Osteopathic Treatment Helps with Reducing Pain of Primary Dysmenorrhea
Quantitative Study (Within-subject design method)

Zvonka Tomasovic, D.O.

Association Indigo, 12 Barciceva Street, Zagreb, Croatia



Dysmenorrhoea is a term that denotes the convulsive pain during menstruation and is one of the most common problems in women during reproductive age. There are many symptoms such as pain in the lower abdomen that extends to the loin, thighs and hips (from mild to strong intensity), and may be accompanied by nausea, headache, vomiting, diarrhea, or pain in the body.


The primary research objective was to determine whether and how well the osteopathic treatment helped to decrease the pain, to enhance the primary respiratory mechanism (PRM) of the uterus and the quality of life of women suffering from primary dysmenorrhea.

The researcher’s goal was to show osteopathy as a complementary method for the treatment of gynecological problems.



Study Design:

The quantitative type of research, “within subject design” was used for this research, which means that the same group of participants was a control and experimental group in itself. The research consisted of 16 women suffering from primary dysmenorrhea according to a gynaecological exam. Each participant received five 60-minute treatments within two menstrual cycles. Osteopathic treatment was focused on musculoskeletal, cranial and visceral osteopathy, the work on the fascia and the general osteopathic technique.

Outcome Measures:

• PRM of the uterus (osteopathic sensory test)

• The quality of life (WHOQOL-Bref questionnaire)

• Pain levels (enhanced VAS pain measurement scale)

An osteopathic practitioner carried out two initial and two final PRM assessments of the uterus, using an osteopathic sensory test. The quality of life was assessed in the same way by using the WHOQOL-Bref questionnaire. The practitioner was well trained to perform the tests which were blind at all stages. The participants monitored their pain levels for two menstrual cycles before the first treatment and for additional two cycles following the end of the final treatment. To monitor the pain levels, the enhanced VAS pain measurement scale was used.

Inclusion Criteria:

Suffering from Primary Dysmenorrhea based on Gynecological diagnosis, 6 months without hormonal therapy, regular menstrual cycle.

Exclusion Criteria:

Diagnosis of fibroids, diagnosis of endometriosis, diseases that requires medical therapy, a surgical procedure, pregnancy, using analgesics during pain measurement or receiving similar treatments.



Pain: Statistical analysis and post-hoc test to compare mean scores between individual measurements showed that the average estimate of the pain level did not differ significantly between the first and second measurements nor between the third and fourth measurements (p>0.05), but there was a noticeable difference in the pain reduction between the first two measurements compared to the last two (p<0.05). To sum up, the results of this study showed a large decrease of pain (p<0.05) in women with primary dysmenorrhea.


PRM of uterus (movement/vitality): The results of this study indicated that the movement and the vitality within the PRM of the uterus improved significantly. Before the beginning of the treatment, most of the participants indicated very low PRM levels, whereas, after the treatment, all of the test subjects showed a substantial improvement to movement and vitality of their uteruses. This proves that, from the osteopathic point of view, all obstacles to good PRM were removed.



Quality of Life: Descriptive statistics based on the WHOQOL-Bref measurement results, in the domains of physical and psychological health, social relationships and environment, showed that the best improvement was realised in the domain of psychological health quality. The domains of physical health quality and social relationships showed some improvement. The environmental domain showed a decrease in the quality of life.

This can be explained by the fact that most of the women stated that after every performed test they became more aware of their condition and were able to give more accurate answers to test questions.




This study shows that, in women suffering from primary dysmenorrhea, the osteopathic treatment noticeably reduces pain, significantly improves the PRM of the uterus and positively affects the quality of life.

In spite of the small number of participants, a significant improvement in the pain reduction, which did not increase after a few months, indicates that osteopathy can be considered as a complementary approach to primary dysmenorrhea treatment.



Extract from discussion

As we expected, in this research, we found some similarities with the observed participants:

- 70% of participants are women who have not given birth

- 75% of participants regularly take pills to reduce the pain

- 100% of participant have pain that lasts for 1-2 days and start on first day of their menstruation cycle or day before

* * *

Medical questionnaire, which the participants filled in before treatment shows the following characteristics of the participants:

- 65% of women have low blood pressure

- 50% of participants have digestive problems

- 50% of participants have a history of concussion

- 50% of women suffer from headaches

- 45% of participants have a history of injury or pain of left ankle, left foot or left knee

- 30 % of participants experienced a car accident

- 20% of participants have a history of head trauma in the fall

- 20% of participants have circulatory disorders

* * *

According to the schematic diagram for the location of pain during menstrual bleeding, participants indicated the following:

- 100% of participants have pain in the lower abdomen

- 80% of participants have pain in the lower back and hips

- 50% of participants have pain in the lower limbs

- 30% of participants have nausea

- 20% of participants have headaches

* * *

The following osteopathic lesions were found during the osteopathic examination and treatment of the participants:

- 100% of women had significantly reduced cranial rhythm and distinctive cranial compaction

- 60% of women had significantly spinal dura mater tension

- 60% of women had thoracic diaphragm in tension

- 85% of women had a lesion of coccyx

- 70% of women had a compaction of sacrum

- 70% of women had pelvic bone lesions (iliac, pubis and sacrum)

- 65% of women had a problem with SI joint

- 36% of women had an osteopathic spinal lesion

- 50% of women had a lesion of the left limb, which has often been in the UR. It is interesting that the same percentage of women said that they had the injury of left ankle or foot

- 85% of women had an osteopathic lesion in the left kidney (A possible reason for this lesion and its connection with primary dysmenorrhea can be the fact that the vena gonadica sinistra flows into the left renal vein, which flows into the vena cava)

- 100% of women had very low PRM of uterus (in the sense of movement and vitality but also the feeling of hardness and lack of elasticity during palpation)

- 20% of women had ovarian lesion

- 30% of women had stomach lesion

- 30% of women had liver lesions

* * *

At the end of all treatments, participants reported satisfaction with the following improvements:

- complete absence or reduction of spasms

- reducing the symptoms of PMS, or a shorter duration of symptoms of PMS

- balanced cycles

- reduced the need for taking pain killers

- lower abdominal strain

- lightness in the legs

- return of sexual desire

- pregnancy (We had one participant who became pregnant after a long time tried unsuccessfully to get pregnant. This participant was not taken into account in the statistical analysis.)