The regular intrauterine bleeding of female after puberty is called menstruation, and various physical and mental pains accompanied by menstruation is called dysmenorrhea. [1]

Dysmenorrhea is cyclical lower abdominal or pelvic pain which may also radiate to the back and thighs. It occurs before or during menstruation or both. Cramps and pain are experienced in the lower abdominal after regular ovulation is establish. It began soon after menarche. It is the common gynecologic complain among adolescent. From India, the prevalence range reported is between 50 to 87.8%. [2-5]Furthermore, dysmenorrhea is critical global health issue in reproductive age women, as it causes school absences, poor academic performance, lost work time, an has a significantly negative affect on daily activities.[6]

Although the majority of women experience dysmenorrhea at some time, data on the natural history of primary dysmenorrhea over the reproductive life span are lacking.[7]

The first theories on the cause of dysmenorrhea were anatomical. Hippocrates believed that cervical obstruction and subsequent stagnation of menstrual blood was the cause of painful menstruation. The believe in a mechanical obstruction to the release of menstrual blood persisted for a long time. The suggested physiology causes for dysmenorrhea include the excessive production of uterine prostaglandins and the over production of vasopressin, a harmone which stimulates uterine muscular contractions.[8, 9]

There are two type of dysmenorrhea: primary and secondary. Primary dysmenorrhea is also known as painful period or menstrual cramps, which causes pain during menstrual cycle. It usually begins around the time when menstruation begins. It is the commoner in the years after menarche peaking at 20-24 years of age and decreasing thereafter. It occurs in up to 40-50% young women, with severe forms limiting the activity and causing missed school days in 15%. Primary dysmenorrhea usually start within 6-12 month of menarche, once ovulatory cycle are established. The duration of pain is commonly between 8-72 hours. The pain is usually in the pelvis or lower abdomen, which may radiate into low back and upper thigh. Other symptoms include diarrhea, headache, stress, and nausea. Prostaglandins makes uterus to contract which causes pain during menstrual cycle and also affects those with heavy irregular menstrual cycle, those who attain menarche before 12 years of age, or one with less body weight. [10-13] .Primary dysmenorrhea reportedly stops spontaneously after 1-3 years; however, sometimes it is possible to continue until the childbirth.[14]

Secondary dysmenorrhea is a consequence of the presence of pelvic pathology. The typical age of patient is the 3^rd or 4^th decade of life and it may be associated with other symptoms such as dyspareunia, dyscheziaendometriosis, pelvic inflammatory disease, inter-uterine devices, uterine tumors, and ovarian cysts and disturbances of menstrual cycle.[10, 11]

Different type of treatment used for dysmenorrhea are medical treatment, physiotherapy treatment and other treatments. Medical treatment: Medical management of primary dysmenorrhea with non-steroidal, mefenamic acid, and naproxen. Non-pharmacological treatments such as physical therapy, yoga, heating pad, massage etc. are shown to be effective. Physical therapy to the abdominal and pelvic floor muscles helps to stretch and strengthen the muscle. Other techniques such as taping and aerobics are also used for the participants with primary dysmenorrhea which effectively could reduce pain and discomfort. Yoga such as cat pose, tiger pose ,cobra pose, bow pose and fish pose if practiced regularly help to stretch and strength the back and pelvic floor muscle and has positive effect in female with primary dysmenorrhea. Swiss ball exercises are also effective in reducing the pain intensity and diminished the level of menstrual distress in female with primary dysmenorrhea.[13]

As there are various treatment techniques available, there is a need for a standard treatment protocol, which will have good result in terms of pain reduction and improving the quality of life.[13]

This study is intended to compare two different type of intervention namely yoga asana and Swiss ball exercises to treat female with Primary Dysmenorrhea

Type of study: Comparative study

Type of sampling: Convenient sampling

Place of study: MVP’S College Of Physiotherapy and college of Nursing, Hospital and Research Centre, Nashik.

Sample size: 40; Group A: 20; Group B: 20

Duration – 6 months

Subject included were Age between 18 to 25years, Dysmenorrhea (pain affecting daily activity), Dysmenorrhea for at least one day of menses, Primary dysmenorrhea, VAS of 5-8. Subject were excluded if With irregular or infrequent menstrual cycles (usually outside of the typical range of a 21 to 35 day cycle), Using an intra-uterine contraceptive device (IUCD),Taking oral contraceptive pills (OCP), Gynecological related surgeries, Poly cystic ovarian Disease, Pelvic inflammatory disease, Thyroid problem, Hereditary problem

Table no.1: Comparison of pre and post mean treatment scores of VMS and VAS of group A (YOGA ASANA) using paired t test.

Table no 2: Comparison of pre and post mean treatment scores of VMS and VAS of group B (SWISS BALL) using paired t test

Table no 3: Comparison of the mean difference in group A and group B for VMS using unpaired t test.

Table no.4: Comparison of the mean difference in group A and group B for VAS using unpaired t test.