Empowering Women Through Movement: A Randomized Controlled Trial Comparing the Effects of Strengthening Exercises and Tai Chi on Menstrual Symptoms, Pain, and Psychological Outcomes in Primary Dysmenorrhea.

BACKGROUND AND PURPOSE: Primary dysmenorrhea affects women's quality of life through menstrual pain and associated psychological distress. While pharmacological treatments are available, concerns over side effects highlight the need to explore non-pharmacological approaches. This study compared the short-term effects of strengthening exercises and Tai Chi on menstrual symptoms, pain, and self-reported stress, anxiety, and depression in women with primary dysmenorrhea.

METHODS

This randomized controlled trial included 90 women aged 18-25 years with primary dysmenorrhea. Participants were randomly assigned to strengthening exercises, Tai Chi, or a control group (n = 30 per group). Interventions were conducted for 4 weeks with five sessions per week. The primary outcome was menstrual symptom severity measured using the Menstrual Symptom Questionnaire (MSQ). Pain intensity and emotional distress were assessed using a 0-10 visual analog scale (VAS) and the Depression, Anxiety, and Stress Scale (DASS-21), respectively. Baseline-adjusted repeated-measures ANCOVA was used to test group × time interactions with baseline values included as covariates to account for baseline variability between groups. Post hoc analysis with Holm adjustment was performed where appropriate.

RESULTS

Significant baseline-adjusted group × time interactions were observed for the primary outcome, menstrual symptoms as well as pain intensity, stress, anxiety, and depression (all p < 0.001), with both intervention groups demonstrating greater short-term reductions than the control group. Strengthening exercises were associated with comparatively greater reductions in pain intensity (mean difference = 3.43, p < 0.001) and menstrual symptoms (mean difference = 26.56, p < 0.001), relative to Tai Chi. Tai Chi demonstrated comparatively larger short-term improvements in stress (mean difference = 9.04, p < 0.001) and anxiety scores (mean difference = 6.51, p < 0.001), relative to strengthening exercises. Both interventions significantly reduced depression scores compared with control (p < 0.001).

DISCUSSION: Strengthening exercises and Tai Chi were associated with short-term changes in symptoms and self-reported mental health scores over 4 weeks; however, given the short intervention period, reliance on self-reported outcomes, and greater contextual exposure in the supervised intervention groups compared with the control group, findings should be interpreted cautiously as context-dependent effects rather than definitive evidence of specific therapeutic mechanisms. Replication using attention-matched comparators and longer follow-up is needed to clarify the durability and specificity of effects.

TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI): CTRI/2022/06/043223.