SYSTEMATIC REVIEW article
Front. Med.
Sec. Obstetrics and Gynecology
Heat Therapy for Primary Dysmenorrhea: a systematic review and meta-analysis
Provisionally accepted
- 1School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- 2Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Aim: Primary dysmenorrhea is highly prevalent and often suboptimally managed, as non-steroidal anti-inflammatory drugs (NSAIDs) fail to provide analgesia in 18% of women. This review therefore aims to evaluate the efficacy and safety of heat therapy—a widely used self-care method— for both preventing and acutely treating primary dysmenorrhea. Methods: We searched seven databases (CENTRAL, PubMed, Web of Science, EMBASE, CNKI, VIP, Wanfang) from inception to October 28, 2024 and updated to August 03, 2025. Pairs of reviewers independently screened records, extracted data, and assessed risk of bias using a modified Cochrane RoB 1.0 tool. Random-effects meta-analyses were performed for pain intensity (converted to 10-cm VAS) and adverse events. Evidence certainty was graded via GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Results: We screened 2733 citations and included 57 RCTs (involving 5359 female participants). When compared with no treatment, heat therapy may reduce pain intensity to a greater extent after 3 months (25 RCTs, 2393 females, WMD -1.85 cm, 95% CI -2.29 to -1.41 cm, RD 21%); it may lead to a greater reduction within 24 hours of treatment (3 RCTs, 248 females; WMD -3.52 cm, 95% CI -5.01 to -2.02 cm, RD 45%). When compared to NSAIDs, heat therapy may provide comparable or slightly superior pain relief after 3 months of treatment (22 RCTs, 1938 females, WMD -1.10 cm, 95% CI - 1.51 to -0.70 cm, RD 4%), or within 24 hours of treatment (2 RCTs, 167 females, WMD -1.50 cm, 95% CI -2.86 to -0.15 cm, RD 16%). For the safety assessment, heat therapy probably reduced the risk of adverse effects compared with NSAIDs (8 RCTs, 728 females, RR 0.30, 95% CI 0.15–0.59). This is a provisional file, not the final typeset article Conclusions: Compared to no treatment, heat therapy is likely to reduce pain intensity both during prophylaxis and acute episodes. When compared to NSAIDs, heat therapy may achieve comparable analgesic efficacy while exhibiting a superior safety profile. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251050944, identifier CRD420251050944.
Keywords: Primary dysmenorrhea, heat therapy, Pain, NSAIDs, Meta-analysis
Received: 22 Oct 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Yuan, Liu, Chen, Hu, Li, Zhang, Mao, Ma and Lan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lei Lan
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