In a quasi-experimental clinical
trial conducted from May to June 2025 and published in July 2026, researchers
Aisya Astri Yunas, Jumilia, and Siska Rahmadiya from Institut Kesehatan Payung
Negeri Pekanbaru evaluated a combined non-pharmacological and nutritional
intervention for high school students suffering from anemia and dysmenorrhea.
The study analyzed 62 female students at SMA Negeri 03 Rejang Lebong in
Indonesia to measure the joint impact of iron (Fe) supplements and structured
yoga practice on hemoglobin synthesis and menstrual pain intensity. The
findings reveal that combining weekly iron supplementation with biweekly yoga
practice produces statistically superior outcomes compared to iron
supplementation alone. This dual approach provides a low-cost, scalable
strategy to improve adolescent reproductive health and academic well-being.
Background and Public Health
Context
Iron deficiency anemia and
dysmenorrhea (painful menstrual cramps) remain widespread reproductive health
issues among adolescent girls globally and across Indonesia. According to
national data, anemia affects 26.5% to 32% of Indonesian youth, while over 60%
of high school girls experience menstrual pain that impairs daily activities
and school attendance. Low hemoglobin levels diminish oxygen delivery to pelvic
tissues, triggering tissue hypoxia and worsening uterine muscle cramping during
menstruation. Standard public health strategies primarily rely on distributing
iron tablets to manage anemia, while dysmenorrhea is frequently managed with
non-steroidal anti-inflammatory drugs (NSAIDs). However, prolonged reliance on
pharmacological painkillers carries risks of side effects, creating an urgent
need for safe, complementary interventions that can be integrated into school
health programs.
Research Methodology
The authors conducted a
quasi-experimental pretest-posttest control study involving 62 female high
school students aged 15 to 18 years at SMA Negeri 03 Rejang Lebong.
Participants met specific criteria: a regular menstrual cycle, mild to moderate
primary dysmenorrhea, and mild to moderate anemia with baseline hemoglobin
levels between 9.0 and 11.9 g/dL.
The participants were divided
into two equal groups of 31:
- Iron Supplementation Group (Control):
Received standard iron (Fe) tablets taken daily at night for four weeks.
- Combination Group (Intervention): Received
daily iron tablets combined with 60-minute yoga sessions held twice weekly
for four weeks (eight sessions total). Each session included 5 minutes of
warm-up, 50 minutes of core yoga posture practice (including paschimottanasana
and adho mukha padmasana), and 5 minutes of cool-down.
Hemoglobin levels were measured
using digital hemoglobinometers (g/dL), and dysmenorrhea intensity was recorded
using a validated Numeric Rating Scale (0 to 10). Data were analyzed using
non-parametric Wilcoxon signed-rank tests for intra-group comparisons and
Mann-Whitney U tests for inter-group comparisons, with statistical significance
set at $p < 0.05$.
Key Findings
After four weeks of intervention,
both study groups demonstrated statistically significant improvements ($p =
0.000$). However, the combination group demonstrated markedly superior health
outcomes across both primary metrics:
- Hemoglobin Elevation: The mean hemoglobin
level in the combination group increased by 1.50 g/dL (rising from $10.90
\pm 0.68\text{ g/dL}$ to $12.40 \pm 0.72\text{ g/dL}$). In contrast, the
iron-only group experienced a lower mean increase of 1.07 g/dL (rising
from $10.78 \pm 0.65\text{ g/dL}$ to $11.85 \pm 0.75\text{ g/dL}$).
- Anemia Resolution: Post-intervention
measurements showed that 77.4% of participants in the combination group
were no longer anemic, compared to 45.2% in the iron-only group.
- Dysmenorrhea Pain Reduction: Menstrual pain
scores in the combination group decreased by 3.16 points on the numeric
scale (dropping from $4.29 \pm 1.22$ to $1.13 \pm 1.18$). The iron-only
group showed a minor reduction of 0.87 points (dropping from $3.52 \pm
1.29$ to $2.65 \pm 1.38$).
- Pain Elimination: Following the
intervention, 41.9% of students in the combination group reported complete
freedom from menstrual pain, and zero participants reported moderate
dysmenorrhea. In the iron-only group, 32.3% of students continued to
suffer from moderate dysmenorrhea.
Biomolecular Mechanisms and
Real-World Impact
The researchers explain that iron
supplementation supplies essential substrates for bone marrow erythropoiesis,
while regular yoga enhances lung ventilation, systemic oxygenation, and
splanchnic blood circulation through deep breathing (pranayama) and
pelvic stretching. This enhanced circulation facilitates optimal iron delivery
and tissue oxygenation. Furthermore, yoga movements reduce myometrial uterine
muscle tension and stimulate parasympathetic nervous activity, decreasing
prostaglandin production while promoting natural endorphin release.
These findings demonstrate that
incorporating physical practices like yoga into existing public health
initiatives maximizes the benefits of standard nutrition programs. Integrating
structured yoga sessions into School Health Business (UKS) activities offers an
affordable, non-pharmacological solution to mitigate school absenteeism and
improve academic concentration among adolescent girls.
Academic Quote
"The combination of iron
supplementation and yoga is significantly more effective than iron
supplementation alone in raising hemoglobin levels and reducing dysmenorrhea
intensity in adolescent girls," stated lead researcher Aisya Astri Yunas
and co-authors Jumilia and Siska Rahmadiya from Institut Kesehatan Payung
Negeri Pekanbaru. "A combined approach that targets both nutritional and
non-pharmacological aspects offers comprehensive benefits for school-based
adolescent reproductive health programs."
Author Profile
Aisya Astri Yunas, M.Tr.Keb., is
a health researcher affiliated with the Institut Kesehatan Payung Negeri
Pekanbaru in Pekanbaru, Indonesia. Her expertise encompasses maternal and child
health, adolescent reproductive health, midwifery sciences, and complementary
non-pharmacological therapies.
Source Information
- Article Title: Combination of Iron Tablets
With Yoga in Teenage Girls Experiencing Anemia With Dysmenorrhea
- Journal Name: International Journal of
Natural and Health Sciences (IJNHS)
- Publication Year: 2026
- Volume & Issue: Vol. 4, No. 3, pp.
329–342
- DOI: https://doi.org/10.59890/ijnhs.v4i3.279
- Official URL: https://aprmultitechpublisher.my.id/index.php/ijnhs/index
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