Effect of pelvic floor muscle training with or without dynamic neuromuscular stabilization–based breathing on menstrual pain and symptoms of primary dysmenorrhea: a randomized controlled trial

Background Breathing exercises may modulate dysmenorrhea by enhancing relaxation and eliciting analgesic effects. This study investigated the effects of Pelvic Floor Muscle Training (PFMT) with or without Dynamic Neuromuscular Stabilization (DNS)-based breathing exercises on menstrual symptoms, pain, and quality of life in primary dysmenorrhea (PD). Methods Sixty-six women with PD were randomly assigned to one of three groups: PFMT combined with DNS-based breathing exercises (PFMT + DNS Group), PFMT alone (PFMT Group), or no intervention (Control Group) (once a week for 4 weeks). Outcomes were assessed using the Menstrual Symptom Questionnaire (MSQ), the McGill Pain Questionnaire (MPQ), and the Short Form-36 (SF-36) at baseline, post-treatment, and the 3-month follow-up. Results Both intervention groups showed significant improvements in MSQ subscales and MPQ scores from baseline to post-treatment ( P < 0.05). Significant group × time interactions were observed for somatic complaints ( P = 0.020, η² = 0.088), pain symptoms ( P = 0.001, η² = 0.173), coping methods ( P = 0.001, η² = 0.195), and total MSQ score ( P = 0.001, η² = 0.198), and MPQ ( P = 0.001, η² = 0.270). These improvements were maintained at the 3-month follow-up. Between-group comparisons showed significantly greater reductions in MPQ scores in both intervention groups than in control group, with no significant difference between PFMT and PFMT + DNS. No significant between-group differences were found for SF-36 subscales. Conclusions A four-week PFMT significantly reduced menstrual symptoms and pain, with effects sustained at 3 months. However, adding DNS-based breathing exercises did not provide any additional benefits. Trial registration ClinicalTrials.gov, Trial registration: NCT06615258, Registration date: 26 September 2024.