Empowering Women Through Movement: a Randomized Controlled Trial Comparing the Effects of Strengthening Exercises and Tai Chi on Menstrual Symptoms, Pain, and Psychological Outcomes in Primary Dysmenorrhea

BACKGROUND AND PURPOSE: Primary dysmenorrhea affects women's quality of life through menstrual pain and associated psychological distress. While pharmacological treatments are available, concerns over side effects highlight the need to explore non‐pharmacological approaches. This study compared the short‐term effects of strengthening exercises and Tai Chi on menstrual symptoms, pain, and self‐reported stress, anxiety, and depression in women with primary dysmenorrhea. METHODS: This randomized controlled trial included 90 women aged 18‐25 years with primary dysmenorrhea. Participants were randomly assigned to strengthening exercises, Tai Chi, or a control group (n = 30 per group). Interventions were conducted for 4 weeks with five sessions per week. The primary outcome was menstrual symptom severity measured using the Menstrual Symptom Questionnaire (MSQ). Pain intensity and emotional distress were assessed using a 0‐10 visual analog scale (VAS) and the Depression, Anxiety, and Stress Scale (DASS‐21), respectively. Baseline‐adjusted repeated‐measures ANCOVA was used to test group × time interactions with baseline values included as covariates to account for baseline variability between groups. Post hoc analysis with Holm adjustment was performed where appropriate. RESULTS: Significant baseline‐adjusted group × time interactions were observed for the primary outcome, menstrual symptoms as well as pain intensity, stress, anxiety, and depression (all p < 0.001), with both intervention groups demonstrating greater short‐term reductions than the control group. Strengthening exercises were associated with comparatively greater reductions in pain intensity (mean difference = 3.43, p < 0.001) and menstrual symptoms (mean difference = 26.56, p < 0.001), relative to Tai Chi. Tai Chi demonstrated comparatively larger short‐term improvements in stress (mean difference = 9.04, p < 0.001) and anxiety scores (mean difference = 6.51, p < 0.001), relative to strengthening exercises. Both interventions significantly reduced depression scores compared with control (p < 0.001). DISCUSSION: Strengthening exercises and Tai Chi were associated with short‐term changes in symptoms and self‐reported mental health scores over 4 weeks; however, given the short intervention period, reliance on self‐reported outcomes, and greater contextual exposure in the supervised intervention groups compared with the control group, findings should be interpreted cautiously as context‐dependent effects rather than definitive evidence of specific therapeutic mechanisms. Replication using attention‐matched comparators and longer follow‐up is needed to clarify the durability and specificity of effects. TRIAL REGISTRATION: Clinical Trials Registry‐India (CTRI): CTRI/2022/06/043223.