Exercise, Motor Imagery, and Pain Neuroscience Education for Primary Dysmenorrhea: A Randomized Trial

Inclusion Criteria: * Female, aged 18-25 years * Gynecological examination and ultrasound confirming absence of pelvic pathology * History of primary dysmenorrhea for at least 6 months, with pain intensity ≥4 on the Numeric Rating Scale (0-10) during the first 3 days of menstruation * Regular menstrual cycles (21-35 days) * Nulliparous (no history of pregnancy or childbirth) * No systemic, metabolic, rheumatologic, or lumbar pathology * Willingness to participate in the 8-week intervention program and attend follow-up assessments Exclusion Criteria: * Diagnosis of secondary dysmenorrhea (e.g., endometriosis, pelvic inflammatory disease, uterine fibroids, ovarian cysts) * Current pregnancy or planning to become pregnant during the study period * History of pelvic or abdominal surgery * History of sexually transmitted diseases * Current use of antidepressants, anxiolytics, or hormonal therapy (e.g., oral contraceptives, intrauterine device) * Known neurological, psychiatric, or systemic musculoskeletal disorders * Cognitive impairment or attention deficit that may interfere with participation * Participation in regular exercise in the last 6 months * Use of alternative therapies for dysmenorrhea (e.g., acupuncture, massage)