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Primary dysmenorrheic (PD) pain usually begins during adolescence, at menarche or shortly after (6-24 months), and has a clear and predictable temporal pattern. The pain typically radiates to the back and thighs and lasts for 8-72 hours. The pain is most severe on the first and/or second day of menstrual bleeding. Additionally, systemic symptoms such as nausea, vomiting, diarrhea, fatigue, and insomnia often accompany the pain. In secondary dysmenorrhea, it can result from a range of identifiable pathological conditions, including endometriosis, adenomyosis, fibroids, and pelvic inflammatory disease. Other gynecological symptoms such as intermenstrual bleeding and menorrhagia may also accompany it, depending on the underlying condition. Empirical treatment approaches have been reported as appropriate for patients with primary dysmenorrhea based on symptoms and physical examination results. Recent studies have indicated that during diaphragmatic breathing, all the muscles that make up the thoracic and abdominal walls should expand in a cylindrical manner in all directions through synchronized eccentric activity. Thus, a more effective result will occur with the concentric contraction and 360-degree expansion of the diaphragm during inspiration, which raises intra-abdominal pressure .
Within the framework of this information, the aim of this study is to examine the effects of respiration-based physiotherapy approaches on menstrual symptoms, pain, and quality of life in women with PD.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DNS Based breathing exercises+PFMT | Experimental | Dynamic Neuromuscular Stabilization (DNS)-based respiratory training and pelvic floor muscle training (PFMT) will be applied. |
|
| PFMT | Active Comparator | Pelvic floor muscle training (PFMT) will be applied. |
|
| Control Group | No Intervention | No intervention will be made to the participants in this group. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dynamic Neuromuscular Stabilization based breathing training and pelvic floor muscle training | Behavioral | DNS-based breathing exercises will be taught to the women in this group using tactile biofeedback. To create tactile stimulation, one of the hard sponges placed within a belt will be positioned anteriorly in the inguinal region, and the other posteriorly in the Grynfeltt-Lesshaft triangle region. Breathing training will be provided in 3 different positions: sitting, crawling, and happy baby pose. Pelvic floor muscle training: PFME will consist of 2 parts: relaxation training for pelvic floor muscles and pelvic floor muscle exercises. Pelvic floor muscles will be given relaxation training in 3 different relaxation positions (modified butterfly pose, child pose and deep squatting position) suggested by Çeliker Tosun et al. PFME will be taught by the physiotherapist in the side-lying with external coccyx palpation. PFME will be applied in the hook-lying position, sitting position and standing position. |
| Measure | Description | Time Frame |
|---|---|---|
| Change of Menstruation Symptom Scale score | Individuals menstrual pain and symptoms will be assessed with the Menstruation Symptom Scale. The Turkish validity and reliability of this scale was conducted by Güvenç et al. in 2014. The MSS is a five-point Likert-type scale consisting of twenty-two items. Participants are asked to give a number between 1 (never) and 5 (always) to the symptoms they experience related to menstruation. The scale has three sub-dimensions: 'Negative Effects/Somatic Complaints' (Items 1-13), 'Menstrual Pain Symptoms' (Items 14-19) and 'Coping Methods' (Items 20-22). The highest score that can be obtained from the scale is 110, the lowest score is 22. | 4 weeks after the intervention |
| Change in the McGill pain questionnaire score | The McGill pain questionnaire will be used to assess the severity and quality of menstrual pain in individuals. This questionnaire consists of 11 words to determine the sensory aspect of pain and 4 words to determine the affective aspect, totaling 15 different words related to the quality of pain. In addition, the pain intensity felt at the time of measurement is measured with VAS, and the total pain intensity evaluated is measured with a 6-point Likert-type scale. | 4 weeks after the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Change of Menstruation Symptom Scale score | Individuals menstrual pain and symptoms will be assessed with the Menstruation Symptom Scale. The Turkish validity and reliability of this scale was conducted by Güvenç et al. in 2014. The MSS is a five-point Likert-type scale consisting of twenty-two items. Participants are asked to give a number between 1 (never) and 5 (always) to the symptoms they experience related to menstruation. The scale has three sub-dimensions: 'Negative Effects/Somatic Complaints' (Items 1-13), 'Menstrual Pain Symptoms' (Items 14-19) and 'Coping Methods' (Items 20-22). The highest score that can be obtained from the scale is 110, the lowest score is 22. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Izmir University of Economics | Izmir | İzmir | 35330 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42271328 | Derived | Yakit Yesilyurt S, Birinci Olgun T, Dag Y, Donmez EN, Aytekin I, Erkanli ME, Budak A. Effect of pelvic floor muscle training with or without dynamic neuromuscular stabilization-based breathing on menstrual pain and symptoms of primary dysmenorrhea: a randomized controlled trial. BMC Womens Health. 2026 Jun 11. doi: 10.1186/s12905-026-04578-w. Online ahead of print. |
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| Pelvic floor muscle training | Behavioral | Pelvic floor muscle training: PFME will consist of 2 parts: relaxation training for pelvic floor muscles and pelvic floor muscle exercises. Pelvic floor muscles will be given relaxation training in 3 different relaxation positions (modified butterfly pose, child pose and deep squatting position) suggested by Çeliker Tosun et al. PFME will be taught by the physiotherapist in the side-lying with external coccyx palpation. PFME will be applied in the hook-lying position, sitting position and standing position. |
|
| 3 months after the intervention |
| Change of Quality of Life score | Short Form-36 is a 36-question self-assessment scale consisting of eight subscales. This scale consists of physical function (10 items), role limitations (physical (4 items) and emotional problems (3 items), pain (2 items), vitality (4 items), social function (2 items), mental health (5 items) and general health (5 items) subscales. Each subscale is scored between 0-100, with "0" indicating the lowest and "100" indicating the best quality of life level. | 4 weeks after the intervention |
| Change in the McGill pain questionnaire score | The McGill pain questionnaire will be used to assess the severity and quality of menstrual pain in individuals. This questionnaire consists of 11 words to determine the sensory aspect of pain and 4 words to determine the affective aspect, totaling 15 different words related to the quality of pain. In addition, the pain intensity felt at the time of measurement is measured with VAS, and the total pain intensity evaluated is measured with a 6-point Likert-type scale. | 3 months after the intervention |
| Change of Quality of Life score | Short Form-36 is a 36-question self-assessment scale consisting of eight subscales. This scale consists of physical function (10 items), role limitations (physical (4 items) and emotional problems (3 items), pain (2 items), vitality (4 items), social function (2 items), mental health (5 items) and general health (5 items) subscales. Each subscale is scored between 0-100, with "0" indicating the lowest and "100" indicating the best quality of life level. | 3 months after the intervention |
| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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