Cochrane for Clinicians

Putting Evidence into Practice

Exercise for Dysmenorrhea


Am Fam Physician. 2021 May 1;103(9):525-526.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is exercise a safe and effective treatment for primary dysmenorrhea?

Evidence-Based Answer

Low-intensity exercise, such as stretching or core strengthening, and high-intensity exercise, such as Zumba or aerobic training, improve menstrual pain intensity compared with no exercise (standardized mean difference [SMD] = −1.86; 95% CI, −2.06 to −1.66; nine randomized controlled trials [RCTs]; n = 632).1 (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) It is unclear whether any one type of exercise is superior to another at improving overall menstrual symptoms, mental quality of life, or physical quality of life. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) The evidence is insufficient to draw any conclusions about adverse effects. Also, there is not enough evidence to determine the benefit or harm of exercise compared with nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Primary dysmenorrhea is defined as menstrual pain without known pelvic pathology. It is the most commonly reported menstrual symptom among young women, occurring in about 71% of those younger than 25 years, typically beginning six to 12 months following menarche.1,2 Allopathic treatment options include NSAIDs, none of which have been shown to be superior to another. Combined hormonal, implantable, injectable, or hormone-releasing intrauterine contraceptives are also effective options. Exercise has long been recommended as a low-risk adjunct, and this review evaluated the effectiveness of exercise for treating primary dysmenorrhea.3

This Cochrane review included 12 trials with 854 patients in the subjective review and 10 trials with 754 women in the meta-analysis; participants had regular menses and a diagnosis of primary dysmenorrhea.1 Women 18 to 43 years of age (mean age = 25 years)

Author disclosure: No relevant financial affiliations.


show all references

1. Armour M, Ee CC, Naidoo D, et al. Exercise for dysmenorrhoea. Cochrane Database Syst Rev. 2019;(9):CD004142....

2. American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. ACOG Committee Opinion no. 760: dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018;132(6):e249–e258.

3. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014;89(5):341–346. Accessed October 13, 2020.

4. Myles PS, Myles DB, Galagher W, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118(3):424–429.

5. Armour M, Smith CA, Steel KA, et al. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complement Altern Med. 2019;19(1):22.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

More in AFP

Editor's Collections

Related Content

More in Pubmed


May 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article