Effect of visceral manipulation on menstrual complaints in women with polycystic ovarian syndrome

Abstract

Context Research is lacking regarding osteopathic approaches in treating polycystic ovary syndrome (PCOS), one of the prevailing endocrine abnormalities in reproductive-aged women. Limited movement of pelvic organs can result in functional and structural deficits, which can be resolved by applying visceral manipulation (VM). Objectives This study aims to analyze the effect of VM on dysmenorrhea, irregular, delayed, and/or absent menses, and premenstrual symptoms in PCOS patients. Methods Thirty Egyptian women with PCOS, with menstruation-related complaints and free from systematic diseases and/or adrenal gland abnormalities, prospectively participated in a single-blinded, randomized controlled trial. They were recruited from the women’s health outpatient clinic in the faculty of physical therapy at Cairo University, with an age of 20–34 years, and a body mass index (BMI) ≥25, <30 kg/m2. Patients were randomly allocated into two equal groups (15 patients); the control group received a low-calorie diet for 3 months, and the study group that received the same hypocaloric diet added to VM to the pelvic organs and their related structures, according to assessment findings, for eight sessions over 3 months. Evaluations for body weight, BMI, and menstrual problems were done by weight-height scale, and menstruation-domain of Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ), respectively, at baseline and after 3 months from interventions. Data were described as mean, standard deviation, range, and percentage whenever applicable. Results Of 60 Egyptian women with PCOS, 30 patients were included, with baseline mean age, weight, BMI, and menstruation domain score of 27.5 ± 2.2 years, 77.7 ± 4.3 kg, 28.6 ± 0.7 kg/m2, and 3.4 ± 1.0, respectively, for the control group, and 26.2 ± 4.7 years, 74.6 ± 3.5 kg, 28.2 ± 1.1 kg/m2, and 2.9 ± 1.0, respectively, for the study group. Out of the 15 patients in the study group, uterine adhesions were found in 14 patients (93.3%), followed by restricted uterine mobility in 13 patients (86.7%), restricted ovarian/broad ligament mobility (9, 60%), and restricted motility (6, 40%). At baseline, there was no significant difference (p>0.05) in any of demographics (age, height), or dependent variables (weight, BMI, menstruation domain score) among both groups. Poststudy, there was a statistically significant reduction (p=0.000) in weight, and BMI mean values for the diet group (71.2 ± 4.2 kg, and 26.4 ± 0.8 kg/m2, respectively) and the diet + VM group (69.2 ± 3.7 kg; 26.1 ± 0.9 kg/m2, respectively). For the improvement in the menstrual complaints, a significant increase (p<0.05) in the menstruation domain mean score was shown in diet group (3.9 ± 1.0), and the diet + VM group (4.6 ± 0.5). On comparing both groups poststudy, there was a statistically significant improvement (p=0.024) in the severity of menstruation-related problems in favor of the diet + VM group. Conclusions VM yielded greater improvement in menstrual pain, irregularities, and premenstrual symptoms in PCOS patients when added to caloric restriction than utilizing the low-calorie diet alone in treating that condition.

Osteopathic Manipulative Treatment in Dysmenorrhea: A Systematic Review

“…In the CBA study, two-thirds of the participants received treatment during their menstrual cycle, and then during a different menstrual cycle, they were placed in a non-treatment group [ 15 ]. Two of the RCTs used a control group that did not receive any osteopathic or visceral manipulation [ 19 , 21 ]. One of the RCTs used a control group that received sham manipulation [ 17 ].…”

“…A positive impact on quality of life was observed only in the intervention group [ 18 ]. The final RCT examined females with polycystic ovarian syndrome and utilized OMT in conjunction with calorie-restricted diets vs only calorie-restricted diets [ 21 ]. The PCOSQ scoring evaluated other symptoms besides dysmenorrhea and therefore did not indicate any analysis of the dysmenorrhea symptom alleviation alone.…”

“…The case reports show isolated examples that highlight beneficial outcomes when treating dysmenorrhea with OMT [ 8 , 9 , 18 ]. Both the CBA study and the remaining RCTs provide additional data obtained from larger sample sizes [ 13 , 17 , 19 , 21 ]. Although these studies did not provide a comparison to NSAIDs, their value lies in showing reproducibility and decreasing the margin of error.…”

“…The most important factor to call attention to is the limited number of patients examined in each study, along with the small number of articles available in this field of study. The largest RCT evaluated 60 patients, and the smallest RCT assessed only 30 patients [ 16 , 21 ]. This limits the ability to apply the findings to the larger population of women experiencing dysmenorrhea.…”

“…The last concern regarding this review is that there are two types of dysmenorrhea and depending on the cause of symptoms, there may be differences in the efficacy of OMT. Of the 10 studies, three studies examined secondary dysmenorrhea [ 9 , 18 , 21 ]. Separating and comparing the two types of dysmenorrhea and the efficacy of OMT would enhance the ability to understand which patient populations would benefit and to what degree.…”