Aromatherapy Massage Affects Menopausal Symptoms in Korean Climacteric Women: A Pilot-Controlled Clinical Trial

Abstract

This study investigated the effects of aromatherapy massage on menopausal symptoms in Korean climacteric women. Kupperman's menopausal index was used to compare an experimental group of 25 climacteric women with a wait-listed control group of 27 climacteric women. Aromatherapy was applied topically to subjects in the experimental group in the form of massage on the abdomen, back and arms using lavender, rose geranium, rose and jasmine in almond and primrose oils once a week for 8 weeks (eight times in total). The experimental group reported a significantly lower total menopausal index than wait-listed controls (P < 0.05). There were also significant intergroup differences in subcategories such as vasomotor, melancholia, arthralgia and myalgia (all P < 0.05). These findings suggest that aromatherapy massage may be an effective treatment of menopausal symptoms such as hot flushes, depression and pain in climacteric women. However, it could not be verified whether the positive effects were from the aromatherapy, the massage or both. Further rigorous studies should be done with more objective measures.

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Advance Access Publication 23 April 2007 eCAM 2008;5(3)325–328
doi:10.1093/ecam/nem027
Original Article
Aromatherapy Massage Affects Menopausal Symptoms in Korean
Climacteric Women: A Pilot-Controlled Clinical Trial
Myung-Haeng Hur
1
, Yun Seok Yang
2
and Myeong Soo Lee
3
1
Department of Nursing, Eulji University,
2
Department of Obstetrics & Gynecology, School of Medicine,
Eulji University and
3
Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon,
South Korea
This study investigated the effects of aromatherapy massage on menopausal symptoms in
Korean climacteric women. Kupperman’s menopausal index was used to compare an
experimental group of 25 climacteric women with a wait-listed control group of 27 climacteric
women. Aromatherapy was applied topically to subjects in the experimental group in the form
of massage on the abdomen, back and arms using lavender, rose geranium, rose and jasmine in
almond and primrose oils once a week for 8 weeks (eight times in total). The experimental
group reported a significantly lower total menopausal index than wait-listed controls (P50.05).
There were also significant intergroup differences in subcategories such as vasomotor,
melancholia, arthralgia and myalgia (all P50.05). These findings suggest that aromatherapy
massage may be an effective treatment of menopausal symptoms such as hot flushes, depression
and pain in climacteric women. However, it could not be verified whether the positive effects
were from the aromatherapy, the massage or both. Further rigorous studies should be done
with more objective measures.
Keywords: aromatherapy – climateric – massage – menopausal
Introduction
Techniques for improving the health of post-menopausal
women currently focus on reducing risk factors such as
coronary heart disease, deep vein thrombosis, breast
cancer and gallbladder problems, with which hormone
replacement therapy (HRT) may be associated (1).
Because of the potential for adverse reactions to HRT,
it has been proposed that the use of phytoestrogens,
plant constituents with a phenolic structure similar to
estrogen, may be useful for relieving climacteric symp-
toms rather than HRT (2). Meta-analysis of 29 studies
has shown that phytoestrogens alleviate climacteric
symptoms and improve lipid profiles in post-menopausal
women (3).
Aromatherapy is the therapeutic use of essential oils
from plants and phytoestrogens have been found in some
of the essential oils used in aromatherapy (4–6). Many
studies have found that aromatherapy improves psycho-
logical symptoms such as anxiety, depression and mood
swings, and induces more relaxed states in young and
middle-aged women (4,7–10). Several aromatic oils have
been recommended as phytoestrogens because they
include components related to the sex hormones
(4,6,11–13). Some of these oils have similar structures
and functions such as clary sage, fennel, cypress, angelica
and coriander (4,12). It has been proposed that geranium
oil balances hormones and that rose oil strengthen uterus
function (4,6,11,12). Evening primrose is recommended as
a base oil in aromatherapy for menopausal women (14).
However, the therapeutic effects of aromatherapy
on climacteric symptoms are not well supported by
For reprints and all correspondence: Myeong Soo Lee, PhD,
Department of Medical Research, Korea Institute of Oriental Medicine,
461-24 Jeonmin-dong, Yuseong-gu, Daejeon 305-811, South Korea.
Tel: 82(0)42 868 9266; E-mail: drmslee@gmail.com; mslee@kiom.re.kr
ß2007 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original workis
properly cited.

clinical studies. This study was conducted to investigate
whether lavender, rose geranium, rose and jasmine oils,
which are used frequently in the clinical field for
improving various menopausal symptoms or are recom-
mended as phytoestrogens, improve menopausal symp-
toms in climacteric women when applied with massage.
Participants and Methods
Participants
Sixty participants took part in the study. Participants
were eligible to participate in the program if: (i) they were
between 45 and 54 years old; (ii) they were able to
understand the content of questionnaires and experimen-
tal schedules; (iii) their endometrial thickness was 56 mm;
(iv) they were below Class II in the Papanicolaou smear
test; (v) they had no history of dysplasia or cervical
cancer; (vi) they agreed to the use of aromatherapy and
(vii) they had no allergy to aromatherapy in accordance
with a skin test, which was done during the recruitment
stage. The participants were assigned to an aromatherapy
group (n¼30) and a wait-listed age-matched control
group (n¼30). Eight participants (five from the experi-
mental group and three from the control group) dropped
out without completing the experimental procedure. We
finally analyzed 52 participants (aromatherapy group,
n¼25; age 49.4 2.6 years, mean SD; and control
group, n¼27; age 50.3 2.8 years, mean SD). The
experimental protocol was approved by the Institutional
Review Board (IRB) at the University Hospital. All
subjects agreed to participate in the study and signed the
informed consent form of the IRB. No adverse effects
occurred during the experiment and the data of all
participants were available for analysis.
Menopausal Symptoms
The outcome measures were menopausal symptoms, as
obtained through Kupperman’s 11-item menopausal index
(15–17), before and after 8 weeks of treatment. The
Kupperman index is a numerical conversion index includ-
ing 11 menopausal symptoms: hot flushes (vasomotor),
paresthesia, insomnia, nervousness, melancholia, vertigo,
weakness, arthralgia or myalgia, headache, palpitations,
and formication. The items were rated on the following
four-point scale: ‘none’ (0), ‘mild’ (1), ‘moderate’ (2), and
‘severe’ (3). To calculate the Kupperman index, the
symptoms were weighted as follows: hot flushes (4),
parasthesia (2), insomnia (2), nervousness (2) and all
other symptoms (1). Therefore, the highest potential
score was 51. The score for hot flushes was based on the
number of complaints per day: mild (more than five),
moderate (5–10) and severe (more than 10).
Interventions
Massage and oils
Each subject in the experimental group received one
30-min aromatherapy treatment session a week for
8 weeks (eight sessions in total). The treatment was a
massage with essential oils of lavender, rose geranium,
rose and jasmine diluted in almond and evening primrose
oil. No treatment was provided to subjects in the control
group, who continued their usual daily routines. The
control group was provided the aromatherapy massage
therapy after the 8 weeks had expired; however, the data
were not collected.
The aromatherapy massage was given to subjects in the
experimental group by the same certified aromatherapist
(participants did not know her personally) at the same
time and on the same day each week. The treatment
involved an abdominal, back and arm massage with
essential oils of lavender, rose geranium, rose and jasmine
in a 4:2:1:1 ratio, diluted almond (90%) and evening
primrose oil (10%) at a final concentration of 3%. The
massage treatment room was isolated and equipped with
beds warmed by heating pads. Participants were
requested to lie on a bed and rest after the abdominal
massage.
Massage method
The massage began with effleurage strokes in the shape
of a flat diamond, working clockwise with a pressure of 4
on a scale of 0–10, where 0 is no pressure and 10 is
crushing pressure. The left hand was placed on the right
hand and both hands were placed on the lower right
abdomen. The stroke went to the ribs and then across the
abdomen to the lower left abdomen. A cushion was
placed under the subject’s knees to keep the abdomen
relaxed. This was followed by gentle kneading at the left
and right of the waist, and then stroking across the
abdomen. Finally, the effleurage flat diamond stroke
began again. The massage on the back and arms was
done in the same way. The strokes were slow, smooth
and continuous.
Statistical Analysis
The results were analyzed using SPSS software. All
outcomes were compared using the unpaired t-test for
between-group comparisons and the paired t-test
for comparisons between baseline and post-treatment
for subjects in the experimental group.
Results
The groups did not differ significantly in age, age of
menarche, age at first birth, height or weight (Table 1).
326 Aromatherapy massage for menopausal symptoms

Subcategories of Menopausal Symptoms
Across all categories of menopausal symptoms measured
by the Kupperman index, the mean scores were lower
in the aromatherapy group after 8 weeks of treat-
ment, whereas most scores in the control group increased
(Fig. 1). There were significant intergroup differences in
the amount of hot flushes, melancholia and arthralgia
and myalgia (all, P50.05). There were also significant
reductions in hot flushes, paresthesia and melancholia
for the aromatherapy group compared with baseline
(all, P50.05), whereas the melancholia score (P50.05)
increased significantly in the control group.
Total Menopausal Index
The mean baseline level of the menopausal index did not
differ between the two groups (t¼0.72, P¼0.47; Fig. 2).
However, after 8 weeks of treatment, Kupperman index
scores differed significantly between the aromatherapy
group and the control group (t¼2.08, P¼0.043), with
significant changes from baseline in the aromatherapy
group (t¼2.83, P50.01). The change in the menopausal
index level was more significant in the aromatherapy
group than in the control group (t¼3.00, P50.005,
aromatherapy: 5.44 9.60, mean SD; control:
1.59 7.25).
Discussion
In this study, subjects who received an aromatherapy
massage once a week for 8 weeks showed a greater
reduction in menopausal symptoms than those in the
control group. More specifically, aromatherapy massage
improved hot flushes, depression and pain in climacteric
women.
Figure 1. Scores for each item in the Kupperman index at baseline and after eight weeks in the aromatherapy group (n¼25) and the control group
(n¼27).
*
P50.05 compared with control group.
Table 1. Homogeneity test for demographic characteristics (N¼52)
Characteristics Aromatherapy
(n¼25)
Control
(n¼27)
tor U P
Age (year) 49.4 2.6 50.3 2.8 1.25 0.22
Menache age (year) 15.2 1.3 15.2 1.7 336.0* 0.98
First birth age (year) 27.9 2.0 27.3 2.0 277.5* 0.27
Height (cm) 157.5 4.7 157.0 4.5 0.39 0.70
Weight (kg) 56.0 6.4 58.3 6.6 1.26 0.21
Body fat (%) 30.0 5.2 31.5 4.8 0.97 0.34
Endometrial
thickness (cm)
0.53 0.41 0.42 0.29 223.0* 0.26
Values are expressed as mean SD.
*Mann–Whitney U test.
eCAM 2008;5(3) 327

The results of the present study suggest that aro-
matherapy massage may improve menopausal symptoms
of climacteric women. This is in accordance with previous
uncontrolled trials, which reported improvement of
menopausal symptoms through aromatherapy (13). Our
study also supports the proposal that several aromatic
essential oils have phytoestrogen effects on menopausal
symptoms in climacteric women (8). Furthermore,
aromatherapy massage improved hot flushes, depression
and pain in the experimental group compared with the
control group. These results are consistent with previous
reports of the use of essential oils in treating each of these
symptoms (8).
However, we acknowledge that our study has several
limitations, such as non-randomized design and the lack
of an equivalent-treatment control group to estimate the
superior effectiveness of aromatherapy massage.
Therefore, it is not clear whether the positive effects
were due to the aromatherapy, the massage or both (e.g.
identical results may have been achieved by using only
massage, or by using aromatherapy and massage).
Further randomized studies should be carried out that
include more objective measures, such as hormonal
changes associated with climacteric women, to explain
the possible mechanism of reduction in menopausal
symptoms.
Acknowledgements
This work was supported by the Korea Research
Foundation Grant funded by the Korean Government
(MOEHRD, Basic Research Promotion Fund) (KRF-
2004-002-E00179).
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Received September 13, 2006; accepted December 28, 2006
Figure 2. Mean Kupperman index score at baseline and after 8 weeks in
the aromatherapy group (n¼25) and the control group (n¼27).
328 Aromatherapy massage for menopausal symptoms