What are the non-pharmacological management options for dysmenorrhea (painful menstrual periods)?

From the Guidelines

Non-pharmacological management of painful menstrual periods should prioritize heat therapy, exercise, and stress reduction techniques as first-line approaches to alleviate pain and improve quality of life. According to the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1, nonpharmacologic therapies such as exercise, low-level laser therapy, spinal manipulation, massage, yoga, acupuncture, and multidisciplinary rehabilitation have been associated with improvements in function and pain management. Specifically, heat therapy is highly recommended, as it can relax the uterine muscles and improve blood flow, thereby reducing menstrual pain 1.

Some key non-pharmacological management strategies for painful menstrual periods include:

• Applying a heating pad or hot water bottle to the lower abdomen for 15-20 minutes several times daily during menstruation
• Engaging in regular physical activity, such as moderate exercise like walking, swimming, or yoga for 30 minutes daily, to release endorphins and improve circulation
• Practicing stress reduction techniques, including deep breathing exercises, meditation, and progressive muscle relaxation, for 10-15 minutes daily to decrease pain perception by lowering stress hormones
• Getting adequate sleep (7-9 hours nightly) and staying hydrated (8-10 glasses of water daily) to support overall pain management
• Considering acupressure or massage of the lower back and abdomen to stimulate pressure points that reduce pain signals

These approaches can be used alone or in combination to address the underlying mechanisms of menstrual pain, including prostaglandin production, uterine contractions, and inflammation, and can provide immediate relief and improve quality of life 1.

From the Research

Non-Pharmacological Management of Painful Menstrual Periods

• Non-pharmacologic treatments with strong evidence include:
  • Heat therapy 2
  • Physical exercise 2
• Other non-pharmacologic treatments with less evidence-based data include:
  • Dietary supplements 2, 3
  • Acupuncture 2, 3, 4, 5
  • Transcutaneous nerve stimulation 2, 3
  • Acupressure 5
  • Lifestyle modification 3
  • Topical heat 3
  • Transcutaneous electrical nerve stimulation 3

Acupuncture as a Non-Pharmacological Treatment

• Acupuncture may reduce period pain 5
• There is no absolute contraindication for acupuncture treatment during menstruation 4
• Reasonable selection of acupoints prescriptions and appropriate acupuncture needle manipulations are key points for acupuncture administration during menstruation 4
• Acupressure may also reduce period pain and menstrual symptoms 5

Importance of Shared Decision Making

• Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction 6
• Patients should be informed of the risks and benefits of different treatment options, including non-pharmacologic treatments 2, 3, 6