Non-pharmacological therapies for primary dysmenorrhea: A comparative efficacy

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Created On: 30/07/2025

This network meta-analysis (NMA) determined the efficiency of non-pharmacological therapies (NPTs) in relieving symptoms of primary dysmenorrhea (PD) and to compare the efficacy of different NPT interventions.

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Key take away

Moxibustion, acupuncture, and auricular point therapy are the most effective non-pharmacological treatments for relieving primary dysmenorrhea symptoms.

Background

Method

A comprehensive search was carried out across 7 databases for randomized controlled trials (RCTs) assessing NPTs for PD. Eligible studies included RCTs that reported outcomes using the visual analog scale (VAS), Cox Menstrual Symptom Scale (CMSS), or response rates. Study quality was appraised via the Cochrane risk of bias tool. Both pairwise and network meta-analyses were carried out using RevMan (version 5.4), Stata (version 15.0), and WinBUGS. The Surface Under the Cumulative Ranking curve (SUCRA) was used for ranking the effectiveness of the interventions.

Result

In total, 16 RCTs encompassing 8 types of NPTs were included. In the pairwise meta-analyses, moxibustion showed greater effectiveness compared to acupuncture (standardized mean difference [SMD]: -0.591), acupuncture outperformed placebo (SMD: -0.948), and yoga was more effective than no treatment (SMD: 2.634). The NMA showed that, compared to no treatment, acupuncture (SMD: -4.81), auricular therapy (SMD: -4.36), yoga (SMD: -2.12), moxibustion (SMD: 5.54), and placebo (SMD: 3.10) significantly reduced VAS scores.

Compared to placebo, acupressure (SMD: 2.49), moxibustion (SMD: -2.45), and acupuncture (SMD: -1.72) were also more effective. According to SUCRA rankings, moxibustion, acupuncture, and auricular point therapy ranked among the most effective treatments across multiple outcome measures.

Conclusion

Among the non-pharmacological treatments assessed, acupuncture, moxibustion, and auricular therapy appear to offer the most effective symptom relief for primary dysmenorrhea. Further high-quality RCTs are warranted to refine treatment protocols and strengthen the evidence base.