ISSN: 2348-1412

Guru Drone Journal of Pharmacy & Research. 2014: 2(3): 11- 16

Effectiveness of Dance Therapy on Primary Dysmenorrhoea in

Young Females
Taru Saxena1, Reena Kumari2, Sonia Khurana2, Mamta Rawat 4
Bachelors Student Researcher, Department of Physiotherapy, SBSPGI, Dehradun1
Associate Professor, Department of Physiotherapy, SBSPGI, Dehradun2
Assistant Professor, Department of Physiotherapy, SBSPGI, Dehradun3
Masters Student Researcher, Department of Physiotherapy, SBSPGI, Dehradun4

Received: 18. 08. 2014

Accepted: 25.09.2014

Abstract:
Dysmenorrhoea pain being the major health problem greatly affects the young females,
unfortunately there are very less treatment options available. NSAIDs being the most
appropriate first line of choice of therapy, so majority of women go for medical support first.
But looking at their hazardous side effects, this study aims at use of non pharmacological
treatment option that is Dance therapy to see the effect on pain in young females in primary
dysmenorrhoea. 60 collegiate female students with primary dysmenorrhoea were selected on
the basis of selection criteria, and were divided into Experimental (n=30) and Control (n=30)
groups randomly. Participants in experimental group completed their dance therapy protocol
daily for four weeks. The menstrual pain was measured using VAS.The result between the
experimental and control group was analyzed using independent sample t-test. This data
analysis showed a significant effect of dance therapy on symptoms of primary dysmenorrhoea.
Dance Therapy is effective in primary dysmenorrhoea in young females. A significant decrease
in pain was seen in the experimental group following a four week intervention.
Keywords: Primary Dysmenorrhoea, dance.
up to many minutes and may produce uterine
pressures greater than 60 mm Hg.[2] The prevalence
of primary dysmenorrhoea decreases with increasing
age: prevalence is highest in the 20 to 24 year age
group and decreases progressively thereafter. There
appears to be no relationship with parity when age is
factored in[3] Age is a determinant of menstrual pain
with symptoms being more pronounced in
adolescents than in older women. The evidence that
smoking worsens primary menstrual pain is
convincing. One recent prospective study found that
dysmenorrhoea is also associated with increased
exposure to environmental tobacco smoke as more
frequent life changes, fewer social supports, and
stressful close relationships may be associated with
increased dysmenorrhoea. There may be an increased
prevalence
of
dysmenorrhoea
in
lower
socioeconomic groups.[2] Primary dysmenorrhoea
presents with or shortly after menarche. It may start

Introduction
Menstruation may be described as a periodic
discharge of blood from an endometrium that is
either progravid (ovulatory) or proliferative (anovulatory) every twenty-eight days... [1]
Dysmenorrhoea is derived from a Greek root
translating
to
difficult
menstrual
flow.
Dysmenorrhoea can be divided into two broad
categories of primary and secondary. Primary
dysmenorrhoea is defined as recurrent, cramping pain
occurring with menses in the absence of identifiable
pelvic pathology. Secondary dysmenorrhoea is
menstrual pain associated with underlying pelvic
pathology such as endometriosis. Primary
dysmenorrhoea is caused by myometrial activity
resulting in uterine ischemia causing pain. This
myometrial activity is modulated and augmented by
prostaglandin synthesis. Uterine contractions can last

Corresponding author: Dr. Reena Kumari, Associate Prof. Dept. of Physiotherapy, SBSPGI, Dehradun, Ph. No. 91-9897106232

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within 6 months after menarche characterized by
fluctuating, spasmodic menstrual cramps, sometimes
referred to as labor-like pains that begin only a few
hours before or with the onset of menstrual flow, the
symptoms of primary dysmenorrhoea lasts only 23
days. The pains are most intense on the first or
second day of the menstrual flow, or more precisely
the first 2436 hours, consistent with the time of
maximal prostaglandin release into the menstrual
fluid. With severe pains, the sufferers may be absent
from school or work for a day or two. In the severe
forms, the pain may present as an intense acute
abdominal episode and sometimes mimic the
presentation of an acute ectopic pregnancy[3]]. As in
the normal menstrual cycle changes in the ovarian
hormone productions and in the endometrial
prostaglandins levels lead to cyclic variation in the
uterine activity. During the menstrual phase in
normal women the uterine resting tone is lower less
than 10mmHg, the active pressure is higher than 120
mmHg and the numbers of contractions are fewer
(three to four/ 10 minutes). But in dysmennorrhic
women no single consistent abnormality have been
found like an increase in resting tone, and increase in
active pressure, increase in number of contractions,
incordinate and dysrhythmic uterine activity. These
abnormalities tend to potentiate one another so that if
more than one is present pain is experienced.[4]
Primary dysmenorrhoea is characterized by a crampy
supra-pubic pain that begins somewhere between
several hours before and a few hours after the onset
of the menstrual bleeding. Symptoms peak with
maximum blood flow and usually last less than one
day, but the pain may persist up to 2 to 3 days.
Symptoms are more or less reproducible from one
menstrual period to the other. The pain is
characteristically colicky and located in the midline
of the lower abdomen but may also be described as
dull and may extend to lower quadrants, the lumbar
area, and the thighs. Frequently associated symptoms
include diarrhea, nausea and vomiting, fatigue, lightheadedness, headache, dizziness and, rarely, syncope
and fever seen in high percentage of cases. These
associated symptoms have been attributed to
prostaglandin release. Occasionally adolescents may
experience menstrual pain with their first periods
without any demonstrable underlying cause,
especially when the bleeding is heavy and
accompanied by clots. Menstrual pain appearing after
several years of painless periods is suggestive of
secondary dysmenorrhoea. When a health care
provider identifies menstrual pain on history, an
attempt should then be made to differentiate between
primary and secondary dysmenorrhoea. The history
should focus on the menstrual history, including age
at menarche, length and regularity of cycles, dates of

last two menses, and duration and amount of the

bleeding. The length of time elapsed between
menarche and the beginning of dysmenorrhoea
should be established. The pain should be clearly
defined in terms of type, location, radiation, and
associated symptoms, as well as the chronology of
the onset of pain in relation to onset of menstrual
bleeding [2].
Women who exercise have a reduced incidence of
primary dysmenorrhoea. These may be due to
exercise related hormonal effects on the lining of the
uterus, or increased level of circulating endorphins. It
seems that exercise acts as a nonspecific analgesic for
short term relief of pain [5]. Dance is a good source of
aerobic exercise. Aerobic exercise includes a series
of dance movements in step by step form which are
repeated frequently with the music. [6] It helps the
individual with a number of lasting benefits as not
only do they help to reduce depression and anxiety,
but they also improve both physiological and
psychological well-being.[7]
Another recent study found that more vigorous
exercises (more than 3 times per week) reported less
physical symptoms during menstruation in
comparison with sedentary counterparts. Exercises
were associated with improvement in mood swings
and stress. As aerobic exercises stimulate the release
of -endorphins hormones which acts as analgesics
for pain, seems to have reduction in primary mode of
action. Behavioral intervention is also used in the
treatment of dysmenorrhoea which includes
procedures such as biofeedback, desensitization,
relaxation training. However, surgical interventions
like
Laparoscopy,
Hysterectomy,
Pre-sacral
Neurectomy and Laparoscopic Utero-sacral Nerve
Ablation (LUNA) is done to treat primary
dysmenorrhoea.[2]
Dysmenorrhoea pain being the major health problem
greatly affects the young females, unfortunately there
are very less treatment options available. NSAIDs
being the most appropriate first line of choice of
therapy, so majority of women go for medical
support first. But looking at the hazardous side
effects such as gastrointestinal intolerance, headache
and drowsiness, there is a need for other therapeutic
interventions too. So this study aims at use of non
pharmacological treatment option that is Dance
therapy to see the effect on pain in young females in
primary dysmenorrhoea.

Reena kumari et. al.

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Method
Table 1: Showing the mean and standard deviation
of pre (0th week) and post (4th week) VAS score
between Experimental and control groups.

The study consists of 60 collegiate female subjects of

age group between 18-25 years, based on the
selection criteria of primary dysmenorrhoea.
Inclusion criteria for the study were the unmarried
females having regular menstrual cycle; menstrual
pain beginning the day before or just after the onset
of menstrual flow. The Quality of life scale was taken
as a measure of function affected due to menstrual
pain. Subjects interest and co-operation for the
dance therapy was also taken into consideration.

S.No.

The subjects who were diagnosed with psychological

disorders, musculoskeletal problems were excluded
from the study. 60 subjects with primary
dysmenorrhoea were divided randomly into two
groups (experimental and control group) consisting
30 subjects each. Experimental group received dance
therapy including two forms i.e.; belly dance and
Zumba dance, once a day for 30 min, five days a
week for four weeks. No intervention was given to
the subjects of control group. The menstrual pain was
measured using VAS.

Group

Mean SD

Experimental (Pre)

6.66671.02833

Experimental (Post)

2.40001.56690

Control (Pre)

6.53331.19578

Control (Post)

6.36671.49674

Graph 1: Showing the

comparison of Mean and SD
of pre and post VAS scores
between experimental and
control groups
mean

SD

Results
6.6667
Data obtained was tabulated and analyzed using
SPSS 17.0 software package. The dependent variable
VAS within the groups was analyzed using paired ttest. The result between the experimental and control
group was analyzed using independent sample t-test.
This data analysis revealed that dance therapy is
effective treatment in primary dysmenorrhoea. Level
of significance used for all comparisons was P<0.05.

6.5333

2.4
1.5669
1.02833

Expre

Reena kumari et. al.

Expost

1.19578

Contpre

6.3667

1.49674

Contpost

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Guru Drone Journal of Pharmacy & Research. 2014: 2(3): 11- 16

Table 2: Showing the mean difference of pre & post

VAS scores within experimental and control Group
S.No

Group

ExpPre-ExpPost

4.26671.20153

ContPreContPost

0.16671.41624

Table 3: Showing the comparison of pre-pre and

post-post VAS score between experimental and
control groups.

Mean SD
S.
no.
1.

Graph 2: Showing the Mean

difference of pre and post
value of experimental and
control group

Mean Difference

2.

Between the
groups
Between pre
values of
control and
experimental
group

Between post
values of
control and
experimental
group

T
value

Significance

P
Value

0.463

0.645

P>0.05

10.27

0.000

P<0.05

Standard Deviation

4.2667

Discussion
The present study aimed to find out the effectiveness
of Dance Therapy on Primary Dysmenorrhoea in
young females. The study was performed on 60
female subjects with mean age 21.51.15.
Experimental group consisted of 30 subjects who
received dance therapy for 4 weeks and control group
consisting of 30 subjects with no intervention.

1.41624

1.20153

According to data analysis and statistical inference,

the mean values of experimental group showed a
statically highly significant (p<0.05) improvement in
decreasing pain during menstruation following a four
week dance intervention program. Therefore, this
suggests that dance therapy program is beneficial for
reducing pain during primary dysmenorrhea.

0.1667
ExpPre-ExpPost

ContPre-ContPost

Natausha light et al (2006) suggested that menstrual

cycle is an incredible stress to the female body.
During the stress of menstruation, weak core
musculature creates an inability for the body to
handle the forces required for normal movement and
function thus leaving the female body vulnerable to
the pain associated with improper biomechanical
functions of the structures. After increasing core
stability, the symptoms of dysmenorrhoea were
improved [8]. This could be due to dance which helps
in core strengthening, as it allows the small intrinsic
musculature surrounding the lumbar spine to be
conditioned for greater performance. This type of
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the muscles involved in Belly Dance helps in
relieving muscle tension.[10]
Noorbakhsh Mahvash et al found that dysmenorrhoea
has been treated successfully with stress reduction
techniques, physical activities and exercises. It is
widely accepted as a means of moderating stress and
stress- related symptoms. Exercise is known to cause
the release of endorphin hormones in brain that raises
the pain threshold and is shown to improve mood
swings of exercising subjects. However, because of
high prevalence of primary dysmenorrhoea in
different societies and the potential benefits of
exercise found in treating dysmenorrhea and also
existence of few studies which claimed that physical
activity has no effect on primary dysmenorrhoea
provides the purpose of this study to investigate the
effects of physical activities on primary
dysmenorrhoea.[11]
Physical activities act as a specialized manner of
decreasing pain in primary dysmenorrhea by
decreasing anxiety and mental stress. Stress is
considered as a main factor related to physical
activity and dysmenorrhoea. The role of physical
activity has been regarded as a means to reduce stress
and biochemical changes in body immune system.
On the other hand, researchers stated that increasing
blood flow and metabolism during physical activity
influences the primary dysmenorrhoea.[9] Menstrual
pain may be resulted from increased contraction of
uterine muscle which is innervated by the
sympathetic nervous system. Stress is supposed to
increase the sympathetic activity which may lead to
the increase of menstrual pain by enhancing the
intensity of uterine contraction. So, due to the fact
that exercise reduces stress, the sympathetic activity
may be decreased. Thereby, intensity of menstrual
pain and other related symptoms may be reduced as
well.

training allows for isolation and strengthening of core

muscle groups. When these muscles are strong, they
are much more prepared to handle daily forces of
normal biomechanics, even when the body is under
the stress of the menstrual cycle[8].
In primary dysmenorrhoea pain begins few hours
before or after the onset of menstruation and lasts for
24-48 hours. The pain is more at the first day and
rarely continues to next day. The most prevalent
symptoms include irritability, mood lability,
depression, anxiety, impulsivity, fluid retention,
breast swelling and general aches. Primary
dysmenorrhoea arises from the release of
prostaglandins with menses, which is secreted during
the luteal phase and subsequent menstrual flow. One
likely mechanism for increasing prostaglandins is
that, during premenstrual phase, progesterone
decreases which results in the synthesis of
prostaglandins
in
endometrial
cells
by
membrancephospholipids. Excessive release of
prostaglandins increases the amplitude and frequency
of uterine contraction and causes vasospasm of the
uterine arterioles, resulting in ischemia and cyclical
lower abdominal cramps. It seems that women who
exercise have a reduced incidence of dysmenorrhoea.
These may be due to exercise related hormonal
effects on the lining of the uterus. On the other hand,
the increasing endorphin levels related to exercise
may cause significant reductions in depression and
changes in mood state and pain perception. Exercise
may act as a distraction from intrusive thoughts and
promote positive thoughts, decreasing short-term
depression. Exercise also increases concentration,
improves mood swings and behavior.[9]
In our study zumba and belly dance were
incorporated as the treatment option. Although
research has not been conducted on zumba dance, but
in this experiment we found that this dance form was
also effective. Belly Dance is an aerobic exercise,
practicing it regularly burns calories. Dance is
strength and conditioning exercise for many muscles,
such as the quadriceps and hamstrings, and all the
muscles of the shoulders, arms, and wrists involved
in arm movements. Dance especially strengthens the
muscles of the torso: the abdominal, pelvic, lumbar,
and gluteus muscles, which in turn improve the
dancers posture. It is well known that good posture
is the first step for a chain of many physiological
benefits for the human body. Because dance
improves both cardiovascular fitness and posture, it
also develops appropriate circulation and regulates
breathing, which in turn augments the oxygen levels
in the blood and prevents circulation and digestion
complications. The stretching and strengthening of all

Conclusion
The findings of the study suggested that performing
dance as regular physical activity reduces the primary
dysmenorrhoea symptoms, and improves the
physiological as well as psychological well being.
References
1.

2.

3.

Reena kumari et. al.

Julian W. Ross, 1951 The Endocrinology

and Physiology of Menstruation Journal of
the National Medical Association vol. 43,
(3):184-187
Viola
Antao
,
2005
Primary
Dysmenorrhoea Consensus Guideline
JOGC ( 169):1117-1130
M. Yusoff
Dawood, 2006 Primary
Dysmenorrhoea Advances in Pathogenesis
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and Management Obstetrics & Gynecology
Vol. 108,( 2) :428-441
4. M. Yusoff Dawood, 1984 Ibuprofen and
Dysmenorrhoea The American Journal Of
Medicine :87-93
5. Abbaspour,2006 The Effect of Exercise on
Primary Dysmenorrhea Journal Research
Health Sciences, Vol 6(1) :26-31
6. Parastoo Ossanloo, 2012 The Effects of
Combined Training (Aerobic Dance, Step
Exercise and Resistance Training) on Body
Composition in Sedentary Females Annals
of Biological Research, Vol 3 (7):3667-3670
7. Mastura J, 2012 Effect Of Low-Impact
Aerobic Dance Exercise On Psychological
Health (Stress) Among Sedentary Women In
Malaysia Biology Of Sport, Vol. 29 (1):6369
8. N. Light, 2006 The Effect of Core
Strengthening on Dysmenorrhoea, Journal
of
Research
health
sciences[2006]vol6,no.1pp26-31.
9. Elham Karampour, 2012 The influence of
stretch training on primary dysmenorrhea
Advances in Environmental Biology, Vol
6(12): 3069-3071
10. Nadia De Leon, 2006 Belly Dance as a
Means of Dance Therapy for Survivors of
Sexual Assault Honors College Capstone :
1-47
11. Noorbakhsh Mahvash, 2012, The Effect of
Physical Activity on Primary Dysmenorrhea
of Female University Students World
Applied Sciences Journal Vol 17 (10): 12461252

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