Effects of Lumbopelvic Exercise-based Interventions on Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION

Dysmenorrhea, with a prevalence of 45% to 95% globally, is the most common gynecologic symptom among women. This systematic review and meta-analysis aimed to evaluate the effectiveness of lumbopelvic exercise-based interventions on primary dysmenorrhea.

METHODS

Randomized clinical trials comparing lumbopelvic exercise interventions against passive control groups were included. The Web of Science, PubMed, and Scopus databases were searched from their inception to April 25, 2025. Two authors independently selected studies, extracted data, and assessed quality, with a third author ensuring accuracy. The methodological quality of the included trials was evaluated using the Physiotherapy Evidence Database (PEDro) checklist. Meta-analyses were conducted in Comprehensive Meta-Analysis (version 3.0), calculating pooled effect sizes as Hedges' g with 95% CIs using a random-effects model due to substantial heterogeneity (I2 = 92.88%). Publication bias was assessed via funnel plots and Egger's test, with sensitivity analyses performed to verify the robustness of the results.

RESULTS

Fourteen randomized clinical trials (n = 1078) were included in the systematic review, with 13 in the meta-analysis. Lumbopelvic interventions significantly reduced pain intensity (ES, -1.50; 95% CI, -2.06 to -.94; P = .001). Subgroup analysis showed a significant effect for active interventions (ES, -1.78; 95% CI, -2.47 to -1.09, P = .001) but not for passive interventions (ES, -.93; 95% CI, -1.91 to .05, P = .06), with no significant difference between them (Q-between = 1.65, P = .19). The nonsignificant result for passive interventions was not robust because a sensitivity analysis excluding one study yielded a significant effect (ES, -1.34; 95% CI, -1.99 to -.69, P = .001), suggesting efficacy is specific to the modality used.

DISCUSSION: Lumbopelvic exercises reduce dysmenorrhea pain. Both active and passive methods are beneficial, allowing midwives and clinicians to customize treatment. However, findings should be viewed cautiously due to heterogeneity and limited evidence for passive interventions.