretic hormone is active during physicaland other related symptoms may be reduced as well.
activity and the vasoconstriction action of this hormoneAnother possible dilemma in this respect is that, because
and variations in pelvic blood flow may influence thedoing physical activity leads to the release of endorphins
synthesis or breakdown of prostaglandins . Thiswhich are produced by brain may enhance the pain
finding is not in line with the results obtained fromthreshold.
Shavandi et al.  which indicated that there is noIn conclusion, the results of the present study
change in the volume of bleeding in post-exercise youngsuggested that performing regular physical activity
girls. reduced the primary dysmenorrhea symptoms. As a factor
Our results also depicted that rate of bleeding basedit has been accepted that in developing countries such as
on the number of pads changed per day, was reducedIran, participating in regular physical activity programs
significantly in experimental group. This finding supports are limited by social, cultural and religious factors.
the notion that doing exercise may reduce the volume ofTherefore, because of high potential benefits of physical
bleeding and suggested that exercise may actually beactivity and exercise in reducing the detrimental effects of
associated with higher level of menstrual discomfort. primary dysmenorrhea symptoms, young girls are
Regarding the length of menstruation pain, therecommended to take part in such physical activity
finding of this study showed that the length ofprograms in order to help them to decrease the negative
menstruation pain was reduced significantly in ourimpact of these symptoms on their academic, social and
experimental group after 8 weeks training. Thiseven personal life.
finding is supported by previous studies carried out by
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