Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea.
ABSTRACT To compare the effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea.
This was a double-blind comparative clinical trial conducted from September 2006 to February 2007. Participants were 150 students (18 years old and over) with primary dysmenorrhea from the dormitories of two medical universities who were alternately divided into three equal groups. Students in the ginger group took 250 mg capsules of ginger rhizome powder four times a day for three days from the start of their menstrual period. Members of the other groups received 250 mg mefenamic acid or 400 mg ibuprofen capsules, respectively, on the same protocol. A verbal multidimensional scoring system was used for assessing the severity of primary dysmenorrhea. Severity of disease, pain relief, and satisfaction with the treatment were compared between the groups after one menstruation.
There were not significant differences between groups in baseline characteristics, p > 0.05. At the end of treatment, severity of dysmenorrhea decreased in all groups and no differences were found between the groups in severity of dysmenorrhea, pain relief, or satisfaction with the treatment, p > 0.05. No severe side effects occurred.
Ginger was as effective as mefenamic acid and ibuprofen in relieving pain in women with primary dysmenorrhea. Further studies regarding the effects of ginger on other symptoms associated with dysmenorrhea and efficacy and safety of various doses and treatment durations of ginger are warranted.
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ABSTRACT: According to the biopsychosocial model, menstrual symptoms are caused not only by a combination of biological factors such as hormonal disorders and lifestyle, but also by psychological and social factors such as working environment. This study aimed to determine the relation between occupational stress and dysmenorrhea in Iranian midwives. This prospective correlational study was performed on 150 midwives at public and private hospitals and health care centers of Mashhad, Iran. The subjects were selected through two-stage cluster sampling during 2010-2011. At the beginning of the study, participants completed questionnaires containing demographic information, work circumstances, the 21-item Depression, Anxiety, and Stress Scale, and the Job Content Questionnaire. They then completed the short form of daily Menstrual Distress Questionnaire during three consecutive menstrual cycles. Independent Student's t-test, one-way analysis of variance, Kruskal-Wallis, Mann-Whitney, and chi-square tests, correlation coefficients, and linear regression analysis were used to analyze the data collected data in SPSS11.5. Dysmenorrhea was observed in 63.3% of the participants. Among these individuals, 15.7%, 45.2%, and 38.9% had mild, moderate, and severe symptoms, respectively. Moreover, 59.3% of the studied midwives had severe occupational stress. There was a significant positive correlation between occupational stress and severity of dysmenorrhea (P = 0.002, r = 0.82). Occupational stress is associated with increased risk of severe dysmenorrhea. This finding can be used to guide preventive measures to eliminate or decrease occupational stress and dysmenorrhea among Iranian midwives. However, identification of sources of occupational stress and related workloads is necessary.Iranian journal of nursing and midwifery research 01/2013; 18(4):316-322.
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ABSTRACT: Clinical use of mefenamic acid has generally declined in an era where other NSAID use has flourished. While having modes of action and general toxicities similar to other NSAIDs, mefenamic acid, as a member of the fenamates, nevertheless possesses some unique in vitro effects that have the potential to distinguish this agent from others. Use of this drug remains relevant for pain syndromes and some gynecological disorders, albeit with considerable competition from other NSAIDs. New basic science has considerably improved the understanding of the biochemistry of mefenamic acid. As well as maintaining its use in traditional settings, there is a tremendous potential for expanding the application of mefenamic acid to niche roles.Expert Review of Clinical Pharmacology 05/2013; 6(3):289-305.
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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 15, Number 2, 2009, pp. 129–132
© Mary Ann Liebert, Inc.
Comparison of Effects of Ginger, Mefenamic Acid,
and Ibuprofen on Pain in Women
with Primary Dysmenorrhea
Giti Ozgoli, M.Sc.,1Marjan Goli, M.Sc.,2and Fariborz Moattar, Ph.D.3
Objectives: To compare the effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary
Methods: This was a double-blind comparative clinical trial conducted from September 2006 to February 2007.
Participants were 150 students (18 years old and over) with primary dysmenorrhea from the dormitories of
two medical universities who were alternately divided into three equal groups. Students in the ginger group
took 250 mg capsules of ginger rhizome powder four times a day for three days from the start of their men-
strual period. Members of the other groups received 250 mg mefenamic acid or 400 mg ibuprofen capsules, re-
spectively, on the same protocol. A verbal multidimensional scoring system was used for assessing the sever-
ity of primary dysmenorrhea. Severity of disease, pain relief, and satisfaction with the treatment were compared
between the groups after one menstruation.
Results: There were not significant differences between groups in baseline characteristics, p ? 0.05. At the end
of treatment, severity of dysmenorrhea decreased in all groups and no differences were found between the
groups in severity of dysmenorrhea, pain relief, or satisfaction with the treatment, p ? 0.05. No severe side ef-
Conclusion: Ginger was as effective as mefenamic acid and ibuprofen in relieving pain in women with primary
dysmenorrhea. Further studies regarding the effects of ginger on other symptoms associated with dysmenor-
rhea and efficacy and safety of various doses and treatment durations of ginger are warranted.
women. Most adolescents experience dysmenorrhea in the
first few years after the menarche. Primary dysmenorrhea is
defined as pelvic pain around the time of menstruation in
the absence of an identifiable pathologic lesion, present from
menarche.1It is a frequent cause of absenteeism and med-
ical visits, and affects personal as well as economic aspects
of life. It is estimated that severe dysmenorrhea results in the
loss of 600 million working hours and $2 billion in lost pro-
Although the etiology of primary dysmenorrhea is not
completely understood, symptoms are generally associated
with increased production of prostaglandins (PGs) in the en-
ysmenorrhea is one of the most frequent gynecologic
disorders, affecting more than half of menstruating
dometrium with menses, and approximately 80% of patients
can experience pain relief by taking prostaglandin inhibitors,
including proponics and phenamates.3Non-steroidal anti-
inflammatory drugs (NSAIDs) are widely used as first-line
therapy in women with primary dysmenorrhea. Evidence-
based data support the efficacy of ibuprofen, naproxen,
mefenamic acid, and aspirin.4These agents, however, have
side effects, of which gastrointestinal disorders such as nau-
sea, dyspepsia, and vomiting are the most common.5
Some patients with primary dysmenorrhea do not respond
to treatment with NSAIDs or oral contraceptives. In addi-
tion, some women have contraindications to these medica-
tions. Consequently, researchers have investigated numer-
ous alternative/complementary treatments such as herbal
and dietary therapies,6behavioral interventions,7acupres-
sure,8and aromatherapy.9Ginger, the rhizome of Zingiber
1Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2Nursing and Midwifery School, Islamic Azad University of Najafabad, Isfahan, Iran.
3Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
officinale, is a traditional medicine with anti-inflammatory
and anticarcinogenic properties.10It is a botanical general
recognized as safe (GRAS) by the United States Food and
Drug Administration (FDA)11with no report of severe side
effects or drug interactions in Germany’s Commission E
Monograph.12Ginger has been widely used in medicine, and
has been administered in Traditional Chinese Medicine for
more than 2500 years as an anti-inflammatory agent in mus-
culoskeletal disorders.10Two compounds in ginger, -Gin-
gerol and Gingerdiones, are potent inhibitors of PGs by
blocking cyclooxygenase.10,13Traditional application of gin-
ger to relieve symptoms of dysmenorrhea has been noted in
several classical sources14such as Kitab al Qanun fi Al Tibb
by Ibn Sina (The Canon of Medicine by Avicenna).15However,
to the best of our knowledge, there are no reports of a con-
trolled study of the use of ginger in dysmenorrhea. The aim
of the present study was to compare the effects of ginger
with mefenamic acid and ibuprofen on pain in women with
Materials and Methods
This was a double-blind comparative clinical trial con-
ducted from September 2006 to February 2007. Patients in-
cluded students (aged 18 years and over) with primary dys-
menorrhea selected by continuous sampling from the
dormitories of Isfahan and Shahid Beheshti Universities of
Medical Sciences. The purpose and method of the study were
explained and informed consent was obtained from all pa-
tients. The ethics committee of Shahid Beheshti University
of Medical Science approved the study.
At baseline, the severity of dysmenorrhea, demographic
data, and menstrual characteristics were assessed by a self-
administered questionnaire. Severity was assessed before
and after the intervention by a verbal multidimensional scor-
ing system that has been used in previous studies9,16with
four grades: painless menstruation ? 0, menstruation with
pain but rare use of analgesics or limitation of activities ? 1,
menstruation with moderate pain with influence on daily ac-
tivities and use of analgesics with relief ? 2, and menstrua-
tion with severe pain with significant limitations on daily ac-
tivities, ineffective use of analgesics, and such symptoms as
headache, tenderness, nausea, vomiting, and diarrhea ? 3.
Patients with moderate to severe dysmenorrhea (score 2 or
3) were included. Exclusion criteria were a pre-existing di-
agnosed disease, history of gestation or taking oral contra-
ceptives, medicinal or herbal sensitivities, body mass index
(BMI) ?19 or ?26, and mild dysmenorrhea (score 1).
The 150 patients were alternately allocated into three
groups. Each group took their medication four times a day
for three days from the start of their menstrual period. In the
first group, patients received capsules containing 250 mg of
ginger rhizome powder (Zintoma; Goldaru Co., Iran). The
second group received 250 mg mefenamic acid capsules
(Ponstan; Razak Co., Iran) and the third group took 400 mg
ibuprofen capsules (Brufen; Roozdaru Co., Iran). The cap-
sules in all groups were similar in shape and package and
were administered anonymously with coding by a midwife
colleague with no knowledge of the codes. To measure com-
pliance we asked patients to report the number of capsules
they have took.
Final assessment was performed after one menstrual pe-
riod by another colleague who had no information about the
groups. Patients and assessor were blinded to the groups. In
addition to the verbal multidimensional scoring system, a 5-
point scale was used to assess pain relief (considerably re-
lieved, relieved, unchanged, worse, considerably worse) and
patient satisfaction with the treatment was also assessed (sat-
isfied, not satisfied). Analysis of variance (ANOVA) and chi-
square tests were used to identify any difference between the
groups in baseline characteristics, severity of disease, pain re-
lief, and satisfaction with the treatment; a p value ? 0.05 was
considered significant. A sample size of 150 patients was re-
quired assuming 90% power and estimation of improvement
for mefenamic acid (80%) and for ginger (at least 50%).
At baseline, no significant differences were found between
the groups regarding age, BMI, or menstruation characteris-
tics (Table 1).
There were no significant differences between the groups
in severity of dysmenorrhea before or after treatment (Table
2). Also, no significant differences were found between the
three groups in relief, stability, or aggravation of symptoms.
Compliance in using the capsules was the same in all three
Four students in each group reported a slight increase in
bleeding as a menstrual change. One student in the mefe-
namic acid group and one in ginger group experienced de-
creased bleeding, and one student in the ibuprofen group re-
ported increased duration of menstruation.
OZGOLI ET AL.130
TABLE 1.BASELINE DEMOGRAPHICS
(n ? 50)
(n ? 50)
(n ? 50)
Body mass index
Menarche (age in years)
Duration of menses (days)
Duration of cycles (days)
Interval of cycles (days)
Pain in all cycles
21.8 ? 2.3
22.2 ? 2.2
12.9 ? 1.3
6.4 ? 1
28 ? 1.8
22.4 ? 2
3.1 ? 1
21.3 ? 2.3
22.3 ? 2.2
13 ? 1.5
6.2 ? 1.2
28.9 ? 2.9
22.4 ? 3
2.7 ? 0.9
21.5 ? 2.6
22.2 ? 2.3
12.9 ? 0.9
6.6 ? 1.1
29.1 ? 2
22.6 ? 2.3
2.8 ? 0.9
Our findings showed that ginger was as effective as mefe-
namic acid and ibuprofen in relieving menstrual pain. Mefe-
namic acid and ibuprofen are the drugs of choice for treat-
ing primary dysmenorrhea,17with up to 80% efficiency.3
Different theories exist regarding dysmenorrhea-inducing
mechanisms, one of which is increased production of PGs in
the endometrium. PGs originate from arachidonic acid in cy-
clooxygenase and lipooxygenase pathways. Studies have
shown that the menstrual blood of women with dysmenor-
rhea has greater amount of two PGs—PGE2and PGF2?. In
women with primary dysmenorrhea, pain results from my-
ometrial contractions induced by PGs (mainly PGF2?) orig-
inating in secretory endometrium.3
Anti-prostaglandins such as NSAIDs can relieve dysmen-
orrheal pain. Mefenamic acid from fenamate groups and
ibuprofen from propionic acids act as inhibitors of PGs syn-
thesis.5The question is why ginger has similar effects as the
other two drugs. In a search of the literature, we found no
study that assessed the effects of ginger on dysmenorrhea;
its use has been been based on traditional sources.15How-
ever, the effects of other herbs such as fennel,16,18cumin, and
chamomile on dysmenorrhea have been studied.11Like other
herbs, ginger compounds are very complex and include
many substances such as carbohydrates, free fatty acids,
amino acids, proteins, phytoesterols, vitamins (niacin), and
some nonaromatic compounds such as gingerols and
shogaols.11Its essence mainly includes sesquiterpene.14Alt-
man and Marcussen compared the effects of two ginger
species (Z. officinale and Alpinia galangal; 510 mg twice daily)
with placebo in patients with knee osteoarthritis and found
that ginger extract had a significant effect on reducing symp-
toms of osteoarthritis.19Salicylate has been found in ginger
in amounts of 4.5 mg/100 gm fresh root. Therefore, there
was less than 1mg salicylate in the capsule in the study of
Altman and Marcussen, and this could not explain the ob-
served effects of ginger.19In fact, ginger inhibits cyclooxy-
genase and lipooxygenase pathways in PGs synthesis.10,13In
pharmacopoeias, ginger is indicated for dyspepsia, disten-
sion, colic, vomiting, diarrhea, spasms and other smooth
muscle disorders, colds, influenza, and rheumatism as an
anti-inflammatory agent.14It has been shown that gingerols
in ginger have anti-inflammatory effects both in vitro and in
vivo.20,21The anti-inflammatory property of ginger has been
attributed to the inhibition of cyclooxygenase and lipooxy-
genase, leading to reduction of leukotriene and prostaglan-
Considering this evidence, it seems that ginger had anti-
prostaglandin effects similar to those of mefenamic acid and
ibuprofen, and gingerols may be the principle active ingre-
dient for these effects. Measuring PGs in plasma or men-
strual blood throughout the treatment may help to clarify
the mechanism of action of ginger on primary dysmenor-
rhea. Dysmenorrhea is sometimes associated with nausea
and vomiting, and ginger also works to alleviate these symp-
toms. The efficacy of ginger in treatment of chemotherapy-
induced delayed nausea23and nausea and vomiting in preg-
nancy and after surgery24,25has been reported, with minor
It has been reported that more than 6 g of dry powder of
ginger can cause desquamation of the epithelial cells in the
stomach lining of humans. Therefore, the dosage should be
limited to less than 6 g on an empty stomach.26It can also
result in sensitivity reactions, dermatitis27and, at high doses,
in depression of the nervous system as well as cardiac dys-
rhythmia.28Although there is no evidence regarding drug
interactivity of ginger,11NSAIDs, particularly aspirin, have
the potential to interact with herbal supplements, and fur-
ther research is needed to confirm and assess the clinical sig-
nificance of these potential interactions.29
There are some limitations to this study. Because ran-
domization was not easily possible, patients were alternately
allocated into the groups. However, all three groups were
similar in baseline characteristics. Although participants
could not determine whether they received a ginger or other
capsule even after examining, smelling, and swallowing it,30
questioning participants whether they thought they had re-
ceived an active treatment or a placebo could specify a dou-
ble blind setting. We did not assess other possible symptoms
GINGER IN TREATMENT OF PRIMARY DYSMENORRHEA131
TABLE 2.SEVERITY OF DYSMENORRHEA BEFORE AND AFTER TREATMENT
(n ? 50)
(n ? 50)
(n ? 50)
Change in pain severity
Rate of satisfaction
Number of capsules used
11.2 ? 1.4
11.1 ? 1.9
11.5 ? 1.5
associated with dysmenorrhea; that is suggested for future
studies. Also, using measurements such as the visual ana-
logue scale or the numeric rating scale for assessing symp-
toms may help to find minimal differences between the
Ginger is as effective as mefenamic acid and ibuprofen in
relieving pain in women with primary dysmenorrhea. Fur-
ther studies regarding the effects of ginger on other symp-
toms associated with dysmenorrhea, the efficacy and safety
of various doses and treatment durations of ginger, and the
exact mechanism of action are warranted.
Our special thanks to students who participated in this
study. We thank the staffs of the dormitories of Isfahan and
Shahid Beheshti Universities of Medical Sciences who helped
us conduct this research, and Ali Gholamrezaei who helped
us in writing this report.
Conflicts of interest
No competing financial interests exist.
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Address reprint requests to:
Marjan Goli, M.Sc.
Nursing and Midwifery School
Islamic Azad University of Najafabad
OZGOLI ET AL. 132