Effectiveness of Therapeutic Exercise in Reducing the Severity of Primary Dysmenorrhea and Associated Symptoms: A Systematic Review and Meta-Analysis

Background and objectives: Primary dysmenorrhea is a major contributor to chronic pelvic pain. It negatively impacts quality of life. Therapeutic exercise has become recognized as a non-pharmacological alternative for reducing the severity of symptoms. Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Randomized controlled trials involving adult women with primary dysmenorrhea who underwent therapeutic exercise interventions were selected. Databases searched were Embase, PubMed, Scopus, CENTRAL, Web of Science, ProQuest, PEDro, and CINAHL up to 31 January 2026. The main variables were symptom severity, pain intensity, and duration. The secondary outcomes were quality of life, anxiety, and sleep quality. The Cochrane’s Risk of Bias 2 tool was used to assess the risk of bias, while the certainty of evidence was determined using GRADE. Results: Twenty-nine studies (1704 participants) were included. Therapeutic exercise significantly improved symptom severity (SMD = −0.91), pain intensity (SMD = −2.17), and duration (SMD = −0.70), and enhanced quality of life (SMD = 0.70) and sleep quality (SMD = 0.33). These results were maintained into the second menstrual cycle after the intervention. I2 values were high across all outcomes. Subgroup analysis revealed a greater effect of mind–body and stretching interventions on symptom severity, and of aerobic and strength exercise on pain intensity. The certainty of the evidence was low to very low. Conclusions: Therapeutic exercise appears effective for improving the severity of primary dysmenorrhea and associated symptoms, although caution is warranted when interpreting these conclusions due to the insufficient certainty of the evidence.