Mechanistic Insights Into Photobiomodulation for Primary Dysmenorrhea: A Narrative Review

Primary dysmenorrhea is widely recognized as a prevalent source of menstrual pain among individuals of reproductive age, with some patients reporting limited symptom relief with commonly used pharmacologic treatments. Photobiomodulation (PBM), including low-level light therapy in the red-light spectrum (approximately 610-630 nm), has emerged as a nonpharmacologic modality that has been explored in clinical research settings for dysmenorrhea. However, the biological mechanisms potentially underlying PBM-associated symptom improvement in this context are not fully elucidated, which may limit optimization of treatment parameters and broader clinical application. This narrative review synthesizes existing literature describing proposed molecular and cellular mechanisms through which PBM may influence dysmenorrhea-related pathways, with particular attention to inflammatory mediators, lipid metabolism, and implications for wavelength-specific treatment design. A narrative synthesis approach was employed, integrating findings from clinical studies that included biomarker assessments with established experimental and theoretical literature on PBM mechanisms. Sources reviewed included controlled clinical studies reporting biochemical outcomes, metabolomic investigations, and foundational mechanistic research. No new human or animal data were generated for this review. Prior experimental and translational work suggests that red-light PBM may interact with mitochondrial components involved in cellular energy processes, including cytochrome c oxidase, with downstream effects on cellular signaling pathways. In clinical and laboratory contexts, PBM exposure has been associated with changes in inflammation-related biomarkers, including prostaglandin-associated measures. Metabolomic studies further describe alterations in lipid-related metabolic pathways implicated in inflammatory processes, such as glycerophospholipid, linoleic acid, and arachidonic acid metabolism, with some findings suggesting potential wavelength-dependent effects. Collectively, these observations are compatible with the current understanding of dysmenorrhea pathophysiology and provide a plausible biological framework for reported clinical observations. In summary, PBM may influence dysmenorrhea-related symptoms through interconnected effects on mitochondrial signaling, inflammatory mediator activity, and lipid metabolism. Treatment protocols utilizing red-light wavelengths applied to lower abdominal or sacral regions are biologically plausible based on known optical and tissue interaction principles. Future research may benefit from systematic evaluation of dose parameters, standardized biomarker outcomes, and mechanistically informed approaches to patient selection.