The Effects of Manual Lymphatic Drainage and Self-Manual Lymphatic Drainage

Comparison of the Effects of Manual Lymphatic Drainage and Self-Manual Lymphatic Drainage on the Autonomic Nervous System and Premenstrual Symptoms in Women With Premenstrual Syndrome: A Sham-Controlled Study

This randomized controlled study aims to compare the effects of manual lymphatic drainage (MLD), self-manual lymphatic drainage (self-MLD), and sham MLD on autonomic nervous system activity and premenstrual symptoms in women with premenstrual syndrome (PMS). A total of 60 women with PMS will be randomly assigned to three groups: MLD, self-MLD, or sham MLD. The intervention will be conducted during the luteal phase of the menstrual cycle for 2 weeks, with three sessions per week, for a total of six sessions. Outcomes will include premenstrual symptoms, heart rate and heart rate variability, blood pressure, pain, edema, quality of life, fatigue, depression, anxiety, and stress. Assessments will be performed at predetermined time points before, during, and after the intervention to compare the acute and overall effects of the three approaches.

Premenstrual syndrome (PMS) is characterized by physical, emotional, and behavioral symptoms occurring during the luteal phase of the menstrual cycle. Manual lymphatic drainage (MLD) is a physiotherapy technique involving gentle, slow, rhythmic, and repetitive manual movements designed to support lymphatic flow. This study will investigate whether MLD and self-MLD influence autonomic nervous system activity and PMS-related symptoms and will compare their effects with a sham intervention.

Participants meeting the eligibility criteria will be randomly assigned to one of three groups: MLD administered by a physiotherapist, self-MLD performed by participants after instruction, or sham MLD. The intervention period will last 2 weeks during the luteal phase, with three sessions per week and six sessions in total.

Assessments will include the Premenstrual Syndrome Scale, blood pressure, heart rate and heart rate variability, pain threshold and tolerance, pain intensity, edema, quality of life, fatigue, depression, anxiety, and stress. Measurements will be performed at predetermined time points to evaluate both acute responses to the interventions and changes over the intervention period.

Inclusion Criteria:

• Female participants aged 18-40 years
• Having a regular menstrual cycle every 24-32 days during the last 6 months
• Having symptom severity above the cut-off score determined according to the Premenstrual Syndrome Scale (PMSS) during the premenstrual period
• Having premenstrual syndrome symptoms for at least the last 3 menstrual cycles
• Being literate and having the cognitive ability to complete the questionnaires
• Providing voluntary informed consent after being informed about the study

Exclusion Criteria:

• Having an irregular menstrual cycle, amenorrhea, or being in the menopausal period
• Being pregnant or breastfeeding
• Having a history of significant cardiovascular, respiratory, neurological, orthopedic, or metabolic disease
• Regular use of medications that may affect the autonomic nervous system, pain, or sleep, such as antidepressants or beta-blockers
• Having a condition that constitutes a contraindication to manual lymphatic drainage, such as acute infection, deep vein thrombosis, or advanced heart failure