Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study

Primary dysmenorrhea (PD) is a common gynecological condition characterized by menstrual pain without underlying pelvic pathology. It has been linked to functional and structural changes in the core musculature, but limited evidence exists regarding its association with diaphragmatic and respiratory...

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Main Authors: Rebeca del Prado-Álvarez, María García-Arrabé, Ángel González-de-la-Flor, Marta de la Plaza San Frutos, Jaime Almazán-Polo, Cecilia Estrada-Barranco
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Language:English
Published: MDPI AG 2025-02-01
Series:Methods and Protocols
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Online Access:https://www.mdpi.com/2409-9279/8/1/15
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author Rebeca del Prado-Álvarez
María García-Arrabé
Ángel González-de-la-Flor
Marta de la Plaza San Frutos
Jaime Almazán-Polo
Cecilia Estrada-Barranco
author_facet Rebeca del Prado-Álvarez
María García-Arrabé
Ángel González-de-la-Flor
Marta de la Plaza San Frutos
Jaime Almazán-Polo
Cecilia Estrada-Barranco
author_sort Rebeca del Prado-Álvarez
collection DOAJ
description Primary dysmenorrhea (PD) is a common gynecological condition characterized by menstrual pain without underlying pelvic pathology. It has been linked to functional and structural changes in the core musculature, but limited evidence exists regarding its association with diaphragmatic and respiratory mechanics. This study aimed to elaborate on these potential associations by assessing the diaphragmatic structure and respiratory function in women with PD compared to healthy controls, utilizing ultrasound imaging, spirometry and respiratory pressure measurements. Methods: An observational, cross-sectional study was conducted with 44 female participants (22 with PD and 22 healthy controls). Diaphragmatic structure was evaluated through ultrasound, measuring the intercostal distance, diaphragmatic thickness, and diaphragmatic excursion at rest and during maximum voluntary contraction. Spirometric assessments included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FVC/FEV1 ratio, along with measurements of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Group differences were analyzed using Student’s <i>t</i>-test and effect sizes were reported with Cohen’s d. Results: No significant differences were observed between the groups in diaphragmatic thickness, diaphragmatic excursion, or global respiratory capacity (<i>p</i> > 0.05). However, women with PD presented a significant reduction in the left intercostal distance both at rest (<i>p</i> = 0.035, d = 0.56) and during contraction (<i>p</i> = 0.039, d = 0.54). No other significant group differences were detected. Conclusions: While primary dysmenorrhea does not appear to affect overall diaphragmatic function or respiratory capacity, it is associated with subtle localized changes in the left intercostal dynamics. These findings suggest a potential compensatory mechanical adaptation rather than global respiratory dysfunction. Further longitudinal studies with larger sample sizes are needed to explore the clinical significance of these findings.
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spelling doaj-art-1e16e2cd122b4a0a9dca170d7116cf252025-08-20T02:03:41ZengMDPI AGMethods and Protocols2409-92792025-02-01811510.3390/mps8010015Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational StudyRebeca del Prado-Álvarez0María García-Arrabé1Ángel González-de-la-Flor2Marta de la Plaza San Frutos3Jaime Almazán-Polo4Cecilia Estrada-Barranco5Department of Physiotherapy, Faculty of Medicine, Health and Sport, European University of Madrid, 28670 Madrid, SpainDepartment of Physiotherapy, Faculty of Medicine, Health and Sport, European University of Madrid, 28670 Madrid, SpainDepartment of Physiotherapy, Faculty of Medicine, Health and Sport, European University of Madrid, 28670 Madrid, SpainDepartment of Physiotherapy, Faculty of Medicine, Health and Sport, European University of Madrid, 28670 Madrid, SpainDepartment of Physiotherapy, Faculty of Medicine, Health and Sport, European University of Madrid, 28670 Madrid, SpainDepartment of Physiotherapy, Faculty of Medicine, Health and Sport, European University of Madrid, 28670 Madrid, SpainPrimary dysmenorrhea (PD) is a common gynecological condition characterized by menstrual pain without underlying pelvic pathology. It has been linked to functional and structural changes in the core musculature, but limited evidence exists regarding its association with diaphragmatic and respiratory mechanics. This study aimed to elaborate on these potential associations by assessing the diaphragmatic structure and respiratory function in women with PD compared to healthy controls, utilizing ultrasound imaging, spirometry and respiratory pressure measurements. Methods: An observational, cross-sectional study was conducted with 44 female participants (22 with PD and 22 healthy controls). Diaphragmatic structure was evaluated through ultrasound, measuring the intercostal distance, diaphragmatic thickness, and diaphragmatic excursion at rest and during maximum voluntary contraction. Spirometric assessments included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FVC/FEV1 ratio, along with measurements of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Group differences were analyzed using Student’s <i>t</i>-test and effect sizes were reported with Cohen’s d. Results: No significant differences were observed between the groups in diaphragmatic thickness, diaphragmatic excursion, or global respiratory capacity (<i>p</i> > 0.05). However, women with PD presented a significant reduction in the left intercostal distance both at rest (<i>p</i> = 0.035, d = 0.56) and during contraction (<i>p</i> = 0.039, d = 0.54). No other significant group differences were detected. Conclusions: While primary dysmenorrhea does not appear to affect overall diaphragmatic function or respiratory capacity, it is associated with subtle localized changes in the left intercostal dynamics. These findings suggest a potential compensatory mechanical adaptation rather than global respiratory dysfunction. Further longitudinal studies with larger sample sizes are needed to explore the clinical significance of these findings.https://www.mdpi.com/2409-9279/8/1/15primary dysmenorrheadiaphragmatic functionrespiratory mechanicsultrasound imagingchronic painintercostal distance
spellingShingle Rebeca del Prado-Álvarez
María García-Arrabé
Ángel González-de-la-Flor
Marta de la Plaza San Frutos
Jaime Almazán-Polo
Cecilia Estrada-Barranco
Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study
Methods and Protocols
primary dysmenorrhea
diaphragmatic function
respiratory mechanics
ultrasound imaging
chronic pain
intercostal distance
title Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study
title_full Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study
title_fullStr Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study
title_full_unstemmed Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study
title_short Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study
title_sort exploratory ultrasound analysis of the diaphragm and respiratory capacity in women with primary dysmenorrhea a cross sectional observational study
topic primary dysmenorrhea
diaphragmatic function
respiratory mechanics
ultrasound imaging
chronic pain
intercostal distance
url https://www.mdpi.com/2409-9279/8/1/15
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