CONTEXT: Research is lacking regarding osteopathic approaches in treating polycystic ovary syndrome (PCOS), one of the prevailing endocrine abnormalities in reproductive-aged women. Limited movement of pelvic organs can result in functional and structural deficits, which can be resolved by applying visceral manipulation (VM). OBJECTIVES: This study aims to analyze the effect of VM on dysmenorrhea, irregular, delayed, and/or absent menses, and premenstrual symptoms in PCOS patients. METHODS: Thirty Egyptian women with PCOS, with menstruation-related complaints and free from systematic diseases and/or adrenal gland abnormalities, prospectively participated in a single-blinded, randomized controlled trial. They were recruited from the women's health outpatient clinic in the faculty of physical therapy at Cairo University, with an age of 20 to 34 years, and a body mass index (BMI) >= 25, < 30 kg/m2. Patients were randomly allocated into two equal groups (15 patients); the control group received a low-calorie diet for 3 months, and the study group that received the same hypocaloric diet added to VM to the pelvic organs and their related structures, according to assessment findings, for eight sessions over 3 months. Evaluations for body weight, BMI, and menstrual problems were done by weight-height scale, and menstruation-domain of Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ), respectively, at baseline and after 3 months from interventions. Data were described as mean, standard deviation, range, and percentage whenever applicable. RESULTS: Of 60 Egyptian women with PCOS, 30 patients were included, with baseline mean age, weight, BMI, and menstruation domain score of 27.5 +/- 2.2 years, 77.7 +/- 4.3 kg, 28.6 +/- 0.7 kg/m2, and 3.4 +/- 1.0, respectively, for the control group, and 26.2 +/- 4.7 years, 74.6 +/- 3.5 kg, 28.2 +/- 1.1 kg/m2, and 2.9 +/- 1.0, respectively, for the study group. Out of the 15 patients in the study group, uterine adhesions were found in 14 patients (93.3%), followed by restricted uterine mobility in 13 patients (86.7%), restricted ovarian/broad ligament mobility (9, 60%), and restricted motility (6, 40%). At baseline, there was no significant difference (p > 0.05) in any of demographics (age, height), or dependent variables (weight, BMI, menstruation domain score) among both groups. Poststudy, there was a statistically significant reduction (p = 0.000) in weight, and BMI mean values for the diet group (71.2 +/- 4.2 kg, and 26.4 +/- 0.8 kg/m2, respectively) and the diet plus VM group (69.2 +/- 3.7 kg; 26.1 +/- 0.9 kg/m2, respectively). For the improvement in the menstrual complaints, a significant increase (p < 0.05) in the menstruation domain mean score was shown in diet group (3.9 +/- 1.0), and the diet plus VM group (4.6 +/- 0.5). On comparing both groups poststudy, there was a statistically significant improvement (p = 0.024) in the severity of menstruation-related problems in favor of the diet plus VM group. CONCLUSIONS: VM yielded greater improvement in menstrual pain, irregularities, and premenstrual symptoms in PCOS patients when added to caloric restriction than utilizing the low-calorie diet alone in treating that condition.
Reprinted from JAOA, The Journal of the American Osteopathic Association. Copyright American Osteopathic Association. Permission given with the consent of the American Osteopathic Association.

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