Has the menstrual cycle been considered in assessment of pain in clinical trials of physical therapy modalities for women with primary dysmenorrhea? A scoping systematic review

Primary dysmenorrhea (PD) is a gynecological condition characterized by painful menstrual cramps, with pain intensity varying across menstrual cycle phase. Physiotherapy is a non-pharmacological treatment used to manage PD symptoms, but it is unclear whether the menstrual cycle phase has been considered in physiotherapy randomized clinical trials (RCTs) for PD. This scoping review aims to investigate whether the menstrual cycle phases are considered in the assessment of pain in clinical trials of physical therapy modalities for women with PD. A search was conducted in PubMed, Embase, Scopus, Lilacs, and PEDro. This review included RCTs of physiotherapy modalities for management of pain in women with PD, published until December 2024. The review included 42 RCTs with a total of 3694 participants. Most studies were from Iran (21.4 %), Turkey (19 %), China (11.9 %), and Brazil (11.9 %). The most common physiotherapy modalities were exercise (23.8 %), acupressure (21.4 %), acupuncture (11.9 %), transcutaneous electrical nerve stimulation (11.9 %), education/information booklets (11.9 %), and massage (7.1 %). The mean PEDro score for the trials was 5.81 (range: 3–9). The majority of included studies focused on pain assessment during menstruation, which aligns with the critical period of pain for many women with PD. However, the lack of focus on pain in the 48 h leading up to menstruation may lead to an underestimation of pain severity. This scoping review highlights the importance of considering menstrual cycle phases in pain assessments and PD treatment for more personalized and effective physiotherapy interventions. • Future research should improve methodological rigor and include menstrual cycle phases explicitly in trial design. • Missing pain in the 48 hours before menstruation may overlook significant symptoms and underestimate overall severity. • The review urges using cycle phases to assess primary dysmenorrhea and guide individualized physiotherapeutic treatment.