Self-management strategies for menstrual cycle symptoms: a systematic review

Abstract

Purpose

Menstrual cycle symptoms, such as discomfort, fatigue, and mood swings, are prevalent among women and can significantly diminish quality of life. Many women employ non-clinical, self-management strategies to mitigate symptoms, yet the supporting evidence for these strategies is equivocal. This systematic review sought to identify, evaluate and synthesise existing evidence from randomised controlled trials (RCTs) for non-clinical, self-management strategies for menstrual cycle symptoms.

Methods

A systematic literature search was performed in PubMed, Scopus, Web of Science, and Cochrane Library in March 2025 and updated in December 2025. The review adhered to PRISMA principles. Eligible studies comprised double- and triple-blinded RCTs published from 2000 onwards that examined non-clinical, self-management strategies including physical activity, nutrition, heat treatment, sleep, stress management, education, and over-the-counter medications for alleviating menstrual cycle symptoms in females aged 18 years and older. The JBI Critical Appraisal Checklist for RCTs was utilised for quality assessment.

Results

Of the 13,208 screened records, 39 were included in the final synthesis, comprising 42 treatment interventions and 3,806 participants. This provided categories of physical activity strategies (n = 5), nutritional strategies (n = 26), other self-management strategies (n = 7), and combined strategies (n = 4). Physical activity, especially yoga, consistently showed improvements in menstrual discomfort, exhaustion, and mood. The most researched strategies were nutritional, including vitamin and mineral supplementation, and demonstrated varied yet predominantly positive results. Some of the other self-management strategies, including low light therapy, listening to music and drawing, also reduced total PMS scores. Some of the combined strategies, investigating two or more strategies in combination, reduced menstrual cycle symptoms and menstrual pain intensity. Methodological shortcomings were prevalent, including small sample sizes and inconsistent outcome measurements.

Conclusions

Data from 39 RCTs indicate that strategies including physical activity, nutrition, other self-management strategies and combined strategies may effectively alleviate menstrual cycle symptoms. There are limitations in the evidence base due to limited research and methodological inconsistencies, and publication bias may have skewed the results to being predominantly positive. Future research ought to evaluate common strategies that are yet to be investigated using blinded RCTs, and the long-term efficacy of existing self-management strategies.

Trial registration

CRD420250612937.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12905-026-04717-3.

Background

The menstrual cycle is a multifaceted, hormonally regulated process experienced by biological females from menarche to menopause. It includes cyclical alterations in the reproductive system and hormonal variations that may result in a diverse array of physical, emotional, and behavioural responses. Menstrual cycle symptoms (MCS) may include dysmenorrhea (painful cramps), bloating, breast tenderness, heavy menstrual bleeding, exhaustion, mood fluctuations, irritability, depressive moods, and concentration difficulties [1, 2]. For some individuals, MCS can markedly diminish quality of life, academic and vocational performance, physical capability, and overall welfare [3, 4]. Furthermore, MCS among working-age women significantly diminish workplace productivity due to absenteeism and presenteeism. For example, a national survey in the Netherlands involving 32,748 women revealed that MCS resulted in significant productivity losses, underscoring their extensive effect on adult functioning [5]. Similarly, dysmenorrhea in Australian women correlated with diminished work capacity and heightened absenteeism, which also illustrates the occupational impact of menstrual pain [6]. The impact of dysmenorrhea extends beyond occupational challenges, imposing a significant disease burden that influences life trajectory, quality of life, and overall health outcomes throughout adulthood [7, 8]. Although MCS affect approximately 75–90% of women [9], therapeutic symptom management strategies have traditionally been confined to pharmacological approaches, including hormonal contraceptives and prescription of non-steroidal anti-inflammatory drugs (NSAIDs) [10, 11]. However, these methods may be inappropriate or undesirable for certain individuals due to contraindications, adverse effects, accessibility challenges, religious or cultural beliefs, or personal preferences [10, 11]. Consequently, there is a growing focus on non-clinical, self-management strategies, which are characterised as proactive methods initiated and sustained by the individual to manage MCS, enhance health, and preserve daily functioning [12].

Self-management strategies for MCS may span various lifestyle modifications including physical activity [13], dietary alterations [14], sleep hygiene practices, stress alleviation strategies, heat application [15], educational strategies [16], and the utilisation of over-the-counter (OTC) supplements or medications. These strategies are particularly relevant for fostering autonomy, improving symptom management, and decreasing healthcare demands [17]. Nutritional strategies, including dietary alterations and supplementation (such as magnesium, B vitamins, and omega-3 fatty acids), have demonstrated potential in alleviating premenstrual syndrome (PMS) symptoms and systemic inflammation [18, 19]. Sleep hygiene is both affected by and affects hormone cycles, with inadequate sleep linked to heightened fatigue, mood disturbances, and pain perception during menstruation [20]. Strategies for relaxation and stress management, including mindfulness and breathing exercises, have demonstrated the ability to control the stress–pain axis and alleviate psychological and physical MCS [9]. Moreover, OTC NSAIDs and paracetamol are readily available therapies for dysmenorrhea and are extensively endorsed in self-management strategies [10, 21].

Despite the increasing interest in non-clinical methods, a consensus on the efficacy of existing strategies remains elusive. Furthermore, societal transformations, including increased transparency concerning menstrual health and welfare, intensify the demand for evidence-based, accessible, and sustainable treatment strategies [17]. This is especially significant for individuals who may lack consistent access to clinical treatment or favour non-medical solutions. No existing systematic reviews were found that encompassed the extensive range of self-management strategies available across several domains (e.g., lifestyle, behavioural, educational, non-clinical), hence necessitating this study. The aim of this study was therefore to provide a systematic review of the existing literature regarding the effectiveness of non-clinical, self-management strategies in mitigating MCS in adults. Effective, accessible, and user-driven MCS management evidence is beneficial for future practice, education, and research.

Methods

This systematic review was prospectively registered with PROSPERO (CRD420250612937) and conducted in accordance with the PRISMA 2020 guidelines [22, 23]. The review evaluated published literature on the effectiveness of self-management strategies for MCS in adults. The initial scoping searches facilitated the refinement of the study question, the identification of clinically relevant outcomes and interventions, and the formulation of inclusion and exclusion criteria. The inclusion and exclusion criteria were structured with the PICOS (Population, Intervention, Comparator, Outcomes, Study Design) framework [24]. This review encompassed research including biological females aged ≥ 18 years exhibiting menstrual symptoms, including dysmenorrhea, PMS, premenstrual dysphoric disorder (PMDD), exhaustion, mood alterations, or cramps, reflecting the symptom clusters which are commonly reported within clinical and epidemiological literature [3, 9]. By contrast, biological males, individuals < 18 years, postmenopausal females, and studies concentrating exclusively on clinical conditions were excluded to support the focus within general MCS self-management rather than condition-specific treatments. Eligible interventions included non-clinical self-management strategies which individuals could independently conduct without specialised supervision or a prescription, OTC treatments, lifestyle modifications (via nutrition, exercise, sleep, hydration and stress management strategies), physical strategies (e.g., heat), and educational strategies. The selection of these self-management strategies was deliberate, based on initial scoping searches, epidemiological data regarding prevalent menstrual self-care practices, and existing clinical and public health guidelines that consistently emphasise OTC analgesics, lifestyle changes, physical interventions such as heat application, and educational/behavioural methods as viable and commonly employed options for alleviating symptoms. In this review, widely available OTC drugs (e.g., ibuprofen, paracetamol) were considered self‑management, non‑clinical techniques and thus met the inclusion criteria, whereas prescribed pharmacological interventions were excluded. Prescription medications, psychological/cognitive behavioural therapy (CBT), and surgical or invasive procedures were excluded as they require clinically-led treatments and are commonly treated by formal medical care as opposed to self-management strategies. The intervention comparators included placebo, no strategy, other OTC interventions, or baseline comparisons. Included outcomes encompassed symptom alleviation, quality of life, efficacy, adherence, and feasibility, which are consistent with accepted core goals for research on menstrual health and self-management. To reflect current diagnostic standards, document modern self-management techniques, and guarantee applicability to the availability of contemporary products and instructions, the review was restricted to double- or triple-blinded RCTs. Non-randomised controlled trials, case reports, reviews, animal or in vitro studies, and retracted publications were excluded due to the greater chance of bias or limited applicability. The categories of self-management strategies (i.e., OTC medications, lifestyle modifications, physical strategies, and educational approaches) were based on preliminary scoping searches, epidemiological data regarding prevalent menstrual self-management behaviours, and existing clinical and public health guidelines, which uniformly endorse these methods as viable and potentially effective for alleviating symptoms.

Search strategy

A systematic search method was developed in collaboration with an academic research librarian. Searches were performed across four electronic databases: PubMed, Web of Science, Scopus, and Cochrane Library, encompassing papers from the inception of the databases until March 25, 2025. The database searches were updated on December 9, 2025, to incorporate the latest evidence. In accordance with best practice guidelines, the inclusion criteria were refined, specifically in relation to date restriction and study design following preliminary full text screening, to improve the methodological quality and relevance of the final synthesis [25, 26]. Only studies published from the year 2000 onwards were considered. The start date was implemented to emphasise contemporary menstrual health research, aligning with current diagnostic criteria, reporting standards, and self-management practices, while ensuring a manageable review workload; prior studies were deemed less pertinent to present public health contexts. Research methodologies, intervention strategies, and reporting criteria have evolved significantly during the past 26 years, rendering earlier studies less relevant to contemporary circumstances [25, 26]. This timeframe also captures the advancing methodology in menstrual health research and incorporates more recent strategies and health habits [27, 28]. Alongside the date restriction, the scope of the included studies was limited to double- or triple-blinded. In clinical research, double-blind usually means blinding both participants and key study personnel to group assignment. Such blinding is rarely possible in exercise and other behavioural interventions since participants and therapists must be aware of which intervention is being administered. Blinding of participants and intervention providers was typically impractical due to the characteristics of exercise programs; hence, preference was accorded to trials that blinded outcome assessors and/or data analysts to group allocation. These study design and date restrictions were implemented after full-text screening, narrowing the scope of this review to high-quality trials that reduced bias and more closely corresponded with the aim to emphasise self-management strategies. The search approach employed a blend of Medical Subject Headings (MeSH) and free-text phrases for thorough coverage of pertinent subjects. Keywords and terms pertaining to menstruation, menstrual symptoms (e.g., dysmenorrhea, premenstrual syndrome), and self-management strategies (e.g., “heat therapy,” “sleep hygiene,” “exercise,” “diet,” “relaxation,” “OTC medications,” “self-care,” and “non-pharmacological treatment”) were amalgamated using Boolean operators such as AND, OR, and truncation techniques (e.g., “educat*”) to ensure both sensitivity and precision [26, 27]. Searches were conducted in the Title/Abstract and Subject areas to optimise relevance. Filters were implemented to limit articles to those published in English and in peer-reviewed journals. Grey literature, including theses, dissertations, government reports, and conference proceedings, were excluded to improve the quality of the included studies, which is crucial for synthesising empirical evidence [27, 29]. The search terms can be found in the PROSPERO registration document: https://www.crd.york.ac.uk/PROSPEROFILES/827a4183eed9c2b51bbd6d499cc2a11f.pdf.

Screening and selection of studies

Upon completion of the database searches, all records were exported to Covidence software (Melbourne, Australia: Veritas Health Innovation) for systematic organisation. Duplicate entries were eliminated automatically and verified for precision and then checked manually to minimise the risk of erroneous exclusions. The first author independently conducted title and abstract screening using the predetermined inclusion and exclusion criteria, as outlined above and within the PROSPERO registration [22], in line with the established guidance for protocol‑driven systematic reviews. Two co-authors independently conducted title and abstract screening of a random sample of 20 studies to assess the reliability of the screening decisions, resulting in universal agreement and supporting the consistency of the selection process [23]. The first author conducted comprehensive full-text screening using the predetermined inclusion and exclusion criteria. A random sample of 20 studies were independently assessed for inclusion by two co-authors, again resulting in universal agreement. Finally, one of the co-authors independently screened 10 randomly chosen full-text studies to evaluate screening reliability for the updated search to assess reliability over time, with consensus on every choice. These methods are consistent with generally acknowledged guidelines for minimising selection bias in systematic reviews and for transparent, repeatable research selection [22, 23, 25, 26, 29], and all of the results were unanimous.

Study selection and quality appraisal

After full-text screening, the additional methodological criterion to focus on high-quality evidence was implemented, such that only double- and triple-blinded RCTs were included in the final synthesis [30]. All included studies were evaluated by the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomised Controlled Trials (See Additional File 1) [31]. The checklist assesses 13 categories, encompassing randomisation techniques, blinding, outcome assessment, and statistical analysis. These criteria are deemed crucial for minimising bias and ensuring the validity of findings, hence informing judgements regarding research inclusion [28]. The first author conducted the critical evaluation of each study, while a co-author verified all assessments. Consensus was attained in every instance. Only studies that satisfied the JBI quality criteria, specifically concerning blinding, follow-up completeness, and outcome validity, were selected for inclusion. A JBI decision-making process-aligned numerical scoring system (Yes = 1, No = 0, Unclear = 0.5) was used for this review (Additional File 1), where a threshold score of ≥ 9.5 out of 13 was predetermined to indicate at least moderate methodological quality, and a threshold of 11 and above was considered high [31]. The item scores were aggregated to provide a total ranging from 0 to 13. The selected standards were established to guarantee that research of at least moderate quality fulfilled the majority of JBI criteria with minimal doubt, while studies rated as high quality adhered to nearly all requirements. These threshold scores align closely with other JBI-aligned reviews that utilise about 70–80% and ≥ 80–85% of checklist items fulfilled to differentiate between moderate and high-quality research [32, 33]. Utilising the JBI appraisal method and limiting inclusion to double or triple-blinded RCTs minimised the risk of bias.

Data extraction and synthesis

Data were extracted with a custom template informed by the PICOS framework and recognised systematic review processes [24]. Essential information encompassed study features, interventions, outcomes, and limitations. This facilitated a narrative synthesis, categorising studies by self-management technique and thematically synthesising the findings.

Author contact for clarification

Corresponding authors of published articles were contacted via email by the first author when study details were ambiguous. Specific clarification was requested for studies where important details like the intervention, timing in relation to the menstrual cycle, or outcome definitions could not be ascertained from the published report. One email reminder was sent after the initial two-week response time if no reply had been received. An additional two-week response period was then allocated. Studies were excluded if an explanation was not obtained within this four-week timeframe due to persistent ambiguity affecting the classification of the intervention or outcomes, as recommended by methodological guidelines to maintain transparency and reduce the possibility of misinterpretation or data extraction bias [26, 34]. All decisions about study inclusion were finalised after the revised search and data extraction; no study necessitated a change of its inclusion status due to late author explanation, as no additional replies were received beyond the predetermined four-week period. This period was chosen to align with standard practices in systematic reviews, wherein the majority of useful clarifications are acquired after one or two interactions, and to ensure the review remains feasible within the designated timeline [35].

Results

Search Results

The preliminary search produced 20,852 records. Following de-duplication, 13,208 distinct records were retained for screening. After the initial screening step, full-text evaluation was conducted on 1,691 articles that satisfied the inclusion criteria. Exclusion reasons at the full-text stage were documented and incorporated into the PRISMA flow diagram (Fig. 1) to maintain transparency in the review process [23]. Clarification was requested from the corresponding authors of 33 studies and one author responded with additional details (which did not meet the inclusion criteria) within the total four-week timeframe; therefore, all 33 studies were excluded. After full-text screening, a pool of 179 qualifying studies included quasi-experimental trials, prospective observational studies, crossover studies, single-blind clinical trials, open-label trials, pilot studies, and cross-sectional designs. Following the additional criterion of including double- and triple-blinded RCTs only, 64 studies remained.

Fig. 1.

PRISMA 2020 flowchart

Quality appraisal

The methodological quality of the 64 included studies were moderate to high. The majority of studies offered explicit descriptions of their randomisation procedures, outcome evaluations, and statistical analysis techniques [36]. However, compliance with treatment procedures was frequently self-reported, especially in nutritional and technology-driven strategies, and the outcome measures exhibited considerable variability, complicating direct comparisons. After quality assessment, 25 low-quality studies were removed and 39 moderate to high quality studies were included in the final synthesis.

Study characteristics

The included studies were published from 2000 to 2026 and represented 14 countries which were identified via the university location of the corresponding author, with the most studies conducted in Iran (n = 18), followed by Turkey (n = 9). The sample sizes of participants varied from 31 to 478, predominantly aged between 18 and 50 years, and the 39 studies collectively included 3,806 participants. Seven of the studies explicitly enlisted university students. The trials reported a diverse range of MCS, such as PMS, dysmenorrhea, bloating, exhaustion and mood disorders. Management strategies varied in duration, intensity, and delivery manner, encompassing both structured physical and lifestyle-oriented interventions. The assessed MCS management strategies were classified into four categories comprising of 42 treatment interventions: physical activity (n = 5), nutrition-based strategies (n = 26), combined strategies (n = 4), and other self-management strategies (n = 7). For the physical activity strategies, we first describe the blinding procedures for the five trials that met the requirements for higher methodological rigour (randomised design, allocation concealment, and blinding of key research workers), as these provided the major evidence for the synthesis. The characteristics of each study are summarised in Table 1.

Table 1.

Characteristics of the 39 included RCTs of non-clinical, self-management strategies for MCS

Study ID	Author(s), Year, Country	Study Design: Double blind or Triple Blind	Total Sample Size (n)	Age Range (yr)	Menstrual Status	Health Status Characteristics	Symptom(s) Reported	Self-Management Strategy
Self-Management Strategy: Physical Activity
1	Kamalifard et al., 2017, Iran [37]	Double Blinded groups: Researcher and data analysts. Further detail: The allocation of treatment was concealed from participants	62	20–45	PMS	Referred patients to private clinics complaining of PMS.	Emotional, behavioural (symptoms), impact of PMS on QOL, i.e. anger or irritability, anxiety or stress, crying or rising sensitivity to negative issues, depressed mood or hopelessness, loss of interest to work activities, decreased interest to house activities, loss of interest to social activities, concentration problems or lack of focus.	Yoga
2	Aksu et al., 2025, Turkey [38]	Double Blinded groups: Outcome assessor and data analysts. Further detail: The allocation of treatment was concealed from participants	478	18+	Dysmenorrhea	Regular menstrual periods (with 21–35-day intervals and lasting 3–8 days), having a menstrual cramp pain score above 4 points on the 10-point VAS for pain, and having a Menstruation Symptom Scale score of ≥ 60.	Dysmenorrhea	Yoga
3	Günebakan, et al., 2023, Turkey [39]	Double Blinded groups: Physiotherapist and outcome assessors. Further detail: The allocation of treatment was concealed from participants	32	18–45	Regular menstrual cycle	Healthy, no medication or mineral supplements during the last three menstrual cycles.	Menstrual symptoms, QOL, anxiety-depression level, body awareness, and self-esteem.	Tele-yoga training
4	Yosri, et al., 2022, Egypt [40]	Double Blinded groups: Participants engaged in various forms of exercise without knowledge of the designated groups and therapists were blinded. The allocation of treatment was concealed from participants.	120	19–25	Dysmenorrhea	BMI of 19–29 kg/m2, having normal menstrual cycles with no history of pelvic diseases, not receiving any hormonal therapy, or taking any analgesics during the menstrual cycle preceding the intervention.	Pain, water retention.	Yoga with different squatting exercises
5a	Yang et al., 2025, Taiwan [41]	Double Blinded groups: : Outcome assessors and statistical analysts. The allocation of treatment was concealed from participants.	15	18–40	Dysmenorrhea	Presence of PD, VAS score of the SF-MPQ (0–2 for the non-dysmenorrhea control group; >5 for the dysmenorrhea group).	Menstrual pain	High-intensity interval training
Self-Management Strategy: Nutrition- Herbal Supplementation
6	Atallahi et al., 2014, Iran [42]	Triple Blinded groups: Participants, researchers and data analysts.	80	20–45	Regular menstrual cycle	BMI of 19.8 to 26 kg/m2, having no night shifts, no smoking, regular menstrual periods with 21-day to 35-day cycles and three-day to ten-day bleeding period, no identified physical or psychological diseases and no antidepressants, hormones, or contraceptives use in the preceding three months.	Fatigue, Nausea, Vomiting, Lack of Energy, Headache, Diarrhoea, Mood Swings, Syncope.	Wheat germ extract
7	Schmidt et al., 2018, Germany[43]	Double Blinded groups: Participants and researchers.	48	18–45	PMS	PMS diagnosed by a gynaecologist, with regular menstrual cycles of 25–35 days.	Psychological symptoms including depression, anxiousness, mood swings, irritability, and difficulties in concentration, but also physiological symptoms like breast tenderness, headache, or weight gain.	A lecithin phosphatidylserine and phosphatidic acid complex (PAS)
8	Shabani et al., 2022, Iran [44]	Double Blinded groups: Participants and data analyst.	200	18–30	Dysmenorrhea	Moderate to severe menstruation pain (≥ 4 pain intensity based on VAS), menstruation pain started before 20 years of age, regular menstruation cycles with intervals of 21–35 days, menstrual bleeding lacking passing clots (low and moderate bleeding), onset and duration of menstruation from a few hours before menstruation up to day 5 of bleeding.	Back pain, vomiting, diarrhoea, dizziness, headache, anorexia.	Chamomile (and mefenamic acid)
9	Canning et al., 2010, UK [45]	Double Blinded groups: Participants and researchers.	36	18–45	PMS	Regular menstrual cycles (25–35 days).	PMS	St John’s wort
10	Mirghafourvand, et al., 2016, Iran [46]	Triple Blinded groups: Participants, researchers and data analysts.	93	18+	PMS	A regular (21–35 day) menstrual cycle, a normal BMI (18.5–25 kg/m2) and experience PMS symptoms during the luteal phase of the menstrual cycle.	PMS	Lemon balm (Melissa officinalis L.) alone and combined with lemon balm-Nepeta menthoides
11	Farahmand et al., 2020, Iran [47]	Double Blinded groups: Participants and researchers.	84	18–35	PMS	Regular menstruation (menstrual cycles of 21 to 35 days), with diagnosed PMS, no record of smoking cigarettes or consuming alcoholic beverages, no record of consuming drugs including hormonal, herbal, anticonvulsant or antidepressant medications, and no record of allergic reactions to herbal medicines.	Anger, irritability, tearful, depressed, decreased interest- work, home and social activities, difficulty concentrating, fatigue, overeating, insomnia, overwhelmed, physical symptoms.	Echium amoenum
12	Taavoni et al., 2014, Iran [48]	Triple Blinded groups: Participants, researchers and outcome assessors.	110	18–35	PMS	No systemic or genital diseases, regular menstrual cycles, have not been using analgesics or any kind of medication to overcome symptoms, diagnosis of PMS according to accepted criteria in the initial screening questionnaire and daily rating of symptoms severity using the Premenstrual Profile 2005 questionnaire.	PMS symptoms	Royal jelly
13	Saki et al., 2015, Iran [49]	Triple Blinded groups: Participants, researchers and outcome assessors.	80	18–30	PMS	Regular menstrual period with 24–35 day intervals, without any other physical, illness, mental disorder specially depression, and anti-depressants intake and hormone drugs. No special diet.	Menstrual pain	Primrose oil
14	Shabani et al., 2020, Iran [50]	Double Blinded groups: Participants and researchers.	200	18–30	Dysmenorrhea	Moderate to severe menstruation pain having a score of four or higher in terms of pain intensity according to VAS, a pain score of 0–3 were excluded, initiation of menstruation pain before 20 years of age, regular menstruation cycles with intervals of 21–35 days, menstrual bleeding without passing clots (low and moderate bleeding), onset and duration of menstruation from a few hours before menstruation up to day 5 of bleeding.	Menstrual pain, back pain, vomiting, diarrhoea, dizziness, headache, fainting, fatigue, mood changes, anorexia.	Ginger-chamomile sachet
15	Afrin et al., 2025, Bangladesh [51]	Double Blinded groups: Participants and researchers.	40	18–35	PMS	A regular menstrual cycle of 25–35 days in the last 6 months.	PMS symptoms- mood, physical and behavioural symptoms.	Nigella sativa seeds *
16	Lopresti et al., 2025, Australia [52]	Double Blinded groups: Participants and researchers.	92	18–50	Dysmenorrhea	Mild-to-moderately severe pain before and/or during menstruation for at least 3 months; physical and/or emotional symptoms, for at least 3 months; regular menstrual cycle length of 21 to 35 days; non-smoker; body mass index between 18 and 30 kg/m2.	Menstrual pain, menstrual distress, physical and psychological scores.	Khapregesic
17	Shabani et al., 2025, Iran [53]	Double Blinded groups: Participants and researchers.	62	18–25	PMS and dysmenorrhea	A regular 21–35-day menstrual cycle. Patients with primary dysmenorrhea and premenstrual syndrome must have a VAS score of ≥ 4 (indicating moderate to severe pain) and a PSST score of ≥ 20 (indicating moderate to severe symptomatology).	PMS symptoms and menstrual pain.	Curcumin capsules
18	Zhou et al., 2025, China [54]	Double Blinded groups: Participants and researchers.	156	18–45	PMS	A menstrual cycle of 21–35 days for 12 months. They passed the American College of Obstetricians and Gynaecologists’ PMS test. PMS was diagnosed when at least one affective (depression, anger outbursts, irritability, anxiety, or mood swings) and one physical (breast tenderness, abdominal bloating, headache, or extremity swelling) symptom occurred periodically within five days before menstruation and recurred in at least three cycles.	Premenstrual breast and nipple tenderness, anxiety, nervousness, easily excited, and restlessness, decreased interest in daily life, difficulty concentrating, drowsiness, feeling tired, feelings of devastation, difficulty coping with daily tasks, breast tenderness or swelling, headache, joint muscle pain, or swelling.	Jingqianshu granules
19	Rao et al., 2025, Australia [55]	Double Blinded groups: Participants and researchers.	80	18+	Dysmenorrhea	Menstrual cramps (primary dysmenorrhea): mild to moderate. Regular menstrual cycle (28 days ± 7 days), a history of menstrual cramp pain in four of the past six cycles, and take at least one OTC analgesic medication (e.g., naproxen, aspirin, ibuprofen, or acetaminophen) on at least one day of the cycle for effective pain relief.	Menstrual pain	Palmitoylethanolamide (Levagen+)
20	Herrera et al., 2024, Spain [56]	Double Blinded groups: Participants and researchers.	44	18–40	Regular menstrual cycle	Normal weight (BMI = 18.5–24.9 kg/m2), not taking oral contraceptives, antipsychotics, or anti-inflammatory drugs, having had normal menstrual cycles and bleeding during the last three months (3–7 days) and not having taken food supplements in the previous 3 months.	Mood, QOL, duration of their last menstrual cycle; the appearance of the affective and somatic symptoms described by American College of Obstetricians and Gynaecologists); the experience of pain, and its intensity, before the menstruation, the need for analgesics.	PREMEN-CALM® nutrition supplement
Self-Management Strategy: Nutrition – Vitamins and Minerals
5b	Yang et al., 2025 [41]	Double Blinded groups: Participants and researchers.	15	18–40	Dysmenorrhea	Presence of PD, VAS score of the SF-MPQ (0–2 for the non-dysmenorrhea control group; >5 for the dysmenorrhea group.	Menstrual pain	Probiotic supplementation
21	Lak et al., 2023, Iran [57]	Double Blinded groups: Participants and researchers.	112	18–50	Dysmenorrhea	No current history of gynaecologic or psychological diseases, no stressful events, no urogenital disorders, no abnormal vaginal and cervical secretions, no use of herbal remedies, non-smoker, no alcohol consumption, no coagulation disorders, irregular menstrual cycles, no history of pelvic or abdominal surgery, and no history of uterine and ovarian disorders. A history of primary dysmenorrhea (PD) over three menstrual cycles for at least 1 day per month.	Dysmenorrhea	Vitamin D and vitamin E supplements
22	Nikkhah et al., 2015, Iran [58]	Triple Blinded groups: Participants, researchers and data analysts.	118	18–25	Dysmenorrhea	Normal BMI(19.8–25 kg/m2), and regular menstrual periods with moderate to severe PD.	Dysmenorrhea/menstrual pain.	Boron supplement
23	Ahmadi et al., 2023, Iran [59]	Double Blinded groups: Participants and researchers.	86	18–35	PMS	Not reported	PMS symptoms	Zinc supplement
24	Aker et al., 2024, Turkey [60]	Double Blinded groups: Participants and researchers.	65	18+	PMS	Menstrual cycle length within the normal range (21–35 days), regular menstruation in the last three cycles, scoring 132 or above on the PPMS, not receiving medical treatment for PMS, and not having any psychiatric diagnosis.	PMS symptoms	Hydrogen-rich water consumption
25	Amzajerdi, et al., 2023, Iran [61]	Double Blinded groups: Participants and researchers.	84	18–25	Dysmenorrhea	BMI ≤ 30 (kg/m2), regular menstrual cycles of 21–35 days with menstrual period of 3–7 days, experience at least four consecutive painful periods in the past six months with the pain starting a few hours before or just after the onset of bleeding, vitamin D deficiency (25[OH]D serum level ≤ 30 ng/mL), normal serum calcium (8.6–10.3 mg/dL),	Menstrual pain	Vitamin D
26	Yaralizadeh et al., 2024, Iran [62]	Double Blinded groups: Participants and researchers.	60	18–22	Dysmenorrhea	Regular menstrual periods, moderate or severe PD (pain score of 5–9 using a VAS in previous cycles).	Menstrual pain	Magnesium supplement
27	Retallick-Brown et al., 2020, New Zealand [63]	Double Blinded groups: Participants and researchers.	78	18+	PMS	Regularly menstruating, with a cycle length of 21–35 days and met the diagnosis of PMS	PMS symptoms	Vitamin B6 with broad-spectrum micronutrients
28	Zarei et al., 2017, Iran [64]	Double Blinded groups: Participants and data analysts.	85	18–32	Dysmenorrhea	Painful and regular menstruation (duration of menstrual cycle 21 to 35 days) in recent six cycles with maximum pain intensity between 5.0 and 9.1 according to 10 cm VAS, with PD pain features.	Menstrual pain	Calcium and vitamin D and calcium alone
29	Zakaria et al., 2024, Malaysia [65]	Double Blinded groups: Participants and researchers.	72	23–41	Dysmenorrhea	Regular menstrual cycle, PD.	Menstrual pain, severity, physical and mental health scores.	Probiotics
30a	Jafari et al., 2019, Iran [66]	Triple Blinded groups: Participants, researchers and data analysts.	30	18–25	Dysmenorrhea	Moderate to severe PD, regular menstrual cycles (every 21–35 days and bleeding 3 to 10 days for at least three recent cycles).	Menstrual pain	Liquorice
Self-Management Strategy: Other Self- Management Strategy
30b	Jafari et al., 2019, Iran [66]	Triple Blinded groups: Participants, researchers and data analysts.	30	18–25	Dysmenorrhea	Moderate to severe PD, regular menstrual cycles (every 21–35 days and bleeding 3 to 10 days for at least three recent cycles).	Menstrual pain	Ibuprofen
31	Shin et al., 2012, South Korea [67]	Double Blinded groups: Participants and outcome assessors.	31	20–25	Dysmenorrhea	Not reported	Menstrual pain	Low light therapy
32	Heydari et al., 2018, Iran [68]	Triple Blinded groups: Participants, researchers and data analysts.	64	Age at enrolment 22.25 ± 2.65 (mean ± S.D.) years	PMS	Moderate- to- severe PMS (defined by PSST score of at least 20), had a menstrual cycle of 24–35 days, and were without psychological disorders based on a general health questionnaire (total score below 23).	Social and psychological symptoms.	Aromatherapy with essential oils of Rosa damascene
33	Samadipour, et al., 2021, Iran [69]	Double Blinded groups: Participants and researchers.	124	18–25	PMS	Regular menstrual cycle, no acute or chronic disease and not taking medicines or supplements.	PMS symptoms	Nigella sativa oil *
34	Küçükkaya et al., 2024, Turkey [70]	Double Blinded groups: Researchers and data analysts.	96	18–25	Dysmenorrhea	A VAS (100 mm VAS of pain) severity of 5 or higher and a regular menstrual cycle (28 ± 7 days) in the previous year.	Pain, perceived stress, menstrual symptoms.	Listening to music and drawing
35	Bai et al., 2017, China [71]	Double Blinded groups: Participants and data analysts.	134	18–30	Dysmenorrhea	Diagnosis of PD, a history of lower abdominal pain for more than 6 menstrual cycles moderate or severe pain, with an NRS score ≥ 5 out of 10; no alternative therapy including TENS within 1 month prior to enrolment in the study.	Menstrual pain	Transcutaneous electrical nerve stimulation therapy
36	Ozer et al., 2025, Turkey [72]	Triple Blinded groups: Participants, outcome assessor and researchers.	90	18–44	PMS	A regular menstrual cycle, no chronic illnesses, and a premenstrual syndrome scale score more than 110.	Anxiety, tiredness, nervousness, sadness, discomfort, and changes in appetite. Menstrual pain, bloating, sleep disturbances, negative impacts (somatic symptoms), coping mechanisms and MSQ total.	Aromatherapy with bergamot and grapefruit essential oils
Self-Management Strategy: Combined Strategy
37	Dayican et al., 2024, Turkey [73]	Double Blinded groups: Participants and researchers.	34	18–30	Dysmenorrhea	Presence of PD diagnosis, having a regular menstrual cycle for the last six months (21–35 days), having menstrual pain intensity ≥ 5 according to the VAS on the first day of the menstrual period,	Menstrual pain	Exercises and kinesio taping and electrotherapy
38	Yilmaz-Akyuz et al., 2019, Turkey [74]	Double Blinded groups: Participants and researchers.	111	18–35	PMS	BMI of 18.5–29.9 kg/m2 and regular menstrual cycles.	Menstrual pain	Diet and aerobic exercise
5c	Yang et al., 2025, Taiwan [41]	Double Blinded groups: Participants and researchers.	14	18–40	Dysmenorrhea	Presence of PD, VAS score of the SF-MPQ (0–2 for the non-dysmenorrhea control group; >5 for the dysmenorrhea group.	Menstrual pain	Probiotic supplementation and high-intensity interval training
39	Shabani et al., 2024, Iran [75]	Double Blinded groups: Participants and researchers.	135	18–24	Dysmenorrhea	Diagnostic criteria of PD with menstrual pain in the last three months, VAS for pain ≥ 5 for at least three consecutive menstrual cycles, BMI 19 to 30 kg/m2, regular periods, cycle duration 21 to 35 days, and bleeding duration between 3 to 7 days.	Menstrual pain	Rosa foetida extract and self-care education

Abbreviations

Tools: NRS Numeric Rating Scale, SF-MPQ Short-Form McGill Pain Questionnaire, VAS Visual Analogue Scale. Study Design types: D-2 Double blind Randomised Control Trial, RCT Randomised controlled trial, T-3Triple blind Randomised Control Trial. Symbols: n Sample Size/Total, N Population size, p Statistical significance p-value, S.D. Standard Deviation. Unit of measurement: BMI Body Mass Index, Yr Years. Menstrual/Symptom-related: PD Primary Dysmenorrhea, PMS Premenstrual Syndrome, PPMS Premenstrual Syndrome Scale, PSST Premenstrual Symptoms Screening Tool, QOL Quality of Life. Self-Management Strategy-Related: HIIT High-Intensity Interval Training, OTC Over-the-Counter Medication, PA Physical Activity, PAS A Lecithin Phosphatidylserine and Phosphatidic Acid Complex, TENS Transcutaneous Electrical Nerve Stimulation

Studies 30a and 30b originate from the same study but are separated due to the evaluation of different interventions

Studies 5a, 5b and 5c originate from the same study but are separated due to the evaluation of different interventions

*Nigella sativa appears in two rows as it reflects two independent studies: one using oral seed supplementation (nutrition) and one using topical oil (other self-management)

Strategy outcomes

Table 2 summarises the principal findings of the included studies, detailing the self-management strategies assessed and their reported impacts on MCS. Statistical results are reported as per the original study.

Table 2.

Results of the 39 included RCTs of non-clinical, self-management strategies for MCS

Study ID	Author(s)	Strategy Sub-type	Objectives	Intervention Details	Comparator	Between or within Subjects Design	Measurement Tools Used	Main Results	Evidence in-favour of Intervention (Yes / No)
Self-Management Strategy: Physical Activity
1	Kamalifard, et al., 2017 [37]	Yoga	To assess how yoga affects PD discomfort, menstrual symptoms, and quality of life.	Yoga for 10 weeks in 3 60-minute sessions.	Control group	Between	PSST questionnaire	Significantly reduced PMS symptoms (p < 0.05).	Yes
2	Aksu et al., 2025 [38]	Yoga	To assess how yoga affects PD discomfort, menstrual symptoms, and QOL.	A Hatha yoga curriculum included pranayama (10 min), warm-up (10 min), asanas (30 min), and deep relaxation (10 min). 12 weeks, 60 min twice a week, 24 times.	Control group	Between	VAS and MSS	Significantly reduced menstrual pain and symptoms, and improved QOL (p < 0.001).	Yes
3	Günebakan, et al., 2023 [39]	Tele-yoga	To examine the effects of tele-yoga training on menstrual symptoms, quality of life, anxiety-depression level, body awareness, sleep and energy.	Hatha yoga training via zoom for 6 weeks, 2 days a week, 45 min per session.	Control group	Between	Menstrual pain and symptoms, quality of life, depression, anxiety, body awareness, and self-esteem were measured BDS score, NHP , STAI, BAQ, and RSES.	Significantly reduced MSS (p = 0.001), menstrual pain symptoms (p = 0.003) and improved BDS (p = 0.000), NHP sleep (p = 0.021) and sub-parameters: energy (p = 0.002), emotional (p = 0.000) and isolation (p = 0.039).	Yes
4	Yosri et al., 2022 [40]	Different squatting exercises alongside yoga	To evaluate dysmenorrhea severity and menstrual distress in individuals with primary dysmenorrhea and the impact of yoga and squatting exercises.	Four yogic positions: cobra, cow-cat, fish, and legs up the wall for 6 days/week for two consecutive menstrual cycles. Squatting exercises: modified wall squat, sumo squat, or deep squat which were compared to a yoga only group.	Yoga only	Between	VAS and MDQ	Pain Intensity (Note: values are effect sizes): Yoga + Sumo Squat: 5.89; Yoga + Modified Wall Squat: 3.97; Yoga + Deep Squat: 3.94; Yoga Alone: 3.68; significantly, adding sumo or wall squats was more effective than yoga alone, with sumo squats, significantly outperforming deep squats	Yes
5a	Yang et al., 2025 - Treatment 1 [41]	HIIT	To evaluate the impact of HIIT on PD severity, physiological modulation and physical fitness.	10 week HIIT programme on spinning bikes led by a certified cycling coach.	Placebo and non-PD control group	Between	VAS score of the SF-MPQ (0–2 for the non-dysmenorrhea control group; >5 for the dysmenorrhea group).	Significantly reduced PMS and pain (p < 0.05) and physiological modulation and physical fitness were significantly improved (p < 0.05)	Yes
		Self-Management Strategy: Nutrition – Herbal Supplementation
6	Atallahi et al., 2014 [42]	Wheat germ extract	To assess the effects of wheat germ extract on the severity and systemic symptoms of primary dysmenorrhea.	1,200 mg wheat germ extract taken daily for 2 months, from sixteenth to fifth day of next menstrual cycle.	Placebo	Between	VAS measured pain severity, and a four-point verbal rating scale from zero to three assessed systemic symptoms (fatigue, diarrhoea, syncope, nausea and vomiting, loss of energy, headache, and mood swings).	Significant reduction in dysmenorrhea systemic symptoms (p < 0.001).	Yes
7	Schmidt et al., 2018 [43]	PAS	To examine the effects of supplementation with PAS on PMS symptom severity.	The PAS group received 100 mg PS, Lysphosphatidylserine, 100 mg PA, lysophosphatidic acid, 235 mg additional phospholipids and glycerides, and 5 mg silicon dioxide each capsule. 4 capsules per day for four menstrual cycles.	Placebo	Between	DRSP to diagnose and evaluate DSM-IV. PMDD/PMS Daily complaint severity determined via 24 questionnaire items.	Significantly reduced PMS symptoms DRSP (total, p = 0.001) and improved physical symptoms (p = 0.002).	Yes
8	Canning et al., 2010 [45]	St john’s wort	To investigate the effectiveness of st john’s wort physical, behavioural, or mental symptoms of premenstrual syndrome (PMS).	St john’s wort tablets 900 mg/day (standardised to 0.18% hypericin; 3.38% hyperforin) for two menstrual cycles.	Placebo	Within	Daily Symptom Report, State Anxiety Inventory, Beck Depression Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale.	Significantly improved physical and behavioural symptoms of PMS (p < 0.05). No significant effect on weekly reports of anxiety, depression, aggression, and impulsivity (p > 0.05).	Yes
9	Mirghafourvand et al., 2016 [46]	Lemon balm (Melissa officinalis L.) alone and combined with lemon balm-Nepeta menthoides (mint plant) capsules	To assess the efficacy lemon balm, both alone and in combination with a mint plant on PMS and associated quality of life.	500 mg capsules (were given (combined 250 mg lemon balm and 250 mg mint plant) daily from seven days after menstruation ended until the next cycle (two menstrual cycles). Lemon balm capsules alone was 500 mg of lemon balm.	Placebo	Between	DRSP and SF-36.	Significantly improved physical quality of life (P = 0.009) for both treatments, after two months. No difference between treatment groups (P = 1.000).	Yes
10	Farahmand et al., 2020 [47]	Echium amoenum (EA)	To evaluate the effect of EA on the severity of PMS.	450 mg of EA taken daily from day 21 of one cycle to day 3 of the next (10 days total) for two cycles.	Placebo	Between	PSST	Significant reduction in mean symptom score (p < 0.001) and PMS score (p < 0.001)	Yes
11	Taavoni et al., 2014 [48]	Royal jelly	To determine the effect of oral consumption of 1000 mg royal jelly capsule on premenstrual syndrome.	1000 mg royal jelly capsule orally daily from the first day of menstruation for two cycles.	Placebo	Between	Premenstrual Profile 2005 questionnaire.	PMS score reduced significantly (p < 0.001).	Yes
12	Saki et al., 2015 [49]	Primrose oil	To investigate the effect of primrose oil on PMS.	Primrose oil 1500 mg for three months.	Placebo	Between	DSMIV-TR criterion for PMS.	Symptom severity decreased significantly (p < 0.001).	Yes
13	Shabani et al., 2020 [50]	Ginger-chamomile Sachet	To investigate the effect of ginger-chamomile herbs with honey in reducing dysmenorrhea pain, associated symptoms and the extent of bleeding.	Ginger-chamomile and honey sachets (1000 mg ginger root powder, 5000 mg chamomile, and a teaspoon of honey). Sachet contents were gently heated in a glass of water for three minutes, strained, and dissolved with a teaspoon of honey before consumption for two menstrual cycles.	Mefenamic acid	Between	The Andersch-Milsom Verbal Scale, VAS, PBAC, and Andersch-Milsom Verbal Multidimensional Scoring System were used to measure bleeding and dysmenorrhea symptoms.	Significantly reduced pain intensity (p < 0.05) and dysmenorrhea and associated symptoms (p = 0.009).	Yes
14	Shabani et al., 2022 [44]	Chamomile	To investigate the impact of chamomile sachet on primary dysmenorrhea, its relevant symptoms as well as bleeding.	5000 mg sachet of chamomile and a teaspoon of honey, three times daily for two menstrual cycles.	Mefenamic acid	Between	Dysmenorrhea pain was assessed using VAS, with 8–10, 4–7, and 1–3 scores representing severe, moderate, and mild pain, respectively. PBAC used to measure the extent of bleeding.	Significant reduction in pain severity (p = 0.001) and the number of pain days (p = 0.0001) after two months of treatment.	No
15	Afrin et al., 2025 [51]	Nigella sativa seeds	To examine the effect of Nigella sativa on the intensity of PMS symptoms.	One pill twice per day for two consecutive menstrual cycles.	Placebo	Between	PSST questionnaire	Significant reduction in overall mean PMS scores (p < 0.05).	Yes
16	Lopresti et al., 2025 [52]	Khapregesic	To evaluate the effectiveness of Khaya senegalensis supplementation (Khapregesic®) on menstrual pain and menstrual discomfort.	Two tablets three times a day, with or without food. It was advised to take the first dose at 8 am, the second at 2 pm, and the third at 8 pm or 1 h before bedtime. Khapregesic tablets were 500 mg, giving a 3 g daily dosage.	Placebo	Between	Daily Symptom Report (DSR-20) and Short-Form-20 (SF-20)	Significant decreases in daily menstrual pain ratings (p = 0.033) and overall menstrual distress (p = 0.042).	Yes
17	Shabani et al., 2025 [53]	Curcumin capsules	To evaluate the impact of curcumin on premenstrual syndrome and dysmenorrhea.	500 mg curcumin capsules, administered once daily after eating for 10 days during each of two menstrual cycles (from 7 days prior to 3 days following the anticipated commencement of menstruation).	Placebo	Between	PSST and VAS	Significant reduction in PMS scores after three menstrual cycles (follow up one month after intervention_ (p = 0.064) and VAS scores (p = 0.029).	Yes
18	Zhou et al., 2025 [54]	Jingqianshu granules	To assess the effectiveness of jingqianshu in females with premenstrual syndrome.	Total of 6 g per day taken in three doses per day, commenced seven days prior to the onset of menstruation and maintained for seven consecutive days during each menstrual cycle.	Placebo	Between	Daily Record of Severity of Problems (DRSP), effectiveness of the treatment questionnaire.	Significant improvements in DRSP symptoms, such as anxiety, fatigue, emotional instability, attention difficulties, and breast tenderness (p < 0.05).	Yes
19	Rao et al., 2025 [55]	Palmitoylethanolamide (PEA) (Levagen+)	To assess the efficacy of PEA in reducing acute menstrual discomfort.	300 mg of PEA at the onset of menstrual discomfort. Pain scores were documented at 30-minute intervals for a duration of up to 4 h. If discomfort continued, a second dose was allowed after 2 h.	Placebo	Between	NRS	Significant decrease in pain scores at 1 (p = 0.045), 1.5 (p = 0.009), 2 (p = 0.015), and 2.5 (p = 0.039) hours following administration.	Yes
20	Herrera et al., 2024 [56]	PREMEN-CALM ® nutrition supplement	To evaluate the effectiveness of a commercial nutritional supplement in treating PMS, quality of life and characteristics of the menstrual cycle were analysed.	A daily capsule (30–60 min before bedtime) for three complete menstrual cycles.	Placebo	Between	Beck Depression Inventory, PSQI, STAI and WHOQOL-BREF.	No statistical differences for QOL and menstrual cycle symptoms.	No
Self-Management Strategy: Nutrition – Vitamins and Minerals
5b	Yang et al., 2025 - Treatment 2 [41]	Probiotic supplementation	To evaluate the impact of probiotic supplementation on PD severity, physiological modulation and physical fitness.	10 week probiotic supplementation (Bifidobacterium longum subsp. longum OLP-01 (OLP-01), L. plantarum PL-02 (PL-02), and Lactococcus lactis LY-66, (ratio 1:1:1). Each capsule included 300 mg of lyophilized probiotics powder, equivalent to 1.5 × 1010 colony-forming units, and 100 mg of excipient of microcrystalline cellulose).	Placebo and non-PD control group	Between	VAS score of the SF-MPQ (0–2 for the non-dysmenorrhea control group; >5 for the dysmenorrhea group).	No significant impact on pain, physiological modulation or physical fitness (p > 0.05).	No
21	Amzajerdi et al., 2023 [61]	Vitamin D supplement	To investigate the effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss.	Six 50,000-IU vitamin D tablets taken five days before start of menstrual cycle.	Placebo	Between	VAS, VMS, and PBLAC questionnaires	Significant reduction in VAS and VMS in first and second menstrual cycles (p < 0.001 for both).	Yes
22	Lak et al., 2023 [57]	Vitamin D and vitamin E supplement	To examine the effects of vitamin D and E on dysmenorrhea.	400 mg of Vitamin E, or 1000 IU of Vitamin D, or 1000 IU of Vitamin D and 400 mg of Vitamin E. Taken in the first and second months (three menstrual cycles).	Placebo	Between	VAS and CMSS.	All three treatment groups (Vitamin E, Vitamin D, and combination) showed significantly lower menstrual pain duration and intensity scores (all p < 0.05). After two months, all showed better results (all p < 0.01).	Yes
23	Nikkhah et al., 2015 [58]	Boron supplement	To determine the effects of Boron supplementation on the severity and duration of menstrual pain.	300 mg capsules (88.5 mg sodium tetraborate and 221.5 mg lactose powder) taken for two menstrual cycles.	Placebo	Between	VAS	Reduced severity and duration of pain (p < 0.05).	Yes
24	Ahmadi et al., 2023 [59]	Zinc supplement	To evaluate the effects of zinc supplementation on premenstrual and associated symptoms.	220 mg zinc sulphate capsules (50 mg zinc) taken daily for 24 weeks.	Placebo	Between	PSST-A	Significantly reduced PMS symptoms, including anxiety, sadness, overeating, breast tenderness, headaches, muscular soreness, bloating, and weight gain, after 24 weeks of supplementation (p < 0.001).	Yes
25	Aker et al., 2024 [60]	Hydrogen-rich water (HRW) consumption	To investigate the effect of drinking HRW on the severity of premenstrual symptoms and the quality of life.	1500–2000 ml HRW every day taken from 16th day of menstrual cycle (start of secretory phase) until 2nd day of next cycle for three menstrual cycles.	Control group	Between	Premenstrual Syndrome Scale	Significantly lower mean PMSS scores (p < 0.05). Significantly higher mean scores in the Physical Health and Psychological domains of the WHOQOL-BREF after three menstrual cycles (p < 0.05).	Yes
26	Yaralizadeh, et al., 2024 [62]	Magnesium supplement	To compare the impact of two different doses of magnesium on severity of menstrual symptoms.	Two groups of either 150 mg or 300 mg) from day 15 of their cycle to the day without menstrual pain in the following cycle (for four menstrual cycles).	Placebo	Between	VAS	Both doses of magnesium significantly reduced all symptoms of dysmenorrhea (p < 0.001).	Yes
27	Retallick-Brown et al., 2020 [63]	Vitamin B6 with broad-spectrum micronutrients (EMP+)	To compare efficacy of a broad-spectrum micronutrient formula (consisting of minerals and vitamins) to a single vitamin (B6) for treatment of PMS.	Either 80 mg of B6 and 0.8 g riboflavin or EMP+ containing 36 ingredients (vitamins, minerals, amino acids and antioxidants) were taken on the first day of their new cycle and ended on the last day of their third cycle.	Placebo	Between	DRSP questionnaire online to confirm the presence of menstrual-related symptoms.	Both vitamin B6 and micronutrient treatments reduced PMS symptoms with moderate effect sizes (ES) (micronutrient ES = 0.50–0.56; B6 ES = 0.43–0.56. The micronutrient group had higher health-related quality of life compared to the B6 group (p < 0.05).	Yes
28	Zarei et al., 2017 [64]	Calcium-vitamin D and calcium alone	To assess calcium-vitamin D and calcium alone on pain intensity and menstrual blood loss.	Calcium-vitamin D group took capsules containing 1000 mg of calcium carbonate and 5000 units of vitamin D and calcium alone group took 1000 mg of calcium carbonate from the 15th day of menstruation until menstrual pain disappeared in the following cycle.	Placebo	Between	VAS, SF-36 questionnaire and (FFQ).	The calcium-vitamin D and calcium-alone groups reduced mean pain intensity but only the calcium-alone group showed a statistically significant reduction (p = 0.001).	Yes- Calcium alone
29	Zakaria et al., 2024 [65]	Probiotics	To examine effect of probiotics on quality of life, reflected by the pain, severity, physical health, and mental health scores and frequency of NSAID use on the second day of menstruation.	Two sachets daily for 3 months containing 5 billion colony-forming units each of Lactobacillus acidophilus BCMC 12,130, Lactobacillus casei subsp BCMC 12,313, Lactobacillus lactis BCMC 12,451, Bifidobacterium bifidum BCMC 02290, Bifidobacterium longum BCMC 02120, and Bifidobacterium infantis BCMC 02129.	Placebo	Between	VAS	Quality-of-life scores were similar. Pain severity scores were significantly decreased (p = 0.003).	Yes
30a	Jafari et al., 2019 - Treatment 1 [66]	Liquorice (G. glabra)	To evaluate the effect of the G. glabra on primary dysmenorrhea.	G. glabra syrup (150 mg/mL), from the first to the fifth day of menstruation for two menstrual cycles).	Placebo	Between	VAS and IPAQ.	Significantly reduced dysmenorrhea (p < 0.001).	Yes
Self-Management Strategy: Other Self-Management Strategy
30b	Jafari et al., 2019 - Treatment 2 [66]	Ibuprofen	To evaluate the effect of the ibuprofen on primary dysmenorrhea.	400 mg ibuprofen tablets every 8 h from the first to the fifth day of menstruation for two menstrual cycles).	Placebo	Between	VAS and IPAQ	Significantly reduced dysmenorrhea (p < 0.001).	Yes
31	Shin et al., 2012 [67]	Low light therapy	To evaluate the effectiveness of skin adhesive LLLT in participants with dysmenorrhoea.	Conception Vessel 4 (Guanyuan) and CV6 (Qihai) acupuncture points, a coloured probe from the skin adhesive LLLT device to both acupuncture locations, for 20 min for five days before menstruation, for six months.	Placebo	Between	Self-reported menstrual pain intensity over 6 by 0–10 VAS scores.	Significant reduction in menstrual pain intensity in VAS changes within 6 months of LLT(p = 0.001).	Yes
32	Heydari et al., 2018 [68]	Aromatherapy with essential oils of rosa damascena	To investigate the efficacy of aromatherapy with essential oils of rosa damascena for the management of PMS.	Aromatherapy with essential oil of rosa damascena (4% concentration) for 5 min, twice daily, throughout a duration of 5 days during the luteal phase, for two months.	Placebo	Between	PSST, general health questionnaire	At 2 months, there were improved psychological, physical, social and total PMS symptoms (p < 0.001).	Yes
33	Samadipour et al., 2021 [69]	Nigella sativa oil	To evaluate the effect of Nigella sativa oil on PMS.	Massaging 0.5 ml drops of Nigella sativa oil on the scalp at night seven days before menstruation for three cycles.	Placebo	Between	PSST, VAS	Significant decreases were noted in psychological (p = 0.01), behavioural (p = 0.02), and physical symptoms (p = 0.05). No significant effects were found for depression or abdominal bloating (both p = 0.10).	Yes
34	Küçükkaya et al., 2024 [70]	Listening to music and drawing	To evaluate listening to music and drawing on menstrual pain, menstrual symptoms and perceived stress levels.	The music group listened to a 29-minute and 32-second song for a total of four days, three days before menstruation and the first day of menstruation. The drawing group were asked to draw pictures for four days (three days before menstruation and the first day of menstruation) for 29 min and 32 s.	Control group	Between	VAS, PSS and MSS	Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music groups decreased significantly at 1st and 2nd months post-intervention (p < 0.001).	Yes
35	Bai et al., 2017 [71]	Transcutaneous electrical nerve stimulation therapy	To investigate the effect and safety of TENS therapy for relieving pain and quality of life in women with PD.	30 min of 2–100 Hz TENS at the uncomfortable lower abdomen area. The treatment commenced on the initial day of menstruation and concluded on the final day of menstruation.	Placebo	Between	NRS	Significant pain alleviation including NRS (p < 0.01), duration of relief from dysmenorrhea discomfort (p < 0.01), and quantity of ibuprofen tablets used (p < 0.01). No significant variations in WHOQOL-BREF scores.	Yes
36	Ozer et al., 2025 [72]	Aromatherapy with bergamot and grapefruit essential oils	To assess the impact of an aromatherapy intervention utilising bergamot and grapefruit essential oils on premenstrual syndrome and menstrual symptoms.	Three drops of 100% concentrated oil (bergamot essential oil or grapefruit essential oil) were applied to a cotton ball and inhaled from 15 cm for 30 min.to last three menstrual cycles during the luteal phase for four days, at the same time of day, three times a day.	Placebo	Between	PMSS and MSQ	Grapefruit essential oil significantly reduced MSQ sub-scale scores, particularly monthly pain symptoms (p = 0.024) and menstrual pain coping techniques (p = 0.011). Bergamot essential oil reduced PMSS scores (p = 0.001), sub-scale scores for depressive affect, irritability, depressive thoughts and appetite changes, and pain (p = 0.001).	Yes
Self-Management Strategy: Combined Strategy
37	Dayican et al., 2024 [73]	Exercises combined with kinesio taping or electrotherapy	To evaluate and compare the effects of exercises combined with either kinesio taping or electrotherapy on reducing menstrual pain and associated symptoms.	Both groups did 40-minute, two-day-a-week exercise. Warm-up (5 min), strengthening (10 min), stretching (10 min), yoga (5 min), and relaxation (10 min). Kinesio group, kinesio taping was performed to the sacral and suprapubic regions. Electrotherapy group, interferential current was applied with four vacuum electrodes using Chattanooga® combined electrotherapy device. All interventions were 8 weeks.	Control group	Between	VAS and MSQ	Both kinesio taping and electrotherapy groups showed significant decreases in VAS, MSQ-pain symptoms, and MSQ-coping strategies scores (p < 0.001). Electrotherapy also improved MSQ-negative effects/somatic complaints (p = 0.047) and total scores (p = 0.030).	Yes
38	Yilmaz-Akyuz et al., 2019 [74]	Diet and aerobic exercise	To determine the effectiveness of aerobic exercise and diet with PPMS.	A 12-week PMS diet (50–55% carbohydrate, 25–30% fat, 15–20% protein; carbohydrate was low in refined sugar, fish 1–2 times a week, calcium > 1000 mg, dried almonds 20 g) and 30 min aerobic exercise, delivered by an expert trainer, delivered 3 days a week, for 12 weeks.	Control group	Between	Student Information Form, VAS, PMSS, and FFQ	Significantly lower PMS score (p = 0.000)	Yes
5c	Yang et al., 2025  - Treatment 3 [41]	Probiotic supplementation and HIIT	To evaluate the impact of probiotic supplementation and HIIT on PD severity, physiological modulation and physical fitness.	10 week HIIT programme on spinning bikes led by a certified cycling coach and probiotic supplementation (Bifidobacterium longum subsp. longum OLP-01 (OLP-01), L. plantarum PL-02 (PL-02), and Lactococcus lactis LY-66, (ratio 1:1:1), was prepared in capsules. Each capsule included 300 mg of lyophilized probiotics powder, equivalent to 1.5 × 1010 colony-forming units, and 100 mg of excipient of microcrystalline cellulose).	Placebo and non-PD control group	Between	VAS score of the SF-MPQ (0–2 for the non-dysmenorrhea control group; >5 for the dysmenorrhea group).	The combination intervention decreased symptoms and inflammatory indicators but remained worse than healthy controls with fewer protective hormones (p < 0.05). No differences between combined and HIIT-only treatments in pain, hormonal outcomes, or fitness (p > 0.05), showing HIIT drove these effects. The combined intervention outperformed probiotics alone in decreasing pain, inflammation, and enhancing cardiovascular endurance and explosive strength (p < 0.05).	Yes
39	Shabani et al., 2024 [75]	Rosa foetida extract along with self-care education	To determine the effect of rosa foetida extract along with self-care behaviours on primary dysmenorrhea.	Education was taught in four 60–90-minute sessions over two days. rosa foetida capsules with 200 mg of extract were taken every 8 h for two menstrual cycles.	Placebo	Between	VAS, MDQ, DSCS, and PBAC	Significant pain decrease in rosa foetida extract group (p < 0.001). Menstrual distress decreased more in the Rosa foetida group. Rosa foetida reduced menstrual bleeding significantly (p = 0.041).	Yes- rosa foetida, No- Self-care

Abbreviations -Tools: BAQ Body Awareness Questionnaire, BDS Beck Depression Scale, CMSS Cox Menstrual Symptom Scale, DSR-20 Daily Symptom Report, DRSP Daily record of severity of problems, DSCS Dysmenorrhea Self-Care Behaviours Scale, DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSMIV-TR Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, FFQ Food Frequency Questionnaire, IPAQ Physical Activity Questionnaire, MDQ Menstrual Distress Scale Questionnaire, MSS Menstrual Symptoms Scale, NHP Nottingham Health Profile, NRS Numeric Rating Scale, PBAC Pictorial Bleeding Assessment Loss Chart, PMSS Premenstrual Syndrome Scale, PSQI Pittsburgh Sleep Quality Index, PSST Premenstrual Symptoms Screening Tool, PSST-A Premenstrual Symptoms Screening Tool-Adolescent, RSES Rosenberg Self-Esteem Scale, SF-20 Short Form 20, SF-36 Quality of life questionnaire-the short form 36, SF-MPQ Short-Form McGill Pain Questionnaire, STAI State and Trait Anxiety Scale, VAS Visual Analogue Scale, VMS Verbal Multidimensional Scoring System, WHOQOL-BREF WHO Quality of Life- Short Form

Study Design: RCT Randomised Control Trial

Symbols: Kg Kilogram, N Population Size, n Sample Size/Total, p Statistical Significance p – Value

Unit of Measurement: BMI Body Mass Index, m2 Meters squared

Menstrual/Symptom-related: PD Primary Dysmenorrhea, PMDD Premenstrual Dysphoric Disorder, PMS Premenstrual Syndrome, QOL Quality of Life

Self-Management Strategy-related: EA Echium Amoenum, HIIT High-Intensity Interval Training, HRW Hydrogen-Rich Water, LLT Low Light Therapy, NSAID Non-Steroidal Anti-Inflammatory Drug, OTC Over-the-Counter Medication, PA Phosphatidic Acid, PAS A Lecithin Phosphatidylserine and Phosphatidic Acid Complex, PS Lipogen's Phosphatidylserine, TENS Transcutaneous Electrical Nerve Stimulation

P values are reported as per original studies. Studies 30a and 30b originate from the same study but are separated due to the evaluation of different interventions. Studies 5a , 5b and 5c originate from the same study but are separated due to the evaluation of different interventions. Nigella sativa appears in two rows as it reflects two independent studies: one using oral seed supplementation (nutrition) and one using topical oil (other self-management)

Physical activity strategies

Physical activity strategies were included in four studies and comprised of five intervention treatments, with a total of 692 participants, and involved self-led and instructed yoga, tele-yoga (i.e., remote, instructor-led yoga using digital communication platforms), and targeted squats. These strategies improved MCS such as pain intensity, psychological well-being, and quality of life. Kamalifard et al. [37] observed that yoga significantly reduced PMS symptoms (p < 0.05) in the 62 participants who were referred to private clinics complaining of PMS. Aksu et al. [38] found that yoga decreased the intensity of menstrual pain and symptoms, with notable improvements in quality of life (QOL) (p < 0.001). Günebakan et al. [39] found tele-yoga to decrease Menstrual Symptom Score (MSS) (p = 0.001) and menstrual pain symptoms (p = 0.003), and improve psychological factors, including Beck Depression Scale (BDS) scores (p = 0.000) and Nottingham Health Profile (NHP) subdomains of sleep, energy, emotional stability, and isolation. Yosri et al. [40] investigated yoga and squatting exercises, showing that yoga plus a modified wall squat or a sumo squat reduced pain intensity (effect size = 3.97 and 5.89, respectively) compared to yoga alone (effect size = 3.68). Taken together, these studies demonstrate that yoga (with or without squats) can reduce primary dysmenorrhea and other MCS. Yang et al. [41] investigated several interventions, including a 10-week high-intensity interval training (HIIT) cycling programme led by a certified cycling coach, and found a significant reduction in PMS and pain (p < 0.05). Furthermore, physiological modulation (i.e., biological systems controlling their activity to preserve homeostasis and adapt to changing internal or external environments) and physical fitness were significantly improved (p < 0.05), while no strategies showed detrimental effects on MCS.

Nutritional strategies

Nutritional strategies were included in 25 studies and comprised of 26 treatment interventions, with a total of 2,145 participants, and involved herbal supplementation and vitamin/mineral supplements.

Herbal supplementation

Atallahi et al. [42] found that 400 mg capsules of wheat germ extract, taken for three menstrual cycles, significantly decreased pain intensity and systemic symptoms in participants experiencing dysmenorrhea (p < 0.001). Schmidt et al. [43] reported that lecithin phosphatidylserine (PS) and phosphatidic acid (PA) combination capsules (PAS) (100 mg PS, 100 mg PA, additional phospholipids and glycerides, and 5 mg silicon dioxide), taken for four consecutive menstrual cycles, significantly improved PMS symptom scores (p = 0.001), including physical and depressive symptoms (p = 0.002 and 0.068). Canning et al. [45] examined 900 mg/day of hypericum perforatum (St John’s Wort), taken for two menstrual cycles, showing significant improvements in physical and behavioural symptoms (p < 0.05), although no significant benefits were observed for mood- or pain-related PMS symptoms (p > 0.05). Mirghafourvand et al. [46] showed that lemon balm alone significantly alleviated PMS symptoms across two menstrual cycles (p = 0.006), while QOL metrics exhibited significant enhancement in both therapy cohorts (lemon balm alone and lemon balm with nepeta menthoides (p = 0.024)). Farahmand et al. [47] demonstrated that echium amoenum capsules (450 mg) taken for two consecutive cycles significantly alleviated PMS symptoms (p < 0.001). Taavoni et al. [48] found that royal jelly capsules (1000 mg) taken for two menstrual cycles improved PMS scores (p < 0.001). Saki et al. [49] demonstrated that 1500 mg of daily primrose oil taken over a 3-month period resulted in a significant reduction in symptom severity (p < 0.01). Shabani et al. [50] established that the ingestion of a sachet comprising 1000 mg of ginger root powder, 5000 mg of chamomile, and one teaspoon of honey three times daily for two successive menstrual cycles led to a significantly greater reduction in pain intensity (p < 0.05) and related dysmenorrhea symptoms (p = 0.009) in comparison to mefenamic acid treatment. Shabani et al. [44] established that there was a significant reduction in pain severity (p = 0.001) and the number of pain days (p = 0.0001) after two months of treatment when chamomile alone was compared to mefenamic acid. Herrera et al. [56] assessed the PREMEN-CALM^® phytotherapeutic supplement (γ-aminobutyric acid, Rhodiola rosea L., Vitex agnus-castus, vitamin B6 and melatonin) taken for three menstrual cycles and identified an increase in antioxidant status (p = 0.002), mood profile (p = 0.02), and affective symptoms (p = 0.01). Afrin et al. [51] found that 500 mg capsules of nigella sativa seeds taken for two menstrual cycles significantly decreased PMS scores (p < 0.05). Lopresti et al. [52] found that a daily dose of 3 g of khapregesic tablets, derived from dry stem bark, taken for one menstrual cycle, significantly decreased daily menstrual pain (p = 0.033) and menstrual distress (p = 0.042). Nigella sativa was represented by two independent studies: one evaluating oral seed ingestion, classed under ‘Nutritional’ strategies, and another evaluating topical oil application, classified under ‘Other’ strategies. Shabani et al. [53] evaluated 500 mg of curcumin capsules daily for two menstrual cycles, which significantly decreased PMS (p = 0.064) and visual analogue scale (VAS) scores (p = 0.029). Zhou et al. [54] discovered that 6 g of jingqianshu granules daily for three menstrual cycles significantly improved daily record of severity of problems (DRSP) symptoms, including anxiety, fatigue, emotional instability, attention difficulties and breast tenderness (p < 0.05). Rao et al. [55] evaluated 300 mg of Palmitoylethanolamide (PEA) (Levagen+) daily for 16 weeks, which led to significant decreases in pain scores 1–2.5 h after administration (p < 0.05).

Vitamins and minerals

Yang et al. [41] issued an eight-week probiotic supplementation, which had no significant impact on pain, physiological modulation or physical fitness (p > 0.05). Amzajerdi et al. [61] demonstrated that a single dose of 300,000 IU vitamin D (six tablets of 50,000 IU taken over 24 h) significantly diminished pain intensity over two subsequent menstrual cycles in women with primary dysmenorrhea and vitamin D deficiency, demonstrated by reductions in verbal multidimensional scoring system (VMS) scores for dysmenorrhea severity and VAS scores for intensity of pain (p < 0.001 for both). Lak et al. [57] reported that vitamin D (1000 IU) and vitamin E (400-mg capsules) taken daily for two menstrual cycles significantly decreased intensity and duration of menstruation discomfort, with cumulative enhancements observed by the second month (p < 0.01). Nikkhah et al. [58] observed significantly decreased pain intensity and duration (p < 0.05) with 10-mg boron capsules taken for two menstrual cycles. Ahmadi et al. [59] found that 220-mg zinc sulphate capsules (containing 50 mg of zinc) taken daily for 24 weeks significantly alleviated many PMS symptoms (e.g., anger, anxiety, breast tenderness, bloating; all p < 0.001). Aker et al. [60] indicated that 1500–2000 mL of hydrogen-rich water taken daily for three menstrual cycles significantly improved PMS scores and physical and psychological health scores on the WHO Quality of Life Short Form (WHOQOL-BREF) (p < 0.05). Yaralizadeh et al. [62] demonstrated that both low (150 mg) and high (300 mg) doses of magnesium taken daily for four menstrual cycles significantly alleviated dysmenorrhea symptoms (p < 0.001). Retallick-Brown et al. [63] found that both a vitamin B6 formula (80 mg of B6 and 0.8 mg of riboflavin) and a broad-spectrum micronutrient supplement taken daily (EMPowerplus Advanced (EMP+), containing 36 elements including vitamins, minerals, amino acids, and antioxidants, taken for five menstrual cycles alleviated PMS symptoms with moderate effect sizes and improved health-related QOL (p < 0.05). Zarei et al. [64] discovered that calcium alone (1000 mg), in contrast to calcium and vitamin D (1000 mg calcium + 5000 IU vitamin D3) taken daily for three cycles significantly alleviated pain (p = 0.001). Zakaria et al. [65] showed that three months of probiotic supplementation taken daily significantly reduced pain severity scores (VRS) using categorical severity levels (p = 0.03), however, the pain score reduction (VAS) using a continuous numerical score was not significant (p = 0.69) after three months of treatment. Finally, Jafari et al. [67] included supplementation with 150 mg/mL of liquorice syrup (G. glabra) every eight hours, from the first to the fifth day of menstruation for two menstrual cycles and found a significant reduction in dysmenorrhea (p < 0.001). These studies demonstrate that nutritional supplementation strategies can reduce PMS symptoms and dysmenorrhea. None of the nutritional strategies showed negative effects.

Other self-management strategies

Other self-management strategies were included in six studies and comprised of seven treatment interventions, with a total of 539 participants, encompassing non-prescription (i.e., OTC) NSAIDs, low-level light therapy (LLLT), aromatherapy, herbal topical applications, creative art strategies, and electrical nerve stimulation. Jafari et al. [66] included an ibuprofen intervention (400 mg every eight hours for two consecutive menstrual cycles) which significantly reduced dysmenorrhea (p < 0.001). Shin et al. [67] showed LLLT administered for six months reduced pain intensity (p = 0.001). Heydari et al. [68] examined the efficacy of aromatherapy utilising rosa damascena essential oils (4% concentration) for two months, reporting enhancements in psychological (p < 0.001), physical (p < 0.001), social (p = 0.002), and overall PMS scores (p < 0.001). Samadipour et al. [69] found that topical administration of Nigella sativa oil to the scalp daily, for three menstrual cycles, decreased almost all psychological (p = 0.01), behavioural (p = 0.02), and physical (p = 0.05) PMS symptoms, while no significant effects were found for depression or abdominal bloating (both p = 0.10). Küçükkaya et al. [70] investigated the impact of listening to music and sketching as creative therapies on dysmenorrhea for two months, with both groups exhibiting substantial decreases in menstrual pain intensity, perceived stress levels and menstrual symptoms (all p < 0.001). Bai et al. [71] found that transcutaneous electrical nerve stimulation (TENS) for three menstrual cycles significantly alleviated pain (p < 0.01), extended the duration of relief (p < 0.01) and reduced reliance on ibuprofen (p < 0.01) in women with dysmenorrhea. Özer et al. [72] found that three menstrual cycles of aromatherapy using grapefruit essential oil significantly lowered menstrual pain coping mechanisms (p = 0.011) and bergamot essential oil significantly lowered PMS scale scores (p = 0.001), and reduced hunger changes, irritability, depression and pain (p = 0.001). Overall, these self-management strategies show distinct patterns in their effects on menstrual symptoms, namely improvements in pain, exhaustion, mood fluctuations, and overall QOL classified as physical, psychological, or functional outcomes. None of the strategies showed negative effects.

Combined strategies

Exercise, nutritional education, kinesio taping, electrotherapy, HIIT and probiotics were some of the strategies used in combination in four studies that included a total of 3,500 participants. Dayican et al. [73] found that exercise combined with kinesio taping or electrotherapy for eight weeks in individuals with primary dysmenorrhea significantly reduced VAS scores (p < 0.001). Electrotherapy alone reduced somatic symptoms (p = 0.047) and Menstrual Symptom Questionnaire (MSQ) total scores (p = 0.030). Yilmaz-Akyuz et al. [74] found that exercise (12 weeks of aerobic exercises three days a week for thirty minutes) and dietary changes (a 12-week PMS diet which contained 50–55% carbohydrates, 25–30% fat, 15–20% protein) over two menstrual cycles reduced PMS scores (p = 0.000). Yang et al. [41] showed that probiotic supplements (300 mg of lyophilised probiotics powder and 100 mg of microcrystalline cellulose excipient) and HIIT for 10 weeks significantly reduced premenstrual symptoms and the Menstrual Distress Questionnaire (MDQ) score. Over two months, Shabani et al. [76] tested rosa foetida extract aromatherapy and self-care education on menstruation symptoms and found that both interventions significantly reduced pain intensity, while rosa foetida aromatherapy showed the greatest improvement (p < 0.001). Both groups reduced monthly anguish and bleeding, but there was a greater reduction in pain intensity for the self-care education group (p = 0.041). Most of these combined strategies included in this review reduced MCS, with no strategies showing negative effects.

Discussion

This systematic review analysed 39 high-quality, double- and triple-blinded RCTs, comprising of 42 treatment interventions examining the effectiveness of non-clinical, self-management strategies for MCS. Menstrual symptoms, such as dysmenorrhea, mood disturbances, bloating, and exhaustion, are widespread and considerably diminish QOL, productivity, and wellbeing [74]. Overall, this review found a wide range of tested strategies to be effective for self managing MCS, and none to have any detrimental effects. The emphasis on blinded RCTs was intentional, enhancing internal validity and reducing bias. The rigorous inclusion criteria reduced the number of eligible studies, highlighting both the potential for high-quality research in this domain and the constraints of the existing evidence base. Specifically, limiting inclusion to double- and triple-blind RCTs resulted in the exclusion of numerous non-blinded but otherwise instructive physical activity and self-management trials; therefore, our results reflect the highest quality of evidence rather than the entire body of research in this field. Four primary categories of strategies were identified.

Physical activity strategies

Strategies including physical activity were consistently linked to decreases in pain and psychological symptoms. Yoga was the most extensively researched modality, resulting in substantial reductions in dysmenorrhea severity and PMS-related suffering [77]. The data also implied that targeted lower-body training in addition to yoga (i.e., squats) may improve menstrual cycle physical symptoms and associated physiological responses [78, 79]. Mechanistically, enhancements may indicate endorphin release, anti-inflammatory benefits, improved pelvic circulation, and stress alleviation [78]. Squatting exercises were identified as effective in engaging particular muscle groups and enhancing uterine blood circulation, hence mitigating cramping [40]. Exercise intensity and type seemed to have a statistically significant impact on pain and severity scores; specifically, HIIT with probiotics yielded superior symptom alleviation compared to aerobic exercise alone [41]. In comparison to healthy controls, the combined intervention of HIIT and probiotics did not completely eradicate symptoms or stabilise inflammatory markers or protective hormone concentrations. Overall, exercise improved dysmenorrhoea, PMS, emotional regulation, and QOL.

Nutritional strategies

Vitamin, mineral and herbal supplementation constituted the most thoroughly examined category of MCS self-management strategies. Numerous studies demonstrated that micronutrients, including magnesium, calcium, zinc, and vitamins D, E, and B6, mitigate menstruation pain and PMS symptoms [57, 59, 61–64]. Magnesium supplementation significantly reduced pain severity and exhaustion, consistent with its function in neuromuscular activity, which is reflective of the current evidence [80]. Vitamin B6 supplementation, often at 80 mg/day, has shown advantages for mood and cramps by influencing neurotransmitter production [80]; nevertheless, the evidence is inconclusive. Variability probably indicates disparities in dosage, initial nutritional levels, and demographic characteristics of participant groups. Vitamin D supplementation, whether at low doses (e.g., 1000 IU/day) or high doses (e.g., 300,000 IU/day), was associated with decreased pain and depression symptoms, supporting its immunomodulatory and neuroprotective effects [57, 61, 81]. This is consistent with findings regarding low vitamin D levels and an increased risk of menstrual disorders [81]. Herbal therapies, including echium amoenum, hypericum perforatum, royal jelly, and lemon balm, showed symptom alleviation, possibly by hormonal regulation and neurotransmitter modulation, which is reflected in the current literature [82]. Probiotics were shown to have no significant impact on menstrual pain, which is consistent with other literature that found no significant difference between placebo and probiotic groups [63, 74]. The sustained benefits observed in many plants indicate that bioactive phytochemicals could serve as a feasible alternative or complement to traditional MCS treatments [81], but standardisation and long-term safety evidence are still insufficient. Overall, nutritional strategies reduced bloating, cramps, fatigue, and mood-related symptoms, and were linked to improved menstrual cycle regularity in certain studies. The majority of vitamin/mineral supplement studies did not include biomarkers, whole food strategies or dietary patterns, presenting a limitation as they did not ascertain whether participants strictly adhered to the consumption of the prescribed supplements [82].

Other self-management strategies

The other self-management strategies expand the limited evidence base for contemporary approaches in self-management of MCS. LLLT, aromatherapy, music and creative arts therapies, ibuprofen and topical essential oils alleviated pain and psychological distress [66–71]. TENS offered notably rapid analgesia, which is reflective of similar studies including TENS [83]. Such other self-management strategies are typically non-invasive, accessible, and well-received by individuals pursuing alternatives to pharmacological treatments. Nonetheless, outcomes exhibited variability and were affected by the frequency of delivery, duration, and participant expectations. The long-term efficacy and cost-effectiveness have been inadequately examined to date, highlighting the necessity for more thorough assessment.

Combined strategies

Combined strategies often had synergistic effects, reinforcing the premise that complex interventions may surpass the efficacy of isolated single strategies. Programmes integrating physical activity, nutritional education, mobile health applications, and symptom monitoring promoted pain management, alleviated PMS symptoms, and increased self-efficacy in the included studies and wider literature [37–40, 84]. Digital health platforms have shown notable efficacy in enhancing adherence and self-monitoring, with aims for health literacy and patient self-management [84, 85]. HIIT coupled with probiotic supplementation yielded superior symptom alleviation compared to aerobic exercise alone, which shows that nutrition supplementation can have a synergistic effect [41], while lower-intensity exercise alongside standard dietary recommendations has been shown to have more moderate effects [78]. This evidence may be seen as conflicting, since HIIT effects have been found to be variable across studies [78]. In comparison to HIIT alone [41], the combined strategy provided no supplementary advantage, indicating that exercise was the primary catalyst for improvement [41]. The combined strategy proved more beneficial than probiotics alone [41], suggesting that exercise significantly improved overall results. This indicates that physiological and supplementary factors can influence outcomes, although differences in regimen, duration, and delivery restrict comparison of studies. The impact of aerobic exercise is consistent with findings in the wider literature, where it has been effective at reducing MCS [86]. Kinesio taping exhibited a notable decrease in menstruation discomfort and reduced the consumption of painkillers, which is consistent with existing literature [87]. Given that rosa foetida is a recently explored topic, comparable studies are currently unavailable; future studies could prioritise its advancement and assessment. These findings underscore the necessity of customising intervention content and delivery to optimise benefits. Overall, combined strategies increased self-efficacy, knowledge, confidence, symptom tracking, and QOL which is consistent with the current literature [88].

Limitations and strengths

The overall quality of the included studies was varied from moderate to high. While the use of blinding and control groups was an inclusion criterion, the sample size and breadth were often constrained: many studies used small samples and convenience sampling (typically including university students), and few followed up after the intervention or had brief durations of interventions, limiting the ability to evaluate the medium- to long-term effects of the strategies [76]. A limitation of using the JBI for RCTs tool for quality assessment was the lack of analysis based upon the duration of the study intervention. This is relevant in the context of menstrual cycle research, given the inter- and- intra-individual variability of cycle characteristics and symptoms. The majority of studies assessed outcomes for one to three menstrual cycles, resulting in insufficient exploration of long-term efficacy due to inter-individual menstrual cycle length variability [89]. A methodological limitation is that 33 studies with ambiguous important elements (such as intervention characteristics or outcome definitions) were eliminated when the authors failed to reply to requests for clarification within the four weeks. Although a longer timeframe might have made it possible to include more research, this response window was selected for practicality within the review timeline. A meta-analysis was not performed due to significant heterogeneity among trials, encompassing variations in intervention types, outcome measures, and methodological approaches. The heterogeneity restricted the comparability of outcomes and prevented meaningful statistical aggregation; hence, the data were synthesised narratively.

The inconsistent documentation of participant demographics, comorbidities, and adherence hindered the evaluation of outcome equality, while the infrequent recording of adverse events constrained the assessment of safety, especially regarding herbal and device-based therapies [83, 90]. Moreover, publication bias may have led to an over-representation of positive findings, as there was a conspicuous lack of negative effects reported in the 39 reviewed studies. The heterogeneity in outcome measures impeded synthesis, as research employed visual analogue scales, symptom diaries, or composite PMS scores, frequently without validated instruments [91]. The variable and frequently inadequately defined definitions of MCS and outcomes across studies, which limited the capacity to synthesise findings by symptom domain (e.g., dysmenorrhea, psychological symptoms), were a limitation found in this study. Despite these limitations, the variety of interventions and the applicability of these findings to other populations highlight the ongoing importance of this research.

The methodological strengths of this systematic review comprise its exclusive emphasis on double- and triple-blinded RCTs, and application of the JBI critical evaluation tool. These attributes improve assurance in the results and mitigate bias. However, this emphasis on double- and triple-blind RCTs may have led to the omission of a significant number of pragmatic, non-blinded intervention trials, especially in relation to physical activity, where blinding is rarely possible. As a result, this review might understate the variety of potentially useful self-management techniques documented in less strictly regulated studies. As the review notably emphasised high-quality, double- and triple-blinded RCTs, there is a distinct necessity for forthcoming lifestyle intervention research to implement more stringent and thorough trial designs to enhance the evidence base. Notwithstanding the array of promising strategies identified, significant evidence gaps persist. Commonly endorsed self-care strategies, such as sleep hygiene, heat treatment, educational programs, and OTC medication (e.g., paracetamol), were lacking in the blinded RCT evidence base, despite support from the WHO endorsing self-management strategies [92]. This is notable considering the recognised correlation between sleep disruptions and menstruation symptoms [93], and the prevalent application of heat therapy for dysmenorrhea [94]. These exclusions underscore an urgent necessity for RCTs assessing standard, first-line interventions already incorporated in self-management guidelines.

Future research

The findings of this systematic review affirm that non-clinical self-management strategies, such as physical activity, nutritional supplementation, combined and other self-management strategies, provide effective alternatives for managing MCS and enhancing QOL. These potential treatments conform to the WHO guidelines for lifestyle-oriented, holistic methodologies [95, 96]. In future, more precise and standardised reporting of symptom definitions and outcome measures is essential to enable clearer, symptom‑specific summaries of effective self‑management strategies. Future research should also investigate how practices may be applied as organised, evidence-informed programs that people can adopt in their daily lives. This includes clarifying optimal doses and combinations of lifestyle strategies, identifying which subgroups benefit most, and examining how digital tools, education, and behavioural support can facilitate sustained and safe engagement. At the same time, research should address safety, acceptability, and equity of access, to ensure that lifestyle-based self-management options are feasible and available across diverse populations and settings [97, 98].

Conclusions

This systematic review of 39 RCTs provides evidence for non-clinical self-management strategies to relieve menstruation symptoms in biological females aged 18 years and older. Non-clinical strategies appear to constitute a viable, person-centred strategy for enhancing menstrual health, diminishing dependence on pharmacotherapy, and progressing integrated health service frameworks. Nutrition strategies were the most extensively researched and often led to reduced menstrual symptoms, but benefits varied by supplement type, dosage and duration. Yoga was an effective intervention for pain, exhaustion, and mental health. However, the evidence base is hindered by small sample sizes, brief intervention periods, no long-term follow-up, inconsistent outcome measures and potential publication bias. Future research should encompass diverse populations and long-term study designs to assess efficacy and safety, prioritising outcomes that are significant to the affected individuals, including quality of life, symptom burden and daily functioning.

Tools

BAQ

Body Awareness Questionnaire

BDS

Beck Depression Scale

DRSP

Daily Record of Severity of Problems

JBI

Joanna Briggs Institute

MeSH

Medical Subject Headings

MDQ

Menstrual Distress Questionnaire

MSS

Menstrual Symptoms Scale

NHP

Nottingham Health Profile

NRS

Numeric Rating Scale

PMS Scale

Premenstrual Syndrome Scale

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PSS

Perceived Stress Scale

PSST

Premenstrual Symptoms Screening Tool

VAS

Visual Analogue Scale

VMS

Verbal Multidimensional Scoring System

Study Design

RCT

Randomised Controlled Trial

Symbols

N

Population size

n

Sample size/total

p

Statistical significance p-value

Units of Measurement

BMI

Body Mass Index

Kg

Kilogram

m²

Meters squared

mg

Milligram

mL

Millilitre

IU

International Unit

Menstrual / Symptom-related strategies

HIIT

High-Intensity Interval Training

MCS

Menstrual Cycle Symptoms

NSAIDs

Nonsteroidal Anti-inflammatory Drugs

OTC

Over-the-Counter

PA

Physical Activity

PAS

A Lecithin Phosphatidylserine and Phosphatidic Acid Complex

PD

Primary Dysmenorrhea

PMDD

Premenstrual Dysphoric Disorder

PMS

Premenstrual Syndrome

QOL

Quality of Life

TENS

Transcutaneous Electrical Nerve Stimulation

Services

HSE

Health Service Executive

NHS

National Health Service

WHO

World Health Organisation

Response

N-

No

Y-

Yes

Authors' contributions

Rebecca Tarpey developed the review, formulated the procedure, executed the literature search (with library assistance), conducted study screening, data extraction, and quality assessment, directed the narrative synthesis, and composed the manuscript. Dr. Ken van Someren rendered principal oversight and continuous counsel. Dr. Lisa Ryan, Dr. Laura Keaver, Prof. Kerry McGawley, and Prof. Charles Pedlar participated in protocol development, offered essential feedback, and evaluated the paper. All writers reviewed and endorsed the final manuscript.

Funding

This review is part of a PhD research programme under the TU-RISE scheme, co-funded by the Government of Ireland and the European Union through the ERDF Northern and Western Regional Programme 2021–2027.

Data availability

All data produced or examined during this investigation are incorporated in this published article and its additional information files. Supplementary data can be obtained from the relevant author upon a reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable. This systematic review did not involve human participants or collection of primary data.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.