World Applied Sciences Journal 17 (10): 1246-1252, 2012

ISSN 1818-4952
IDOSI Publications, 2012

The Effect of Physical Activity on Primary Dysmenorrhea

of Female University Students
1

Noorbakhsh Mahvash, 1Alijani Eidy, 1Kohandel Mehdi,

2
Mehdizadeh Toorzani Zahra, 2Mirfaizi Mani and 1Hojat Shahla
1

College of Physical Education and Sport Sciences, Islamic Azad University - Karaj Branch,
Iran 2Department of Midwifery, Islamic Azad University - Karaj Branch, Iran

Abstract: Primary dysmenorrhea is one of the most common complains and gynecological problem worldwide
among young females. Findings claimed that exercise may positively affect this problem. Therefore, the main
purpose of this study was to examine the effect of 8 weeks physical activity on primary dysmenorrhea of female
students. Based on McGills questionnaire 50 students having moderate to severe primary dysmenorrhea took
part in this study and randomly were divided into experimental (N=25) and control (N=25) groups. The
experimental group participated in a physical activity program for 8 weeks, 3 sessions a week and 90 minutes per
session. The results revealed that performing a regular physical activity significantly reduced type of drugs
consumed (p 0.08), number of drugs consumed (p 0.01), volume of bleeding (p 0.002), rate of bleeding (p
0.005), length of menstruation pain (p 0.001) and total and present pain intensity (p 0.01, p 0.05) in
experimental group when comparing with control group or when comparing pre and post-test findings of
experimental group. Overalls, the results of this study indicated that participating in physical activity program is
likely an approach to reduce the detrimental effect of primary dysmenorrhea symptoms in young females.
University Students
other hand, dysmenorrhea
Key words: Physical Activity Primary
can cause psychological
Dysmenorrhea
next day. Dysmenorrhea problems in some of the
pains are felt in lower females resulting in their
INTRODUCTION
abdomin and may radiate loneliness and inactive
into inner parts of thighs. In participation in different
In the past two decades, the relation between
a high percentage of cases, social activities [10]. The
physical activity and menstrual disorders including
girls
may
experience detrimental
impact
of
primary dysmenorrhea has significantly been studied.
systematic symptoms such as dysmenorrhea on the lives
Research findings have indicated that exercise can
backache, nausea, vomiting, of women has been
affect menstruation in many ways including inducing
diarrhea,
fatigue
and considered by most of the
amenorrhea in athletes and it may decrease symptoms
headache [6]. With severe researchers in this area. In
of premenstrual syndrome and dysmenorrhea [1].
pain, the suffers may be many countries, primary
Primary dysmenorrhea or painful menstruation, in
absent from school or work dysmenorrhea is the leading
absence of any specific pelvic diseases, is one of the
for one or two days [3] and it cause of recurrent shortmost common complaints of women and is also the
could have negative impact term school and work
most common gynecological problem worldwide [2,
on academic, social and absenteeism in young girls
3]. Primary dysmenorrhea begins when young girls
sports activities of young and women [7, 11]. Data
first experience the ovulatory cycles and its
girls [7].
from
few
longitudinal
prevalence increases during adolescence (15-17 years)
Although
primary studies
and reaches to its highest in 20-24 years and decreases
dysmenorrhea is not a real
progressively thereafter [4, 5]. In primary
threat of life, but can impact
dysmenorrhea pain begins few hours before or after
on the quality of female life
the onset of menstruation and lasts for 24-48 hours.
and in case of severity it may
The pain is more in the first day and rarely continues
lead to disability and
to
inefficiency [8, 9]. On the

Univer
sity,
Karaj
Branch
, Iran,
POST:
17-

Corresponding Author: Noorbakhsh

Mahvash, College of Physical
Education and Sport Sciences,
Islamic
Azad

1246

Shenas
a
Street,
Valye
Asr
Ave,
Tehran,

Iran. Tel:
+02122058101,
Cell:
+0916614881
9.

World Appl. Sci. J., 17 (10): 1246-1252, 2012

decreases
which results
showed
that
thein the
absenteeis synthesis of
m
fromprostaglandin
school dues in
to primaryendometrial
dysmenorr cells by
hea is 34 tomembrane
50 percentphospholipid
[12, 13].s. This
Indeed, asprocess is
supported by
reported by
the ability of
many
prostaglandin
studies,
synthesis
there is a
inhibitors in
considerabl
pain relief.
e cost to
As these
both
the
inhibitors
individual only provide
and societypain relief in
as a result70% to 75%
of
of women,
dysmenorr other factors
hea.
may also be
It is involved [1].
believed The results of
that
studies
symptoms carried out in
of primary North
dysmenorr America,
hea stem China,
from raised Australia,
concentrati Turkey and
ons of
Iran have
prostaglan shown that
the
dins F2
(PGF2 ) prevalence of
resulting in primary
dysmenorrhe
uterine
contraction a and
percentage of
s and
ischemia women
[14]. One involved are
different
likely
mechanism from society
to society
for
increasing [15-19].
prostaglan Based on
dins is that, findings of
these and
during
premenstru other studies,
al phase, dysmenorrhe
progestero a is one of
the most
ne

important
health issues
of young
girls which
must be
considered
because
many
researchers
claimed that
primary
dysmenorrhe
a affects
between 50
to 90% of
general
population
[7, 13, 2025].
Due to
its
importance,
different
treatments
including
medical and
non-medical
treatment
such
as
taking nonsteroidal antiInflammatory
drugs
(NSAIDS),
herbal,
dietary
therapies,
yoga,
meditation
and
acupuncture
have
been
used
to
reduce
the
effects
of
dysmenorrhe
a [18, 21, 2628].
Althoug
h
these
treatments
are generally
thought
to
reduce
the
discomfort

associated of bleeding
with
[19].
dysmenorr Shahrjerdi
hea, it isand Sheikh
believed Hoseini
that
(2010)
participatio reported that
n in regularthe severity
physical and length of
activity ispain due to
another
primary
positive dysmenorrhe
way
ofa in young
dysmenorr girls
hea
following 8
treatment weeks
by which itstretching
may
exercises are
diminish diminished
the
and they take
symptoms significantly
of
less medicine
dysmenorr [29].
hea
inHowever, a
exercising number
of
young girlsstudies have
and
shown
a
women. correlation
Shavandi between life
et al .stress
and
(2009)
gynecologica
studied thel symptoms.
effect of 8Similarly,
weeks
women who
isometric train
exercise onintensively
primary have
been
dysmenorr found
to
hea
andexperience
reported fewer
that
symptoms
intensity than women
and
who take part
duration ofin physical
pain
activities
-induced occasionally
by primaryor not taking
dysmenorr part at all
hea
are[30].
reduced
and
less
medicine is
taken, but
it has no
effect on
the amount

In spite
of the fact
that
many
findings
support the
positive
effect
of
physical
activities on
primary
dysmenorrhe
a few studies
results
showed no
effect
of
physical
activities on
primary
dysmenorrhe
a [31, 32].
Due to
the fact that
dysmenorrhe
a has been
treated
successfully
with
stress
reduction
techniques
[33,
34],
physical
activities and
exercise are
widely
accepted as a
means
of
moderating
stress
and
stress- related
symptoms.
Exercise is
known
to
cause
the
release
of
endorphins
hormones in
brain
that
raise the pain
threshold and
is shown to
improve
mood
of
exercising

subjects.
L
S
However,
A
because of
N
high
D
prevalence
M
of primary
E
T
dysmenorr
H
hea
in
O
different
D
societies
S
and
the
potential
All
benefits of
single
and
exercise
non-athlete
found
in
female
treating
university
dysmenorr students from
hea
andIslamic Azad
also
Universityexistence Karaj Branch
of
fewaged 23.34
studies
2.35
years
which
who enrolled
claimed in Physical
that
Education
physical Courses of
activity hasthe
first
no effectsemester of
on primaryacademic
dysmenorr year of 2010hea
the2011
purpose of(N=256) as
this studyresearch
was
topopulation
investigate took part in
the effectsthis
semiof physicalexperimental
activities study. Using
on primaryMc
Gills
dysmenorr questionnaire
hea
of[35],
50
Iranian
students with
female
moderate to
university severe
students. primary
dysmenorrhe
a
were
selected as
M
samples and
A
based
on
T
their
E
menstrual
R
Ihistory and
A
data obtained

from
this
questionnaire
,
were
randomly
divided into
experimental
(N=25) and
control
(N=25)
groups. After
obtaining
ethical
clearance
from
Universitys
committee
for research
on
human
subjects all
subjects
participated
in
an
introductory
session.
Purposes and
methods of
study were
explained.
Thereafter,
all subjects
completed
the different
parts
of
questionnaire
. In the first
part of the
questionnaire
demographic
characteristic
s regarding
age,
mass
body index
and
university
subject were
assessed. In
the
second
part of the
questionnaire
menstrual
characteristic
s including
type
and
number
of
drugs

consumed, menstruation
volume
pain
were
(quality
evaluated. In
and
the third part,
quantity) female
and rate ofstudents were
bleeding asked
to
and onsetquantify their
of
menstrual
menstruati characteristic
on
ands including
length ofpain intensity
1247

by Pain Rate
Index (PRI),
Visual
Analog Scale
(VAS)
and
Present Pain
Intensity
(PPI)
and
total
pain
according to
Mc Gills

World Appl. Sci. J., 17 (10): 1246-1252, 2012

a session in
cycles
short formtwo
questionnaiunder
re.
Totalsupervision
pain scoreof Physical
is equal toEducation
the
totalexperts.
Control
scores
obtained group only
from
alltook part in
dimensions ordinary
of
pain.class which
was
one
Final
session
a
scores
week.
calculated
Physical
from the
activity
third part
program
of
included 5questionnai
10 minutes
re
were
warm up, 30from 0 to
45 minutes
60; from 0
progressive
to 45 was
stretching
considered
exercises
for
PRI,specified for
from 0 topelvic region,
10
was10-15
considered minutes
for
VASstretching
and from 0exercises
to 5 wasusing partner,
considered 10-15
for
PPI.minutes
The
resistant
reliability exercises
of McGillfocusing on
questionnaihip
girdle
re
wasmuscles and
confirmed 5-10 minutes
(r = 0.93). cool down.
At the end of
Physical program, the
Activity questionnaire
Protocol: s
were
Experimen completed by
tal groupsubjects as
took part inpost- test by
training
both groups.
program Subjects in
for
8control group
weeks, 3were
sessions arequested not
week, 90to take part
minutes inin
any

regular
exercise
program
except their
one
university
session up to
the end of the
study.
To check
the normality
of
data
KolmogorovSmirnov test
was used in
order
to
analyze the
findings [36].
Chi-square
and
independent
and
dependent ttest
at
significant
level of P
0.05
were
also used.
RESULT
S
Demographi
c
Characterist
ics
of
Subjects: As
shown
in
Table 1, there
were
no
significant
differences in
the
demographic
characteristic
s
between
subjects of
the
experimental
and control
groups.

Physical was changed

Activities- from
Induced Ibuprofen to
Changes Acetaminoph
in
en
in
Primary experimental
Dysmenor group
rhea
without
Symptoms change
in
:
Whencontrol group
comparing (Table 2).
different
When
types
ofcomparing
drugs
the volume
consumed of bleeding
by
in
both
experiment groups
no
al
andsignificant
control
difference
group,
was found in
significant pre-test
difference (p=0.1) but a
was foundsignificant
between decrease was
two groupsseen in post(p=0.057). test
In pre -testcomparing
Ibuprofen experimental
as a drugand control
was usedgroups
by
most(p=0.002)
subjects in(Table 2).
both
In
groups.
relation
to
But whenthe onset of
comparing menstruation
the
pain,
the
findings offindings
post-test showed no
after
8significant
weeks ofdifferences
physical between two
activities, groups
in
no
pre-test
significant (p=0.43) and
difference post-test
was found(p=0.27)
in
(Table 2).
experiment
When
al
groupcomparing
(p=0.08) the number
and type ofof
drugs
drug
consumed by
consumed

both groups,
there were no
significant
differences
between
experimental
and control
groups
in
pre-test
(p=0.754)
and post-test
(p=0.175)
(Table 3).
But
comparing
number
of
drugs used
by
experimental
group in pre
and post-test,
significant
difference
was
found
(p=0.01)
(Table 4).
When
comparing
the rate of
bleeding
based on the
number
of
pads used, a
significant
difference
between
experimental
and control
groups was
found
(p=0.005)
(Table 3).The
findings also
showed
a
significant
difference
between pre
and post-test
of
experimental
group
(p=0.05)
(Table 4).

Body Mass
Length
Indexof(K
menstruation
g/m, MeanSD)
phase (days, MeanSD)
Age (years, MeanSD)
Table 1: Weight
Comparison
ofAge
characteristics
between experimental
and control groups
at onset of menstruation
(years, MeanSD)
(Kg, MeanSD)
VariablesHeight (Cm, MeanSD)
Length of menstruation cycle (days, MeanSD)

25.87 3.68

Table 2: Comparison of primary dysmenorrhea characteristics between experimental and control groups based on Chi-square analy
Variables
Type of drugs consumption
Volume of bleeding (quality)
Onset of menstruation pain

1248

Pre-test
Post-test
Pre-test
Post-test
Pre-test
Post-test

df

2.9
8.1
4.604
15.21
2.74
3.85

4
4
2
3
3
3

World Appl. Sci. J., 17 (10): 1246-1252, 2012

Table 3: Comparison of primary dysmenorrhea characteristics of experimental and control groups based on independent t-test analysis
Variables

Mean Diff.

df

p-value

Number of drugs consumed

Pre-test

0.16

48

0.315

0.754

Rate of bleeding

Post-test
Pre-test

0.73
0.96

48
48

1.315
1.58

0.175
0.12

Length of menstruation pain

Post-test
Pre-test

1.92
0.17

48
48

4.18
-0.39

0.005
0.69

Volume of bleeding(quantity)

Post-test
Pre-test

1.74
0.18

48
48

3.28
0.33

0.001
0. 75

Post-test

0.50

48

-0.35

0.72

Table 4: Comparison of primary dysmenorrhea characteristics between pre and post-test of experimental group based on dependent t-test analysis
Variables

Mean diff.

df

p-value

Number of drugs consumed

Rate of bleeding

1.040
0.84

24
24

2.68
3.05

0.01
0.005

Length of menstruation pain(days)

Volume of bleeding(quantity/CC)

0.6
2

24
24

2.05
2.87

0.05
0.008

Table 5: Comparison of primary dysmenorrheal pain between experimental and control groups assessed by Mc Gills questionnaire based on independent ttest analysis
Variables

Mean diff.

df

p-value

Pain Rate Index (PRI)

Visual Analog Scale(VAS)

-6.56
-0.84

48
48

-6.56
-1.97

0.01
0.05

Present Pain Intensity (PPI)

Total Pain

-1.04
8.37

48
48

-4.9
-9.21

0.05
0.01

The results of the study

When comparing the length of menstruation pain it was also showed that the total
found that this item is significantly decreased in amount of pain reduction
was significantly more in
experimental group (p=0.05) (Table 4).
group
The results also showed that the difference between theexperimental
length of menstruation pain of experimental and control (p=0.01) in comparison
with control group (Table
groups was significant (p=0.001) (Table 3).
5).
When comparing the volume of bleeding, there was no
DISCUSSION
significant difference between data of control group in pre
AND
and post- test (p=0.22), but this difference was significant in
CONCLUSION
experimental group (p=0.008) (Table 4). When the findings
of two groups regarding the volume of bleeding was
The main findings of
compared, no significant difference was observed (p=0.72)
this
study indicated that
(Table 3).
physical
activity had a
In regard to Pain Rate Index (PRI), the findings showed
positive impact on the most
no significant difference in pre and post-test of control group
of primary dysmenorrhea
(p=0.14), but this difference was significant comparing pre
symptoms in such a way
and post-test of experimental group (p=0.01). PRI was also
that
type
of
drugs
significantly different between experimental and control consumption changed from
groups (p=0.01) (Table 5).
Ibuprofen
to
Findings from Visual Analog Scale (VAS) and the
Acetaminophen (p 0.05).
Present Pain Intensity (PPI) which assess the total and Volume and rate of bleeding
present intensity of pain, showed that significant reduction
decreased (p 0.002, p
was found between experimental and control groups 0.05).
Length
of
(p=0.05) in both cases in favor of experimental group (Table menstruation pain reduced
5).
(p 0.05), number of drugs
consumed reduced, but not

significantly and finally

Pain Rate Index and Total
and Present Pain Intensity
reduced (p 0.01, p 0.05).
Regarding type of
drugs used by subjects prior
to study, it was found that
experimental
group
participating in physical
activity protocol replaced
Acetaminophen
with
Ibuprofen which is a strong
pain relief meaning that
physical activity resulted in
more tolerable menstruation
thereafter. This finding is in
line with Thirza et al. [17].
Due to the fact that painful
menstruation may limit
social activities and may
also lead to school missing
[15, 17, 18, 21, 37] young
girls try to use strong drugs
such as Ibuprofen to
prevent these problems.

1249

World Appl. Sci. J., 17 (10): 1246-1252, 2012

studied, our
Our results
findings indicated that
volume
of
also
bleeding was
showed
that
thesignificantly
number oflowered
in
drugs
postconsumed exercise
by
group.
In
experiment addition to
al
groupthe evidence
decreased that
comparing experimental
pre
andgroup
had
post-test lower volume
data. Thisof bleeding
result is inafter 8 weeks
agreement of physical
with
activity, it is
Shavandi suggested
et al. [19],that physical
Abbaspour activity
et al. [38]might reduce,
and
in
some
Shahrjerdi degree, the
and Sheikhmagnitude of
Hoseini
bleeding,
[29]. Thebecause
it
reasons formay lead to a
this
better
reduction hormonal
might bebalance. On
due to thatthe
other
when
hand,
menstruati evidence
on is veryshows
that
painful, theanti diuretic
suffers usehormone is
more drugsactive during
and preferphysical
to
takeactivity and
antithe
inflammatovasoconstrict
ry
typeion action of
such
asthis hormone
Ibuprophenand
or
othervariations in
strong
pelvic blood
drugs.
flow
may
When influence the
volume ofsynthesis or
bleeding breakdown of
was

prostaglandin
s [1]. This
finding is not
in line with
the
results
obtained
from
Shavandi et
al.
[19]
which
indicated that
there is no
change in the
volume
of
bleeding in
post-exercise
young girls.
Our
results also
depicted that
rate
of
bleeding
based on the
number
of
pads changed
per day, was
reduced
significantly
in
experimental
group. This
finding
supports the
notion that
doing
exercise may
reduce
the
volume
of
bleeding and
suggested
that exercise
may actually
be associated
with higher
level
of
menstrual
discomfort.
Regardi
ng the length
of
menstruation
pain,
the
finding
of

this studyon pain from

showed
uterine
that
themuscle. This
length ofresult is not
menstruati in agreement
on
painwith
was
Kermanshahi
reduced et al. [39]
significantl which might
y in ourbe due to age
experiment of subjects
al
groupand training
after
8conditions.
weeks
Our
training.
findings
in
This
finding isassociation
supported with intensity
of
primary
by
previous dysmenorrhe
studies
a
pain
carried outobtained
by
from
Shavandi McGills
et al. [19],questionnaire
Iorno et al.using
Pain
[28]
andRate Index
Shahrjerdi and
Visual
and SheikhAnalog Scale
Hoseini
for assessing
[29]. Onethe total and
likely
present pain
mechanism intensity
for
revealed that
reducing the intensity
the lengthof pain was
of
reduced
in
menstruati experimental
on pain ingroup after
postcompleting
exercise
training
group
is
protocol.
that
Even though,
physical
a
activity
may help a
faster
transfer of
vast
products
and
prostaglan
dins as a
root
of
menstruati

number
of
studies have
failed to find
any relation
between
intensity of
primary
dysmenorrhe
a pain and
physical
activity [31,
32],
other
studies such
as Smith et
al.
[27],
Iorno et al.
[28],
Abbaspour et
al.
[38],
Shahrjerdi
and Sheikh
Hoseini [29]
and Izzo and
Labriola [30]
support our
results. One
possible
mechanism
explaining
the positive
effect
of
physical
activity
on
intensity of
primary
dysmenorrhe
a pain is
associated
with stress. It
has
been
accepted that
exercise
is
used as a
mean
of
moderating
stress.
Menstrual
pain may be
resulted from
increased
contraction
of
uterine
muscle which
is innervated
by
the

sympatheti may enhance

c nervousthe
pain
system.
threshold.
Stress
is
In
supposed
to increaseconclusion,
the results of
the
sympatheti the present
c activitystudy
which maysuggested
lead to thethat
increase ofperforming
menstrual regular
pain
byphysical
enhancing activity
reduced the
the
intensity ofprimary
dysmenorrhe
uterine
contraction a symptoms.
. So, due toAs a factor it
been
the
facthas
accepted
that
that
in
developing
exercise
reduce andcountries
moderate such as Iran,
stress, theparticipating
regular
sympatheti in
c activityphysical
may
beactivity
decreased. programs are
by
Thereby, limited
intensity ofsocial,
menstrual cultural and
pain andreligious
factors.
other
Therefore,
related
of
symptoms because
high
may
be
reduced aspotential
benefits
of
well.
Another physical
possible activity and
dilemma inexercise in
this respectreducing the
is
that,detrimental
of
because effects
primary
doing
physical dysmenorrhe
a symptoms,
activity
leads to theyoung girls
release ofare
endorphins recommende
which ared to take part
such
produced in
by
brainphysical

activity
programs in
order to help
them
to
decrease the
negative
impact
of
these
symptoms on
their
academic,
social
and
even personal
life.

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RENC
ES

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Warren,
M.P. and
J. Locke
Rebecca,
1999.
What is
the
effect of
exercise
on
primary
dysmeno
rrheal?
WJSM,
33: 227.

2.

Kennedy
,
S.,
1997.
Primary
dysmeno
rrhea.
Lancet,

19: 111
6.

3.

Harel,
Z., 2006.
Dysmen
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1
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group counseling program

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