One study of a 30-minute walk/jog regimen 3 days per week found a benefit for dysmenorrhoea,33 although it was not eligible

for this review because the outcome was a composite symptom score. Although the analgesic benefits of heat, TENS, and yoga were statistically significant, the evidence for each intervention came with minor caveats. All estimates were provided by only a single trial, the confidence interval did not exclude the possibility that the effect was clinically trivial, and the quality of the trial was low. However, these interventions have relatively low costs and risks, so some women with dysmenorrhoea may wish to try them despite these uncertainties. This systematic review has several strengths. Two reviewers independently performed study selection, quality assessment, and data

extraction. Statistically significant benefits were identified GSK126 purchase for several interventions. Important insights into placebo effects were identified by the separation of sham-controlled trials from trials with no-treatment controls. A possible limitation is that the search did not include grey literature, which is more likely to report no statistical significance between groups.34 and 35 This may temper the positive nature of the evidence of efficacy reported in this review. Although there was also potential for language bias, the 13 non-English, non-Swedish articles were excluded for other reasons during the abstract screening. Therefore, ABT 199 language bias was not a limitation. The average PEDro score was within the range we nominated

as high quality, and the rarely achieved blinding items on the PEDro scale were met, with blinding of participants (5 trials), assessors (4 trials), and therapists (2 trials). In conclusion, this review identified that heat, TENS, and yoga can each significantly reduce the pain of dysmenorrhoea. The magnitude of these effects may or may not be Tryptophan synthase clinically worthwhile, but as the costs and risks of these interventions are low, they could be considered for clinical use. The review also identified moderate-grade evidence to support the use of acupuncture and acupressure, although this may be due to a placebo effect. Although one study identified a part from spinal manipulation, the weight of evidence was that it was not effective. Data from further research on these and other interventions, such as whole body exercise, could help to provide more precise estimates of the average effects of physiotherapy interventions for dysmenorrhoea. What is already known on this topic: Many women of reproductive age experience dysmenorrhea. Although medications are available to treat the pain, these produce side effects or incomplete pain relief in a substantial proportion of women with dysmenorrhea. Several physiotherapy interventions have been investigated as non-pharmacological interventions for dysmenorrhea.