TENS for Painful Menstrual Periods: a Physical Therapist’s Opinion

What is TENS?

TENS stands for transcutaneous electrical nerve stimulation for pain relief.

In simpler terms: it’s a device that applies electricity to the skin’s surface via electrodes to alleviate pain either at the application site or remotely.

🚨 Don’t confuse it with electrostimulation, which is sometimes delivered by the same devices. With electrostimulation, the goal is to stimulate muscle nerve fibers, which is not the case with TENS.

TENS aims to stimulate nerve fibers to send a message to the brain, prompting it to release hormones that promote well-being, relaxation, and pain relief.

Why did we think of using TENS for menstrual pain?

TENS has been studied and used since the 1970s.

Its effectiveness has been particularly studied for chronic pain, such as back pain. But it has also been researched for acute pain, which lasts only a few hours or days.

Studies have been conducted on women during their menstrual periods or on women with pelvic pain in other contexts.

Let’s look at the results of these studies!

What are the benefits of TENS on pelvic pain?

I’ll first discuss the studies that focus on menstrual pain before broadening the scope to pelvic pain in general.

Menstrual Pain

The largest and most recent synthesis of studies on TENS [Paley 2021] includes 7 studies on menstrual pain (dysmenorrhea). Here are their conclusions:

We found that there was insufficient data to draw a conclusion from all the reviews on dysmenorrhea to date.

Pelvic Pain (Endometriosis, etc.)

The same synthesis of studies [Paley 2021] includes 4 clinical trials on pelvic pain outside the context of menstruation. This includes chronic prostatitis, chronic pain without an identifiable cause, polycystic ovary syndrome, endometriosis, etc.

Again, the conclusion is the same: the data is of too low quality to conclude on the benefits of TENS.

What to take away?

Since TENS is relatively easy to test on your own, cost-effective, and sometimes covered by insurance when provided by physical therapists, and has few side effects, it remains a potentially interesting technique to try, despite the low level of evidence for its efficacy.

Personal note: As for me, although I have a TENS unit at home (which I lent to my patients to try out when I was a home care physical therapist), I stick to rest, changing positions, and using paracetamol for this type of pain.

Are there any side effects?

With decades of experience with TENS, its side effects are relatively well-documented. They are rare and not severe:

• Skin irritations (itching, redness)
• Skin rashes
• Unpleasant sensations

There are a few rare contraindications to using TENS, meaning situations where its use is not recommended.

Can TENS for Menstrual Pain Be Reimbursed?

All doctors can prescribe physical therapy sessions. Your physical therapist can suggest TENS sessions, which will be reimbursed.

However, only certain doctors can prescribe the purchase or rental of a TENS unit in France: pain specialists working in dedicated centers or those with specific diplomas.

Even among these doctors, menstrual pain is not listed as a condition for which TENS is reimbursed. Finally, only certain devices are reimbursed, such as the TENS Eco 2.

Which Devices and Electrodes to Choose?

TENS units can be purchased without a prescription.

There are dozens, if not hundreds, of brands and devices delivering TENS! Some are specifically designed for menstrual pain: not necessarily more effective, but potentially more convenient to use.

For example, Urgogyn rechargeable, wireless patches are sold for around €80.

The Urgo laboratories cite a clinical study conducted on 37 women with primary dysmenorrhea, reporting relief for 96% of the women.

🚨 However, these studies are not included in the comprehensive reviews published in scientific journals because they are not rigorously conducted. They do not compare the effect of TENS to a placebo TENS, which is easy to implement (just cut the current or significantly lower it).

Entry-level TENS units work just fine. For example, the TENS 7000 (see on Amazon) is a good choice.

My Advice: Invest in an entry-level TENS device from a supermarket or Amazon. It’s cheaper, and you can use it for any part of your body!

How to Properly Place the Electrodes

It appears that the method of using TENS (device, current, electrode placement) does not significantly affect the results [Paley 2021].

However, in a recent study, the following setup is recommended for use during menstruation [Camilo 2023]:

1. Position the electrodes while lying on your stomach (ask for help if needed).
2. Place them near the L3/L4 lumbar vertebrae, towards the lower back. This is where the nerves that connect to the pelvic region originate.
3. Increase the current intensity until you feel something.
4. Move one electrode at a time around this area to see if the effect is greater when repositioned.
5. Keep the TENS on for 30 minutes. You can change positions, which is often more comfortable than staying on your back for 30 minutes!
6. The effect of TENS is supposed to be felt immediately.

Some people prefer to place the electrodes directly on their abdomen.