How can osteopathy, physiotherapy, nutrition and psychology help reduce menstrual pain? What solutions exist to relieve dysmenorrhea and improve quality of life for affected women?

Dysmenorrhea, also known as algomenorrhea, is a painful syndrome of uterine origin, manifesting as abdominal cramps during the menstrual period. These cramps are often described as “menstrual cramps”. The pain may extend to the lumbar region and, in some cases, be accompanied by other symptoms such as headaches, vomiting or diarrhea.

Dysmenorrhea can begin before or during menstruation, though it most often occurs around the second day of the cycle, gradually intensifying before subsiding. It is very common and affects more than half of women of reproductive age, with a prevalence of nearly 73% among adolescents.

Many women experience such intense pain that they are bedridden during their periods. About one in ten women misses 1 to 3 days of work each menstrual cycle. Spain became in 2023 the first European country to introduce a menstrual leave for women with disabling menstrual pain.

However, during the first year of the law’s validity only 1,418 days of absence were recorded, even though the Ministry of Equality estimates that nearly 60,000 women are affected — equivalent to about 1% of the six-million working women.

The low number of recorded sick days appears linked to fear of workplace discrimination and under-recognition of the issue by health professionals, many of whom may lack sufficient training to diagnose menstrual pain disorders.

There are several types of dysmenorrhea, classically divided into two categories:

This accounts for about three-quarters of cases and typically appears in adolescence, coinciding with the onset of menstruation.

The menstrual pain in these cases is due to insufficient oxygenation of uterine tissues, triggered by an hypercontractility of the myometrium (increased frequency, intensity or duration of uterine muscle contractions) and vasoconstriction of the uterine blood vessels.

These phenomena result from an excess of certain hormones, especially prostaglandins, which stimulate and provoke uterine contractions.

This form arises later in life and is caused by an underlying pathology — most often endometriosis, but also adenomyosis, uterine fibroids or pelvic inflammation.

It may be accompanied by inter-menstrual bleeding (metrorrhagia), and pain can also occur outside of menstrual periods.

In all cases, it is essential to consult a physician to rule out a serious pathology.

Anti-inflammatory drugs (NSAIDs) are usually the first treatment option prescribed by doctors due to their inhibitory effect on prostaglandins. In addition, analgesics or antispasmodics may also be recommended to provide temporary relief of symptoms.

Applying a heat source (such as a hot-water bottle or heating patch) is also a simple and accessible measure to reduce menstrual pain.

However, in some cases, applying cold may be recommended. Although heat is more common, cold can help relieve dysmenorrhea thanks to its anaesthetic effect. By inducing vasoconstriction (narrowing of blood vessels), it can help reduce inflammation by decreasing local blood circulation.

It’s also important to note that excessive bleeding may be temporarily reduced when using cold. However, in this latter case, it should only be a one-time measure, and medical follow-up is required, as with dysmenorrhea.

The genital organs, via their various ligamentous attachments, are connected directly or indirectly to surrounding bony structures such as the pelvis and spine, particularly in the lumbar region.

One of osteopathy’s principles states that “structure governs function and vice versa”. This means that if the musculoskeletal system (the container) doesn’t function properly, the genital system (the content) may be affected — and vice versa.

The aim of osteopathic care is to restore proper mobility of the joints and tissues in the abdominopelvic region, thereby ensuring optimal vascularisation and innervation of the organs present in this zone, including the genital system.

Several studies have demonstrated the effectiveness of osteopathy in reducing catamenial low back pain (menstrual-related lower back pain), which falls within the scope of premenstrual syndrome.

For example, a study conducted in Germany among 60 women with primary dysmenorrhea showed that in the group treated by osteopathy there was a reduction in menstrual pain of nearly 60%, compared to only 2% in the control group.

Patients also reported significant improvements in quality of life and a reduction in the use of medications.

Additionally, further research suggests that abdominal massage may help relieve menstrual pain, shorten the duration of periods and reduce excessive menstrual bleeding. More studies are still needed to fully understand the mechanism through which abdominal massage influences these symptoms.

Physiotherapy treatment for dysmenorrhea goes beyond simple pain relief; it focuses not only on symptom control but also on addressing the underlying causes of menstrual pain.

The process begins with a comprehensive assessment, in which the physiotherapist evaluates posture, pelvic and spinal mobility, and muscle tension — especially in the pelvic floor region.

• Myofascial release: to relax deep tissues tense around the uterus and lower back.
• Gentle mobilisation of the pelvis and spine to release accumulated tensions.
• Diaphragmatic breathing exercises, which promote relaxation and improve tissue oxygenation, thereby contributing to reduced inflammation and pain.

In rehabilitation, strengthening the trunk (core) and pelvic floor muscles is essential — these muscles support the lower back and pelvic organs, and an imbalance or weakness can exacerbate menstrual pain.

Additionally, specific stretching of the abdomen, hips and thighs is practiced to relieve tension accumulated during the menstrual cycle.

The physiotherapist may apply internal manual therapy to relax pelvic floor muscles if they are involved in the pain.

These techniques are often complemented by TENS (transcutaneous electrical nerve stimulation) which interrupts pain signals sent to the brain and can be used at home under supervision for immediate relief.

Finally, education is a cornerstone of the physiotherapist’s approach. Time is dedicated to explaining how the menstrual cycle works, the causes of pain and the impact of certain habits or behaviours.

This educational approach enables the patient to better understand her body, play an active role in managing her symptoms and strengthen her autonomy.

In summary, physiotherapy for dysmenorrhea is comprehensive, individualized and preventative, combining immediate relief, functional improvement and self-management strategies.

Diet plays a central role in regulating inflammation and hormonal balance, both key elements in the intensity and onset of menstrual pain. Adopting an appropriate diet can help reduce symptom severity and improve overall comfort during the cycle.

• Omega-3 fatty acids (found in fatty fish such as salmon, sardines and mackerel, flax seeds, walnuts) have known anti-inflammatory effects and help regulate prostaglandins, which are responsible for uterine contractions.
• Magnesium (abundant in almonds, seeds, leafy greens and legumes) helps relax muscles and reduce spasms; when combined with vitamin B6 it can also help decrease irritability and fatigue linked to the cycle.
• Antioxidants (vitamins C and E, flavonoids) present in berries, citrus fruits and green vegetables support hormonal balance and combat oxidative stress.
• Fiber: by improving intestinal transit, it helps regulate excess circulating oestrogens, which can mitigate certain menstrual symptoms.

• Refined sugars and ultra-processed foods: they favour inflammation and hormonal imbalance.
• Caffeine and alcohol: they may worsen fluid retention, intensify pain and disrupt sleep, reducing recovery capacity during menstruation.
• Excess high-fat dairy products: in some women, they may enhance inflammatory processes.

Every woman has different requirements. A nutritionist specialised in hormonal health can help establish an adapted, anti-inflammatory and sustainable dietary plan — the goal being not a strict diet but a balanced, hormone-supportive lifestyle.

Menstrual pain does not only affect the body: it also has significant emotional and psychological impact. The anticipation of pain may increase anxiety, stress or even lower self-esteem. In some cases, dysmenorrhea can lead to social or professional isolation, amplifying the suffering.

Chronic stress activates the sympathetic nervous system and triggers elevated cortisol secretion, which in turn heightens pain perception and may intensify uterine contractions. Emotional fatigue reduces resilience during menstrual cycles.

• Cognitive Behavioural Therapy (CBT): helps identify negative thoughts related to pain and replace them with more adaptive strategies.
• Mindfulness: improves pain tolerance by enabling the individual to accept sensations without judgment and reduce hyper-focus on symptoms.
• Relaxation and breathing techniques (heart-rate coherence, diaphragmatic breathing, guided meditation): reduce nervous tension and promote better sleep, which is essential for menstrual comfort.

Dysmenorrhea may generate feelings of isolation. Participating in support groups or receiving psychological follow-up allows sharing of experiences and finding adapted solutions.

A psychologist specialising in women’s health can effectively complement medical and paramedical approaches, reinforcing psychological resilience in face of symptoms.

Menstrual pain can have a significant impact on quality of life, but a multidisciplinary approach — combining medical treatment, osteopathy, physiotherapy, nutrition and psychology — offers concrete solutions to reduce symptoms, improve well-being and empower women in managing their health.

Menstrual pain can greatly impact women’s quality of life, yet with proper treatment and an integrative approach, symptoms can be reduced and overall well-being improved.

This blog article is not intended to generate new knowledge; its writing is based on the review of scientific publications, blog articles, and other writings.