Pulsed Electromagnetic Field Versus Active Stretching Exercises on Primary Dysmenorrhoea Randomized Controlled Study

Dysmenorrhea is a menstrual disorder characterized by suprapubic cramping of uterine origin and pain occurring a few hours before or after the onset of menstruation. Primary dysmenorrhea begins when young girls experience the first menstrual adulatory cycles, and its prevalence increases during adolescence (15-17 years) and reaches its highest at 20-24 years and decreases progressively thereafter. Primary dysmenorrhea is characterized by abdominal pain, beginning a few hours before and continuing up to 12-72 hours, and is like the delivery of pains along with cramps in the lower abdomen radiating toward the inner side of the thighs. Half of such cases experience systemic symptoms, such as nausea, vomiting, diarrhea, fatigue, irritability, and dizziness.

Primary dysmenorrhea occurs in up to 50% of menstruating females and causes significant disruption in quality of life.4 Menstrual cramps are associated with nausea in 55% and with vomiting in 24%.5 The severity of symptoms positively correlates with the onset of ovulatory cycles and with increased duration and amount of menstrual flow.6 A physiological reason for dysmenorrhea is the production of uterine prostaglandins. During endometrial sloughing, endometrial cells release prostaglandins as menstruation begins. Prostaglandins stimulate myometrial contractions and ischemia.7 During the recent 20-30 years, regular exercise and physical activities have been introduced as effective methods for prevention and treatment of dysmenorrhea.8Exercising affects the levels of steroid hormones in the blood circulation of women in reproductive ages.9 Moreover, the elevation of the endorphin hormone leads to an increase in pain threshold.10 Pulsed electromagnetic field (PEMF) is an efficient modality used in physical therapy field for treatment of many pathological cases; PEMF has strong analgesic effect, anti-inflammatory effect, and a vasodilatation effect, as well as decreasing edema.11 PEMF has electric energy and generates series of magnetic pulses through the tissues, and each magnetic pulse induces a tiny electrical signal that stimulates cellular repair, suppresses inflammatory responses, alleviates pain, and increases range of motion.12 PEMF are effective in relieving pain of primary dysmenorrhea by decreasing prostaglandin levels in the blood, resulting in fewer vigorous uterine contractions and less discomfort.

A range of treatment options have been examined in the literature, including heat application, pelvic floor and aerobic exercises, low-level laser therapy, and pulsed electromagnetic field, with several producing effective outcomes. These interventions were assumed to prevent or minimize menstrual pain by increasing pelvic circulation, decreasing uterine contractions, and activating the release of endorphins and serotonin, but there is still no evidence for the best type of modality chosen.

Additional researches are needed to clarify difference between effect of Pulsed electromagnetic field (PEMF) and active stretching on pain intensity level and menstrual symptoms in females with primary dysmenorrhea.

Inclusion criteria

• Young female students suffering from primary dysmenorrhea
• regular menstrual cycle diagnosed by gynecologist
• BMI ranging from 18.5 to 25 kg/ m 2.
• Pain intensity is 4 or above in VAS.
• Their ages ranged from 18- 24 years old-

Exclusion criteria

• Girls with irregular or infrequent menstrual cycles, using pharmacological or non-pharmacological methods for pain relief during the study
• suffering from pelvic pathology