Preferences In Treatment Of Menstrual Pain Among Women-A Narrative Review Section A-Research Paper Eur

Abstract

Introduction: Menstrual pain, also known as dysmenorrhea, is a common condition that affects a large number of women worldwide. Around 45-95% of women experience menstrual pain, which can significantly affect their quality of life.In India the incidence of menstrual pain is around 84.2%. There are a variety of treatments available to manage menstrual pain, and women have different preferences for these treatments. Methods: A literature search was conducted using electronic databases, including PubMedCINAHL Plus with full text, Cochrane Library (Wiley), Healthcare Journals, Medline/ PubMed, Google, Google Scholar and Science Direct. The search terms used were "menstrual pain," "dysmenorrhea," "treatment," and "preferences." The studies included in this review were selected based on their relevance to the topic, and the data were synthesised narratively. Results: Several studies have explored women's preferences for treatment options for menstrual pain. The most commonly preferred treatment option is non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Women also prefer heat therapy, such as using a hot water bottle or a heat patch, as it provides a non-invasive, affordable, and easily accessible option for managing menstrual pain. Other treatment options that women prefer include exercise, dietary changes, and complementary therapies such as acupuncture and aromatherapy. Exercise, especially yoga and stretching exercises, have been found to be effective in managing menstrual pain. Dietary changes, such as reducing salt and caffeine intake, have also been found to be helpful. Complementary therapies, such as acupuncture and aromatherapy, have shown promising results in managing menstrual pain, but further research is needed to establish their effectiveness. In contrast, women are less likely to prefer hormonal treatments, such as oral contraceptive pills or hormone replacement therapy. These treatments are associated with side effects, and some women are reluctant to use them due to concerns about long-term health risks. Conclusion: Women have different preferences for treatment options for managing menstrual pain. NSAIDs and heat therapy are the most commonly preferred options due to their effectiveness, accessibility, and affordability. Exercise, dietary changes, and complementary therapies are also preferred by some women. Hormonal treatments are less preferred due to their side effects and long-term health risks. Healthcare providers should consider women's preferences when recommending treatments for menstrual pain and work with them to identify the most suitable treatment option for each individual. Further research is needed to explore the effectiveness of complementary therapies and to identify the factors that influence women's preferences for menstrual pain management.

Full text

Preferences In Treatment Of Menstrual Pain Among Women- A Narrative Review Section A-Research Paper
Eur. Chem. Bull. 2023, 12(Special Issue 10), 3462 –3468 3462
PREFERENCES IN TREATMENT OF MENSTRUAL PAIN
AMONG WOMEN- A NARRATIVE REVIEW.
Smruti Swagatika Dash1*, Dr. Annie Thomas2, Dr. Gyanendranath Dash3
Introduction:
Menstrual pain, also known as dysmenorrhea, is a common condition that affects a large number of women
worldwide. Around 45-95% of women experience menstrual pain, which can significantly affect their quality
of life.In India the incidence of menstrual pain is around 84.2%. There are a variety of treatments available to
manage menstrual pain, and women have different preferences for these treatments.
Methods:
A literature search was conducted using electronic databases, including PubMedCINAHL Plus with full text,
Cochrane Library (Wiley), Healthcare Journals, Medline/ PubMed, Google, Google Scholar and Science
Direct. The search terms used were "menstrual pain," "dysmenorrhea," "treatment," and "preferences." The
studies included in this review were selected based on their relevance to the topic, and the data were synthesised
narratively.
Results:
Several studies have explored women's preferences for treatment options for menstrual pain. The most
commonly preferred treatment option is non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
or naproxen. Women also prefer heat therapy, such as using a hot water bottle or a heat patch, as it provides a
non-invasive, affordable, and easily accessible option for managing menstrual pain.
Other treatment options that women prefer include exercise, dietary changes, and complementary therapies
such as acupuncture and aromatherapy. Exercise, especially yoga and stretching exercises, have been found to
be effective in managing menstrual pain. Dietary changes, such as reducing salt and caffeine intake, have also
been found to be helpful. Complementary therapies, such as acupuncture and aromatherapy, have shown
promising results in managing menstrual pain, but further research is needed to establish their effectiveness.
In contrast, women are less likely to prefer hormonal treatments, such as oral contraceptive pills or hormone
replacement therapy. These treatments are associated with side effects, and some women are reluctant to use
them due to concerns about long-term health risks.
Conclusion:
Women have different preferences for treatment options for managing menstrual pain. NSAIDs and heat
therapy are the most commonly preferred options due to their effectiveness, accessibility, and affordability.
Exercise, dietary changes, and complementary therapies are also preferred by some women. Hormonal
treatments are less preferred due to their side effects and long-term health risks. Healthcare providers should
consider women's preferences when recommending treatments for menstrual pain and work with them to
identify the most suitable treatment option for each individual. Further research is needed to explore the
effectiveness of complementary therapies and to identify the factors that influence women's preferences for
menstrual pain management.
Keywords: primary dysmenorrhoea, menstruation, pain, quality of life, physiotherapy, treatment
1*PhD Scholar, Department of Physiotherapy, School of Health Sciences, Garden City University, Bangalore.
2PT, Professor, PhD, Director Physiocare/Professor & Research Coordinator, Department of Physiotherapy,
School of Health Sciences, Garden City University, Bangalore.
3Senior Consultant MD (Obstetrics and Gynaecology)
*Corresponding author:
-
Smruti Swagatika Dash
*PhD Scholar, Department of Physiotherapy, School of Health Sciences, Garden City University, Bangalore.
DOI: 10.48047/ecb/2023.12.si10.00395

Preferences In Treatment Of Menstrual Pain Among Women- A Narrative Review Section A-Research Paper
Eur. Chem. Bull. 2023, 12(Special Issue 10), 3462 –3468 3463
Introduction:
Menstrual pain, also known as dysmenorrhea, is a
common condition that affects up to 95% of
women who menstruate1. This health issue is
prevalent across women of various socio-economic
strata, ethnicity and nationality. It causes severe
physical and psychological symptoms that
interferes with daily activities and quality of life3.
Women with dysmenorrhoea seek various
treatments to cope with their pain, ranging from
self-care methods to medical interventions.
However, there is a lack of comprehensive and
reliable information on the effectiveness and safety
of different treatment options, as well as the
preferences and needs of women with menstrual
pain.
Literature Review:
Incidence of Dysmenorrhoea and common
complaints during menstruation:
Dysmenorrhoea affects approximately 45-95% of
young women who are in the reproductive age
group and who are in their active productive phase
of their lives. In India the prevalence of menstrual
pain is around 84.2% and of these around 2-29%
experience severe menstrual pain which does
affect their studies or job4,5. In a study conducted
by Ju H et al, where they found out that prevalence
of dysmenorrhoea among women varied from 16-
91% in women of reproductive age with 2-29%
women experiencing severe pain6. In yet another
study conducted by Armour et al around 71.1% of
women experienced menstrual pain irrespective of
the economic status of the country to which they
belong. 40.9% of female students complained of
impaired classroom performances and also
complained of lack of proper concentration in
class. These are incidences of 20.1 % of students
who were constantly absent from classes due to
symptoms of dysmenorrhoea3. In the same study it
was also found that the incidence of women
complaining menstrual pain was 92% and they
belong to the age group between 13-25. The most
common complaint for these women being cyclical
pelvic pain3.
Treatment options for managing menstrual
pain:
Dealing with menstrual pain among women has
been a regular phenomenon. Despite the effect of
menstrual pain on attendance, societal
participation, performance at work, decreased
concentration and quality of life, most women
consider menstrual pain as “normal” and silently
bear it considering it as a part of women’s life7.
In a meta-analysis conducted by Xuan Fend et al in
2018, which included 72 RCTs and in that 13 drugs
were compared for common consumption for pain
relief for managing dysmenorrhoea. It was found
that Flubipropen and Tiaprofenic acid were the
optimal drugs used for managing dysmenorrhoea.
In another cross sectional study by Amena Ali et al
in 2022 where 562 female university students in the
age group 18-30 years were included for
preference of medications for pain relief for
dysmenorrhoea and it was found that 42% use
ibufrofen, 40% consumed paracetamol while only
3% took mefenemic acid9. In another study by
Sayako Akimiya et al in 2018 who conducted an
internet-based survey among women participants
within age group of 18-49 years where participants
were asked for their treatment preferences for
managing menstrual pain and other symptoms and
most of the participants preferred OTC
analgesics10. Participants of a cross sectional
observational study conducted by Maria Laura
Parra- Fernnandez et al 2020, where among 224
participants who were administered with self-
administered questionnaire for pain relief and self-
care. In which 43.8% preferred non-
pharmacological treatment mostly consisting of
assuming antalgic position, massages and heat11.
In a cross-sectional study among 550 female
students by Samar Karout in 2021 with the help of
self-administered questionnaire for menstrual pain
relief; where 36.9% females sought medical
advice, while 76.4% received medicine while none
took hormonal contraceptives. The common
medications taken by these women were
mefenamic acid, ibuprofen and paracetamol12. In a
study by Mike Armour et al in 2019, around 55%
women preferred self-care along with
pharmacological and non-pharmacological
treatment. Paracetamol was the most commonly
used drug, while 11% took medical advice from a
doctor7. A study conducted by Minaleswara et al in
2017 for pain relief during menstruation in which
63.8% participants preferred home remedies while
rest consumed Ibufrofen and diclofenac13.
While multiple other studies also concluded that
women did prefer therapeutic exercises and
preferred non-pharmacological methods which
reduced their pain associated with dysmenorrhoea.
In a study by Gemma Matthewman et al in 2018
participants affirmed that regular physical activity
did help in decreasing menstrual pain14. In yet
another systematic review and meta-analysis
among women of 16-25 years, where they found
that therapeutic exercises helped subjects in
decreasing menstrual pain intensity and duration
and also improving their quality of life15. The same
conclusion was also obtained by another
systematic review and metaanalysis conducted by
Egzersiz et al in 201616. The various types of

Preferences In Treatment Of Menstrual Pain Among Women- A Narrative Review Section A-Research Paper
Eur. Chem. Bull. 2023, 12(Special Issue 10), 3462 –3468 3464
exercises that were performed by women were
stretching exercises17, progressive relaxation
exercises18 and aerobic exercises19 which were the
multiple non-pharmacological means which also
helped women relieve them from menstrual pain.
In yet another study, use of thermotherapy which
was found more effective than TENS20. There are
also a few studies conducted where women did
perform some yoga exercises to relieve them from
menstrual pain21,22. There were also few studies
which suggested use of herbs and home remedies
to manage menstrual pain23,24. Some school of
thought also professed that acupressure and app
based acupressure helped women with
dysmenorrhoea25,26.
Aims and Objectives:
1.To understand different treatment options
available for managing Menstrual pain.
2.To understand the preferences of women in
treatment of Menstrual pain.
Materials and Methods
Database search was conducted for relevant peer
reviewed articles, using the search terms
“Menstrual pain”, “musculoskeletal”, and “depres-
sion”, “menstrual pain”.Databases searched were
CINAHL Plus with full text, Cochrane Library
(Wiley), Healthcare Journals, Medline/ PubMed,
Google, Google Scholar, Science Direct (Elsevier),
Scopus etc. Other potentially relevant literature
was identified through bibliography searches of
included articles and expert recommendation.
Studies published between 2010-2023 were
included for this review.Titles and abstracts of
citations were then screened for relevance to the
inclusion. Randomised controlled trials, cross
sectional study survey, systematic review with full
text available all were included out of 50 studies
that were screened, 20 fulfilled the inclusion
criteria and were included in the review.
Inclusion criteria:
1. Studies conducted between the years 2010-2023.
2. Studies specifically focussing on menstrual pain
and treatment options available.
3. Studies including patients above 18 years of age.
Exclusion criteria:
1. Studies conducted before the year 2010.
2. Studies including patients below18 years of age.
3. Studies including other than menstrual pain.
Analysis:
Author & Year
Study type &
sample
Intervention
Outcome
Conclusion
Xuan Feng et al,
2018
Network meta-
analysis, 72 RCTs
were included.
13 drugs were
included.
Pain relief
Flurbipropen & Tiaprofenic
acid are optimal drugs in
managing primary
dysmenorrhoea.
Maria Laura Parra
-Fernandez et al,
2020
Cross sectional
observational
study, 224 women
participants
Self-reported
Questionnaire
Menstrual pain &
self-care
43.8% preferred non-
pharmacological treatment
mostly antalgic position,
massages & heat.
Samar Karout,
2021
Cross sectional
study among 550
female students
Self-administered
Questionnaire
Pain relief
Only 36.9% females with
dysmenorrhoea sought for
medical advice, 76.4%
received medicine while
none took hormonal
contraceptives. Drugs
commonly taken were
mefenamic aid, ibuprofen
and paracetamol.
Amena Ali et al,
2022
Cross sectional
study, 562 female
university
students, 18-30
years
Medications
Pain relief
42% use ibuprofen, 40%
paracetamol & 3 %
mefenamic acid.
Mike Armour et
al, 2019
Systematic review
and meta-analysis,
947 articles were
screened.
Twenty-four
studies including
12,526 young
women were
eligible.
Self-care
Pain intensity
Self-care was used by 55%
of women along with
pharmacological & non-
pharmacological
treatment.Paracetamol most
commonly used. Only 11%
took medical advice from a
doctor.

Preferences In Treatment Of Menstrual Pain Among Women- A Narrative Review Section A-Research Paper
Eur. Chem. Bull. 2023, 12(Special Issue 10), 3462 –3468 3465
C Banikarim ,
2000
706 Hispanic
female adolescents
31 item Questionnaire
about presence,
duration, severity,
treatment &
limitations of
dysmenorrhoea at
local urban high
school
Pain intensity,
absenteeism in
school, social life
Treatment taken commonly
was rest (58%), medications
(52%), heating pad (26%),
tea (20%), exercise (15%) &
herbs (7%).
Minaleshewa
Biruk et al, 2017
Cross sectional
study, female
university students
Self-reported
Questionnaire
Pain relief
63.8% use home remedies.
Ibuprofen & diclofenac most
commonly used medication
to manage dysmenorrhoea.
Sayako Akimiya
et al, 2018
Internet based
survey, 18-49
years
Treatment
preferences
Pain & symptom
relief
Participants preferred OTC
analgesics.
Gemma
Matthewmam et
al, 2018
systematic review
and meta-analysis
of randomised
controlled trials,
15 RCTs, 1681
participants
Physical activity
Pain intensity &
duration
Physical activity is effective
for treatment of primary
dysmenorrhoea.
Mike Armour et
al, 2019
Twenty-three trials
including 2302
women were
eligible and
included in the
meta-analysis.
Exercises
Pain
intensity(VAS/
NRS), Menstrual
pain duration,
absenteeism
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.
Paloma
Carroquino
Garcia et al, 2019
Systematic Review
& Meta-analysis
16-25 years
women old
Studies that included
Exercise as a type of
Therapy
Pain intensity,
duration & QOL
Therapeutic exercise reduces
intensity of pain in patients
with primary
dysmenorrhoea.
Egzersiz et al,
2016
Systematic review
& Meta-analysis
Exercise regimen
Pain intensity &
QoL
Exercises significantly
reduce pain associated with
dysmenorrhoea.
Narges Motahari
Tabari et al, 2017
RCT, 122 female
students, 18-22
years old
Exercise group and
mefenamic acid
group
Pain reduction
and menstrual
characteristics
Stretching exercises were as
effective as mefenamic acid
in treatment of primary
dysmenorrhoea.
Çelik and Apay ,
2021
RCT, 510 students
Progressive
relaxation exercises
Pain intensity
Progressive relaxation
exercises decreased
Menstrual pain.
Aline Fernanda
Perez Machado et
al, 2019
RCT, 88
participants
Thermotherapy,
TENS
NRS, McGill pain
Questionnaire
Thermotherapy reduced
menstrual pain better than
TENS.
Tharini. G et al,
2018
Experimental
study pre- post
type, 30 subjects
in age of 17-23
years
Stretching exercise,
Aerobic dance
VAS, DASS
Aerobic exercise and dance
group was better than
stretching group in reducing
menstrual pain.
Hajar Adib Rad et
al, 2018
Cross over trial,
168 girl students,
18-26 years old
2 groups receiving
drugs Novafen &
Ginger
Pain severity by
VAS
Both Herbal medicine & non
synthetic drug reduce
primary dysmenorrhoea.
Zahara
Rakhshaee, 2011
RCT, 92 girl
students, 18-22
years old
3 yoga poses ( Cobra,
cat and fish poses )
VAS for pain,
pain duration in
hours
Yoga reduced the severity
and duration of primary
dysmenorrhoea.
Sang Dol Kim,
2019
Meta analysis of
RCTs, 230
participants
Yoga program
Pain levels
Yoga is an effective
intervention for alleviating
menstrual pain.
Susane Blodt et
al, 2018
Randomised trial,
women aged 18-34
years, 221 women.
2 arm trial, one is
app-based
acupressure & other
group performed
usual care.
NRS
Smart phone app delivered
acupressure resulted in
reduction of menstrual pain.

Preferences In Treatment Of Menstrual Pain Among Women- A Narrative Review Section A-Research Paper
Eur. Chem. Bull. 2023, 12(Special Issue 10), 3462 –3468 3466
Discussion:
This review aims to summarise the current
evidence on the preferences of treatment and
treatment options for managing menstrual pain
among women, based on a data from previous
studies in the past 10 years.
Multiple studies conducted by various researchers
like Minaleshewa Biruk et al (2017),Feng X
(2018), Samar Karout (2012) and Amena et al
(2022) did document about the frequent use of
OTC analgesics among women, which included
mostly Ibuprofen, Paracetamol,Mefenamic acid
etc. These women did consume these medications
mostly without prescription. So, the side effects for
the same with prolonged use did affect them.
Moreover, most women tried to get some ease with
self-care, while some resorted to rest, consumption
of herbal medications and things like ginger and
tea23,24.
While most women also preferred some form of
physical activity on a daily basis, performed
exercises like stretching, aerobic exercises and
progressive relaxation to help them relieve them
from menstrual pain. These measures helped
mostly by increasing vascularity to ischaemic
spasmodic areas, secretion of endorphins and more
over these treatments did not have any side effects
as suggested by the previous studies14,15,16,17,18,19.
Non-pharmacological self-care techniques or
lifestyle interventions, either physical or
psychological, is mostly practiced by women
themselves such as exercise (including yoga and
Pilates), heat, meditation, aromatherapy, self-
massage or acupressure allowing women to
potentially reduce their menstrual pain and reduce
need for analgesics and improve their health-
related quality of life.
In a recent narrative review also it was discussed
that though prevalence of menstrual pain was high
among younger women still seeking proper
guidance and treatment to resolve menstrual pain
was minimal. Also many women preferred non
pharmacological treatment and resorted to
exercises but these need to be more structured27.
There has to be more awareness sessions and
education being imparted to young women
regarding menstruation, menstrual pain, measures
available to manage it, seeking help regarding it
mostly in developing countries where discussion
regarding menstruation is still considered as a
taboo.
Conclusion:
Dysmenorrhoea is the commonest menstrual
disorder. Women of different ethnicities respond
differently to managing this. There are multiple
ways to manage menstrual pain like NSAIDs,
OCPs, herbal remedies, TENS, Physical activities,
yoga, exercises, acupressure, hot packs and self-
care. As compared to pharmacological means
women preferred nonpharmacological means to
alleviate menstrual pain.
Findings suggest the need for educating adolescent
girls on appropriate and effective management of
dysmenorrhea. A proper exercise prescription will
make a smarter solution than self-care alone .
Limitation and Future recommendations:
More literature reviews needs to be done on
specific categories of medication or specific
alternate mode of treatment for managing
menstrual pain.
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