Awareness and Experiences of Physiotherapy for Managing Primary Dysmenorrhea Among Women in Saudi Arabia: A Cross-Sectional Study

Abstract

Background/Objectives: Primary dysmenorrhea is a common menstrual condition that significantly affects women’s daily functioning and quality of life. Although physiotherapy has been shown to reduce menstrual pain, the awareness of these methods in Saudi Arabia remains unclear. This study aimed to assess women’s awareness and experiences of physiotherapy methods for managing primary dysmenorrhea in Saudi Arabia. Methods: A cross-sectional online survey was conducted among women living in SA between 16 and 28 February 2024. The questionnaire collected information on six sections including on sociodemographic characteristics, menstrual history and pain severity, work-related impact, pain-management practices, healthcare utilisation, and awareness and use of physiotherapy modalities. Convenience sampling was employed, and participation was voluntary and anonymous. Descriptive data analysis was performed using SPSS software. Results: A total of 431 women participated; most were Saudis (91.9%) and aged 18–24 years (43.2%). Primary dysmenorrhea was reported by 86.5% of participants. More than half (58%) had used at least one physiotherapy-related method, mainly heat, massage, or exercise, and 55.2% considered these methods effective. However, most relied on basic home strategies rather than structured physiotherapy interventions. Additionally, 60.8% expressed willingness to use physiotherapy in the future. Conclusions: Despite the frequent use of simple home-based methods, structured physiotherapy interventions remain underutilised. Increasing public education, improving access to physiotherapy services, and integrating self-management guidance and telerehabilitation into women’s health programmes may enhance menstrual pain management and overall quality of life.

1. Introduction

Dysmenorrhea is a menstrual condition characterised by painful cramps in the uterus that occur during menstruation [1]. It is one of the most prevalent reasons for pelvic pain in adolescent and adult women. The pain starts in the lower abdominal area and may radiate to the back and thighs [1]. A systematic review and meta-analysis of over 21,000 young women from 38 countries reported a global prevalence of primary dysmenorrhea of approximately 71.1% [2]. Primary dysmenorrhea (PD) develops without any underlying pelvic disease, while secondary dysmenorrhea results from a specific pelvic disorder or another medical condition and represents about 10% of all cases [3]. Although it is not a life-threatening condition, PD can negatively reduce quality of life and, in severe instances, result in disability and functional restrictions [4].

Women with dysmenorrhea experience significantly lower scores in physical and social functioning, role performance, bodily pain, and general health perception, leading to an overall reduced quality of life during menstruation [5]. This burden extends to academic performance, with approximately one in five (20.1%) reporting school or university absences due to pain [6]. Beyond physical and academic effects, psychological changes are notable as women with primary dysmenorrhea show increased levels of anxiety and depressive symptoms during the menstrual phase compared with controls [7]. This multidimensional burden also involves sleep, with dysmenorrhea linked to poorer sleep quality [7,8]. Therefore, measures to reduce, eliminate, or treat this dysmenorrheal pain should be taken.

Management of primary dysmenorrhea typically involves a combination of pharmacological and non-pharmacological approaches aimed at alleviating pain and improving quality of life [3,5]. First-line medical treatments include non-steroidal anti-inflammatory drugs (NSAIDs), which reduce prostaglandin synthesis and are widely regarded as the most effective pharmacological option [3]. Hormonal therapies, such as combined oral contraceptives, progestin, and intrauterine devices releasing levonorgestrel, are also commonly prescribed to regulate menstrual cycles and decrease uterine contractions [3]. In cases of severe or refractory pain, other options may include gonadotropin-releasing hormone analogues or surgical interventions, though these are rarely indicated for primary dysmenorrhea [3,5]. Alongside these medical strategies, non-pharmacological interventions, particularly physiotherapy, are gaining attention as safe and effective alternatives. Physiotherapy modalities such as aerobic exercise, stretching, yoga, massage, and electrotherapy aim to reduce pain intensity, improve pelvic blood flow, and promote relaxation, offering a holistic approach to symptom management [9].

In Saudi Arabia (SA), the prevalence of dysmenorrhea was found to be 92.3% (1107 women) for non-pathological (primary) cases and 7.7% (92 women) for pathological (secondary) cases [10]. Among women in SA who reported having dysmenorrhea, many used medications for pain relief (64.7%) and sought help or advice from others, such as doctors, teachers or friends [11]. One study reported that engaging in regular physical exercise helped reduce menstrual pain, with 260 women (21.7%) experienced relief following exercise [10].

Global studies showed that physiotherapy is an effective intervention relieving pain in primary dysmenorrhea [12,13,14]. Physiotherapy interventions may represent viable non-pharmacological alternatives to analgesic medication [12]. These interventions include aerobic exercises (such as walking, cycling, or light jogging), yoga, stretching routines, core-strengthening exercises, isometric contractions, and relaxation or breathing techniques [12]. Physical activity is one of the core physiotherapy approaches and has likewise proven effective in reducing dysmenorrhea-related symptoms. Findings from one study demonstrated significant improvements across several outcomes due to the engagement in regular physical activity. These outcomes included reduced reliance on pain medications, lower bleeding volume and rate, shorter duration of menstrual pain, and decreased total and current pain intensity among participants who engaged in exercise, both when compared to a control group and when examined against their own pre-intervention levels [13].

Despite the well-supported evidence of the effectiveness of physiotherapy in reducing pain, the awareness of these benefits may remain limited among women in SA. Several studies conducted in SA have examined the prevalence, severity and impact of dysmenorrhea, as well as women’s self-management strategies and use of medications [10,11]. However, to date, no studies have specifically explored the awareness, perceptions or utilisation of physiotherapy-based interventions for managing primary dysmenorrhea. Therefore, this study aims to evaluate the level of awareness and perceptions of physiotherapy interventions for managing primary dysmenorrhea among women in SA.

2. Materials and Methods

2.1. Study Design

A survey-based cross-sectional design was used [15]. Data was collected in Saudi Arabia from 16 until 28 February 2024. Ethical approval was obtained by the ethics board at Jazan University (REC-45/08/981).

2.2. Inclusion and Exclusion Criteria

Eligible participants were females living in SA from menarche through menopause who agreed to participate in the study. Females self-identified their eligibility upon accessing the survey. The questionnaire began with screening items confirming sex (female), residence in Saudi Arabia, and absence of known gynaecologic (endometriosis, pelvic inflammatory disease, fibroids) or non-gynaecologic (trauma, severe illness, enteritis/IBS, acute/interstitial cystitis) causes of secondary dysmenorrhea. In the eligibility criteria, the term ‘female’ is used to denote biological sex relevant to dysmenorrhea. In all other sections, ‘women’ is used to describe the study population. Conditions reported by some participants (such as minor infections or non-pathological findings) were not included in the predefined list of disorders known to cause secondary dysmenorrhea. Females who reported confirmed diagnoses of secondary causes known only during the screening phase were excluded, and those who met all inclusion criteria were able to proceed.

2.3. Questionnaire Development and Theoretical Framework

Data were collected using a self-administered questionnaire delivered via Google Forms, chosen for its ease of distribution and ability to reach a broad population. The questionnaire comprised six sections: (1) sociodemographic characteristics (e.g., age, nationality, marital status, education); (2) menstrual history, including cycle regularity and dysmenorrhea severity measured on a 0–10 numeric pain scale; (3) work-related impact among employed participants; (4) pain-management strategies; (5) healthcare utilisation; and (6) awareness and use of physiotherapy modalities. Menstrual regularity was self-interpreted by participants; no clinical definition was provided. Participants were instructed to report the maximum menstrual pain intensity experienced during their most recent menstrual cycle using a 0–10 numerical rating scale (NRS). Pain intensity categories were author-defined using NRS cut-points: mild (1–3), moderate (4–6), severe (7–10).

The questionnaire design was guided by the Theory of Planned Behaviour (TPB) [16] to account for psychosocial factors influencing the awareness and experiences with physiotherapy for managing primary dysmenorrhea. TPB posits that behavioural intention, the strongest predictor of actual behaviour, is shaped by three constructs: behavioural beliefs (perceived outcomes of the behaviour), normative beliefs (perceived social expectations), and control beliefs (perceived facilitators or barriers to performing the behaviour). Incorporating TPB allowed the questionnaire to capture attitudes toward physiotherapy, perceived social norms, and perceived control, thereby providing a comprehensive understanding of factors that may influence females’ willingness to adopt physiotherapy-based interventions. The questionnaire was initially developed in English and subsequently translated into Arabic to ensure cultural and linguistic accessibility. All questionnaire items were author-developed based on the literature review and TPB factors. No previously validated survey instruments were used. The Arabic version underwent pilot testing for clarity and face validity, but no formal psychometric testing (e.g., Cronbach’s α) was conducted. A copy of the questionnaire is provided in Supplementary File S1. The questionnaire was developed taking into account factors from the TPB; however, TPB constructs were not measured as scale-based variables, and no TPB-specific analyses were conducted.

2.4. Sample Size

A total of 431 females participated in this cross-sectional online survey. The sample size was determined based on feasibility and previous studies on similar topics, aiming to ensure adequate representation of females living in Saudi Arabia. Convenience sampling was employed, and participation was voluntary and anonymous. This sample was considered sufficient to provide meaningful insights into the awareness and experiences of physiotherapy methods for managing primary dysmenorrhea.

2.5. Data Collection

The questionnaire was employed as the primary instrument for data collection in this study. The survey link (Google Forms) was distributed electronically using a multi-platform approach to reach a broad and diverse sample of females living in Saudi Arabia. The questionnaire was shared across widely used social media platforms including WhatsApp, X (formerly Twitter), Instagram, and Snapchat as well as through university email lists and community groups. Distribution messages briefly described the study purpose, eligibility criteria, and voluntary nature of participation. This approach allowed broad outreach across different age groups, geographic areas, and educational backgrounds within Saudi Arabia. The questionnaire was administered in Arabic to minimise potential limitations and eliminate language or communication barriers. Responses were submitted electronically, and measures were taken to prevent duplicate entries. All participants provided informed consent prior to completing the survey, and no personally identifiable information was collected to maintain confidentiality.

2.6. Statistical Analysis

Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 28.0. Descriptive statistics were calculated by using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. To enhance interpretability, we constructed cross-tabulation matrices (counts) between participant characteristics/employment (y-axis) and menstrual/management/physiotherapy variables (x-axis); all matrices are provided in the Supplementary Materials. No statistical tests were performed given the exploratory aim.

2.7. Quality Assurance

Multiple procedures were undertaken to improve the quality of the questionnaire. Firstly, the face and content validity of the questionnaire were enhanced through a senior researcher review, who assessed each item for relevant, reasonable, unambiguous and clear alignment with the study objectives [17]. Formatting bias was minimised by keeping items simple, short, and written in Arabic to enhance clarity and readability. The translation of questions was performed by two researchers independently to produce a consensus version [18]. Because data collection relied on online distribution, females were not individually contacted; instead, participants self-selected after viewing the survey invitation. To reduce selection bias, the survey was intentionally disseminated across multiple unrelated digital networks, including university groups, professional communities, and general public forums, ensuring the representation of females from diverse sociodemographic backgrounds. The questionnaire was fully anonymous, collected no identifying information, and prevented duplicate submissions by restricting multiple entries from the same device. Administering the survey entirely in Arabic minimised response bias related to language comprehension. These combined measures helped reduce sampling, information, and response bias.

3. Results

3.1. Participant Characteristics

A total of 431 participants agreed to participate in the study. The majority of participants were Saudi females (n = 396; 91.9%), predominantly young women aged 18–24 years (n = 186; 43.2%). Most were single (n = 228; 52.9%) and held a university-level education (n = 256; 59.4%). A total of 102 participants (23.7%) were employed.

Table 1. Participant characteristics.

Nationality	N (%)
Saudi	396 (91.9%)
Non-Saudi	35 (8.1%)
Ages
Less than 18 years old	61 (14.2%)
Between 18 and 24 y	186 (43.2%)
Between 25 and 40 y	105 (24.4%)
Older than 40 y	79 (18.3%)
Marital status
Married	191 (44.3%)
Single	228 (52.9%)
Divorced and widow	12 (2.8%)
Level of education
School level (Primary/secondary education)	165 (38.3%)
University level (Undergraduate degree)	256 (59.4%)
Postgraduate (Postgraduate degrees)	10 (2.3%)
Employment Status
Employed	102 (23.7%)
Unemployed	329 (76.3%)

represents the demographic characteristics of the study participants.

3.2. Menstrual Characteristics

Most women reported regular menstrual cycles (n = 332; 77%) and they experienced pain during menstruation (373 participants; 86.5%). The most common pain intensity category was moderate pain (scores 4–6/10) reported by (n = 186; 43.1%) of the participants. Only 66 participants (15.3%) reported being diagnosed with pelvic or gynaecological conditions (such as infections, narrowing and pelvic distortion, cysts or tumours above the ovary, urinary tract infections and secretions, bacterial infections, and recurrent fungal infections) in addition to the primary dysmenorrhea.

Table 2. Menstrual characteristics.

Regularity of Menstruation	N (%)
Regular	332 (77%)
Irregular	99 (23%)
Feeling of cramps and pain
Yes	373 (86.5%)
No	58 (13.5%)
Intensity of pain
Mild (<4 out of 10)	71 (16.4%)
Moderate (4–6 out of 10)	186 (43.1%)
Severe (>6 out of 10)	174 (40.5%)
Being diagnosed with any diseases
No	365 (84.7%)
Yes	66 (15.3%)

presents the distribution of participants according to the regularity of their menstrual cycle, the presence of cramps or pain, and the reported intensity of pain.

3.3. Impact on Work

Among all participants, 130 (30.2%) reported that primary dysmenorrhea caused absence or delay in job performance. All participants answered this item; therefore, the denominator includes both employed and unemployed women. The full data on the impact of work is shown in

Table 3. Impact on work.

Effect of Menstrual Pain on Job Performance	N (%)
Yes	130 (30.2%)
No	158 (36.7%)
Maybe	143 (33.2%)

.

3.4. Methods Used to Relieve Primary Dysmenorrhea

The most common self-management strategies were warm drinks and analgesics, used by 149 participants followed by hot packs that were used by 107 participants (24.8%). Only 77 participants (17.9%) had sought medical consultation; doctors primarily prescribed analgesics or anti-nausea medication. Methods that were used by participants to relieve primary dysmenorrhea are presented in

Table 4. Methods used to relieve primary dysmenorrhea.

Methods Used to Decrease Primary Dysmenorrhea	N (%)
Warm drinks	149 (34.6%)
Analgesic medications	149 (34.6%)
Hot packs	107 (24.8%)
Massage and other things (e.g., stretching, physical activity, herbal compresses)	25 (5.9%)
Medical consultation for primary dysmenorrhea
Yes	77 (17.9%)
No	354 (82.1%)
The most common treatment (among those who sought medical care; n = 77)
Analgesic pills	69 (90%)
Analgesic injection	23 (30%)
Intravenous analgesic	14 (18.2%)
Anti-vomiting and anti-nausea injection	10 (13.0%)
The least common treatment
Birth control pills to relieve menstrual pain	3 (3.9%)
Pills to regulate menstruation	2 (2.6%)
Hysterectomy	1 (1.3%)
Avoiding certain foods	1 (1.3%)
Nutritional supplements	2 (2.6%)

.

3.5. Awareness and Use of Physiotherapy Modalities for Primary Dysmenorrhea

More than half of participants (n = 250; 58%) reported using at least one physiotherapy method such as hot compresses, massage, or exercise. A total of 239 participants (55.5%) believed these methods were helpful, and 262 participants (60.8%) indicated a willingness to use physiotherapy in the future. Almost half had heard about physiotherapy benefits from peers or relatives, with most giving positive feedback.

Table 5. Awareness and use of physiotherapy methods for primary dysmenorrhea.

Use of Physiotherapy Methods for Primary Dysmenorrhea	N (%)
Yes	250 (58%)
No	181 (42%)
Belief in physiotherapy methods to reduce pain (Attitude)
Yes	239 (55.5%)
No	15 (3.5%)
Maybe	177 (41%)
Use of physiotherapy methods by friends or relatives
Yes	187 (43.4%)
No	116 (26.9%)
Maybe	128 (29.7%)
Impression of physiotherapy experience by friends or relatives (subjective norms)
Positive feedback (it helped them relieve pain)	213 (49.4%)
Negative feedback	2 (0.5%)
They do not know (Neutrals)	216 (50.1%)
Future intention to use physiotherapy methods (Perceived Behavioural Control)
Yes	262 (60.8%)
No	20 (4.6%)
Maybe	149 (34.6%)

summarises participants’ use and perceptions of physiotherapy methods for primary dysmenorrhea.

3.6. Cross-Tabulation Analysis

To provide greater granularity beyond the univariate distributions presented in Table 1, Table 2, Table 3, Table 4 and Table 5, we generated a series of cross-tabulation matrices comparing participant characteristics (age, education, marital status, nationality, and employment) with menstrual characteristics, preferred pain-relief strategies, and physiotherapy-related variables. The full matrices are provided in Supplementary File S2 (“CrossTab_Matrices.xlsx”), with summary tables included in Supplementary File S3 (“CrossTab_Summary_Tables.xlsx”).

Several patterns were evident:

• Pain intensity by age: Moderate pain (4–6/10) was reported more frequently among women aged ≥25 years (48.6–49.4%) compared with those aged 18–24 years (36.6%).
• Effect of pain on employed women: Among employed participants (n = 102), 27.5% reported that menstrual pain interfered with work or study tasks.
• Relief method by education level: University-educated women most often used analgesics (n = 89), whereas women with school-level education most commonly used warm drinks (n = 63).
• Menstrual regularity by marital status: Regular menstrual cycles were more common among married women (83.2%) compared with single women (72.4%).
• Future intention to use physiotherapy: Intention to use physiotherapy was high across all age groups (48–69%) and highest among women aged 25–40 years (68.6%).

These cross-tabulation findings provide additional context to the primary results by illustrating how demographic factors relate to menstrual patterns, management strategies, and physiotherapy awareness.

3.7. Participants’ Comments and Suggestions

At the end of the questionnaire, participants were invited to share any additional comments or suggestions. Their responses consistently reflected strong support for physiotherapy, particularly simple exercises, as a helpful approach to managing primary dysmenorrhea. Many emphasised the need to improve public awareness. One participant noted, “Raising awareness on social media will help more women learn about these methods”, while another explained that “most women may not know about natural treatments or specific exercises”.

Several participants described physiotherapy-related strategies they found personally beneficial, including “daily stretching exercises”, “walking regularly”, and “light yoga to relax the body”. Others mentioned additional lifestyle habits that they believed reduced menstrual discomfort, such as “avoiding cold drinks”, “keeping the home environment warm,” “using traditional remedies carefully”, and “getting enough sleep and rest.” A few participants also reflected on medication use, recommending caution, as expressed by one respondent who wrote, “Painkillers help, but they should not be overused”.

Overall, these open-ended responses complement the quantitative findings by demonstrating women’s interest in physiotherapy-based approaches and highlighting a clear desire for greater education and accessible guidance.

4. Discussion

The purpose of this study was to assess Saudi Arabian women’s knowledge and experiences with physiotherapy for managing primary dysmenorrhea (PD). We found a prevalence of 86.5%, higher than pooled global estimates (~73%) and in line with national reports [19]. Recent Saudi studies among university populations and women of reproductive age similarly report rates of 80–90%, underscoring the local burden [10,20]. Beyond pain, dysmenorrhea is linked to presenteeism, absenteeism, and productivity loss, especially in adolescents and young adults [21]. Several factors may contribute to the higher reported prevalence in Saudi Arabia, including cultural norms around pain reporting, lower physical activity levels among women, and the relatively low use of hormonal contraceptives for cycle regulation and pain management. These observations, alongside our findings, emphasise the need for systemic solutions.

A second observation is moderate awareness and frequent self-management using home physiotherapy modalities (heat, massage, exercise). Similar patterns are seen locally, where many women self-manage and use analgesics while rarely accessing formal physiotherapy, partly due to access constraints and cultural factors [22]. Workforce indicators support this interpretation: the ratio of physiotherapists employed in Ministry of Health facilities is 0.69 per 10,000 population, with significant regional variation suggesting capacity and access limitations that push care toward informal strategies [23].

Limited access to physiotherapy represents another important barrier. Women’s health physiotherapy services are not uniformly available across all regions, and access to female physiotherapists, which is often preferred for cultural reasons, remains constrained in certain areas. Financial barriers, transportation issues, lack of female-only clinic spaces, limited awareness of physiotherapy’s role in menstrual pain, and long waiting times further discourage formal care-seeking. As a result, many women rely on self-administered strategies rather than structured, evidence-based physiotherapy interventions.

Recent systematic reviews and network meta-analyses have shown that exercise is an effective non-pharmacological treatment for PD. A range of techniques, such as resistance, multi-component, stretching, relaxation, and core-strengthening, can produce clinically meaningful pain reduction over four to eight weeks [24,25]. Results are maximised by ≥8 weeks, >3 sessions/week, and >30 min/session, according to subgroup analyses [26]. These results are reinforced by umbrella reviews showing moderate quality evidence for reductions in pain intensity and duration with therapeutic exercise [26]. Given our cohort’s reliance on home strategies, structured exercise prescriptions delivered via primary care, physiotherapy, and digital platforms offer a scalable route to symptom relief. Clinical guidelines endorse remote delivery of physiotherapy assessment and intervention with shared decision-making and appropriate safeguards [22].

Transcutaneous Electrical Nerve Stimulation (TENS) is a pragmatic, non-pharmacological adjunct that women can learn and apply at home. The Cochrane review and subsequent clinical synopses support high-frequency TENS for PD pain relief versus placebo or no treatment [27]. A contemporary narrative review highlights TENS as portable, inexpensive, and generally safe with minimal adverse effects that can be well suited to patient-directed care where regular clinic attendance is challenging [28]. For our context, disseminating clear TENS protocols through MOH-endorsed education and remote consultations may enhance analgesia and reduce reliance on unsupervised analgesic use [22].

Telerehabilitation can deliver exercise prescription, monitoring, and menstrual health education where service availability is limited. International clinical practice guidelines support tele-physiotherapy for examination and intervention when implemented with shared decision-making [22]. Emerging evidence in women with PD shows online yoga-based programmes significantly reduce pain and improve menstrual attitudes, body awareness, and quality of life over eight weeks, underscoring the effectiveness and acceptability of remote formats [29].

Large surveys in Riyadh demonstrate internal barriers (e.g., lack of self-motivation) and external barriers (e.g., limited female-friendly facilities, long working hours) as significant constraints to physical activity participation [30]. University-based research similarly identifies service-related limitations and calls for infrastructure and programmatic enhancements, aligning with Vision 2030 which aims to increase female participation in physical activity [31]. In practice, interventions that expand affordable female-only facilities, embed school/university programmes, and leverage community partnerships could increase the uptake of exercise-based PD management.

The consequences of PD extend beyond symptom burden: menstruation-related symptoms drive substantial presenteeism (working while in pain) and absenteeism, with presenteeism contributing the larger share of lost productivity in large national samples [21]. For Saudi universities and employers, flexible scheduling, access to rest spaces, and evidence-based self-management education could mitigate these losses, particularly for younger women who report higher absenteeism [21]. Contemporary reviews also emphasise the long-term life course impact of dysmenorrhea and the need for early, tailored interventions including exercise, heat, and non-pharmacological adjuncts alongside appropriate pharmacotherapy [32].

Limitations and Direction for Future Research

Our sample was predominantly young and well-educated, which may bias results toward university experiences, a limitation noted in recent Saudi studies [10,20]. We did not specify dosage criteria for physiotherapy techniques, precluding dose–response or method-specific analyses, mirroring gaps in reviews of exercise and TENS [26,27,28]. Pain is subjective and context-dependent, shaped by culture, social environment, and lifestyle [32]; qualitative studies are needed to unpack attitudes, coping, and barriers to physiotherapy and to inform culturally sensitive interventions. Cross-sectional design limits causal inference; prospective and randomised designs, including remote-rehabilitation trials, are needed to assess efficacy and sustainability [22,29]. Future work should also examine cost-effectiveness, long-term adherence to home-based strategies, productivity outcomes, and the integration of digital tools (apps, teleconsultations) for scalable management.

5. Conclusions

This study aimed to assess women’s awareness and perceptions of physiotherapy methods for managing primary dysmenorrhea in SA. The study found a high prevalence of dysmenorrhea and moderate awareness of physiotherapy, with most women relying on simple home-based methods rather than structured physiotherapy interventions. To enhance the use of physiotherapy modalities in menstrual pain management, future research should explore the effectiveness of specific physiotherapy techniques and evaluate innovative delivery models such as telerehabilitation. Increasing public education, expanding access to physiotherapy services, and integrating self-management guidance into women’s health programmes are recommended to improve outcomes for women experiencing primary dysmenorrhea.