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The purpose of this study was to investigate the effect of aromatherapy massage on dysmenorrhea. The study used a quasiexperimental design with the subjects as their own control. Every participant applied both aromatherapy massage with lavender oil and placebo massage with odorless liquid petrolatum [soft paraffin]. The population comprised 438 midwifery and nursing students. The 150 students who had declared that they had suffered from dysmenorrhea used a visual analog scale to indicate their level of pain. Higher scores reflected a greater severity of dysmenorrhea. Forty-four students volunteered to participate in the study. When the lavender massage and the placebo massage were compared, the visual analog scale score of the lavender massage was found to decrease at a statistically significant rate. This study showed that massage was effective in reducing dysmenorrhea. In addition, this study showed that the effect of aromatherapy massage on pain was higher than that of placebo massage.
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From the *Department of Midwifery,
Faculty of Health Sciences, Atatu
University, Erzurum, Turkey;
Department of Nursing, Faculty of
Health Sciences, Atatu
¨rk University,
Erzurum, Turkey.
Address correspondence to Mrs.
Serap Ejder Apay, Department of
Midwifery, Faculty of Health
Sciences, Atatu
¨rk University,
Erzurum, Turkey. E-mail: sejder@
Received September 30, 2009;
Revised April 21, 2010;
Accepted April 22, 2010.
Ó2010 by the American Society for
Pain Management Nursing
Effect of Aromatherapy
Massage on
Dysmenorrhea in
Turkish Students
---Serap Ejder Apay, MSc,
Sevban Arslan, PhD,
Reva Balci Akpinar, PhD,
and Ayda Celebioglu, PhD
The purpose of this study was to investigate the effect of aromatherapy
massage on dysmenorrhea. The study used a quasiexperimental de-
sign with the subjects as their own control. Every participant applied
both aromatherapy massage with lavender oil and placebo massage
with odorless liquid petrolatum [soft paraffin]. The population com-
prised 438 midwifery and nursing students. The 150 students who had
declared that they had suffered from dysmenorrhea used a visual an-
alog scale to indicate their level of pain. Higher scores reflected
a greater severity of dysmenorrhea. Forty-four students volunteered to
participate in the study. When the lavender massage and the placebo
massage were compared, the visual analog scale score of the lavender
massage was found to decrease at a statistically significant rate. This
study showed that massage was effective in reducing dysmenorrhea.
In addition, this study showed that the effect of aromatherapy massage
on pain was higher than that of placebo massage.
Ó2010 by the American Society for Pain Management Nursing
Dysmenorrhea is a disorder involving pain that arises in the inguinal region dur-
ing or just before menstrual bleeding. Dysmenorrhea is associated with lower
abdominal cramps and back pain, as well as nausea, vomiting, fatigue, nervous-
ness, appetite loss, diarrhea, and headache (Banikarim, Chacko, & Kelder, 2000;
Beckman, Ling, & Laube, 2002; Jun, Chang, Kang, & Kim, 2007; Symonds &
Symonds, 2004, p. 253). The pain usually begins just before or as menstrual
bleeding begins, and gradually diminishes over 1-3 days. Pain usually occurs
intermittently, ranging from being mild to disabling (Roger, Smith, Andrew, &
Kaunitz, 2007)
The prevalence of dysmenorrhea is highest in adolescent women, with esti-
mates ranging from 20% to 90%, depending on the measurement method used.
About 15% of adolescent girls report severe dysmenorrhea, and it is the leading
cause of recurrent short-term school absenteeism in adolescent girls in the United
States (Banikarim, Chacko, & Kelder, 2000; Davis & Westhoff, 2001; French, 2005;
French, 2008). Similar results were obtained in a few studies performed in Turkey.
In these studies, the ratio of dysmenorrhea was found to be between 70.3% and
83.13% among adolescent women (Aykut et al., 2007; Eryilmaz & O
2009; Vicdan et al., 1993). Because dysmenorrhea can decrease productivity,
Pain Management Nursing, Vol --,No-- (--), 2010: pp 1-5
Original Article
creativity, and work performance, leading to serious
daily stress and social and economic loss, it is
important to treat this disorder (Dawood, 1990).
Different methods have been used to treat dysmenor-
rhea. Some experimental studies have found alternative
methods such as acupuncture, acupressure, transcutane-
ous electrical nerve stimulation, massage, and aromather-
apy to be fairly effective (Han,Hur,Buckle,Choi,&Lee,
2006; Helms, 1987; Jun, Chang, Kang, & Kim, 2007;
Through massage, hypoxia regresses and the oxy-
gen level in tissues increases, and thus the severity of
the pain decreases. Massage is believed to be an effec-
tive way to improve blood and lymph circulation and
to reduce stress and ease stiff muscles. An effective
massage alleviates pain caused by tight and tense mus-
cles. In addition, after a massage session endorphin
release increases, which consequently increases the
pain threshold and reduces the level of pain felt (Ay,
2007; Buckle, 1999; Han et al., 2006). Earlier studies
have shown that 15 minutes of massage was effective
(Han et al., 2006; Seers, Crichton, Martin, Coulson, &
Carroll, 2008).
Aromatherapy is the therapeutic use of essential
oils from plants and is perceived to be a safe therapy
(Buckle, 2001). There are many types of essential oils
used for aromatherapy, such as melissa, eucalyptus,
and lavender. They have to be used with care, because
they are highly concentrated. They are especially effec-
tive for relaxing, reducing pain and stress, improving
coping mechanisms, and increasing the sense of well-
ness. Keville and Green (1995) suggested that essential
oils should be used for several days before dysmenor-
rhea or menstrual cramps are expected. The essential
oil of lavender is thought to be an adrenocortical stim-
ulant that stimulates menstruation and circulation and
has anticonvulsive properties. It has been asserted that
lavender oil, which is widely used, has relaxation and
sedative effects on the amygdala and it is the least toxic
and allergy-inducing essential oil (Buckle, 1998;
Buckle, 1999; Buckle, 2001; Dunn, Sleep, & Collett,
1995; Maddocks-Jennings & Wilkinson, 2004).
Lavender is also useful as a sedative, local anesthetic,
and analgesic (Ghelardini, Galeotti, & Mazzanti, 1999;
Lavabre, 1996).
Aromatherapy massage is the most widely used
complementary therapy in nursing practice (Kyle,
2006). In the literature there are studies that have
examined the effects of aromatherapy massage on
different patient groups (Hur, Oh, Lee, Kim, Choi, &
Shin, 2007; Rho, Han, Kım, & Lee, 2006). However,
there are few studies related to dysmenorrhea (Han
et al., 2006). The present study investigated the effect
of aromatherapy massage on dysmenorrhea.
Design and Sample
The study was conducted to determine the effect of
aromatherapy massage on nursing students’ reports
of dysmenorrhea. The study used a quasiexperimental
design with the subjects as their own control.
The study population comprised 438 midwifery and
nursing students who had attended the Erzurum
Health School between January and June 2008. Of
the 150 students who had declared that they had suf-
fered from dysmenorrhea, 44 students volunteered to
participate in the study. Participants were asked to
use a visual analog scale (VAS) on the first day of the
menstrual period to record their level of pain. The in-
tensity of dysmenorrhea was measured with a 100-
point VAS, indicated by marking the appropriate value
on a 100-mm horizontal ruled line. Higher scores re-
flected a greater severity of dysmenorrhea pain, and
participants’ VAS scores were >60 on commencement
of the study. Participants indicated that they had not
suffered from any systemic or genital diseases, they
had had regular menstrual cycles, and they had not
been using analgesics to overcome dysmenorrhea.
Every participant was to receive both aromatherapy
massage (with lavender oil) and placebo massage
(with odorless liquid petrolatum [soft paraffin]). The
application order of these massages was determined
Each participant was monitored during 3 men-
strual periods. During the first period participants
documented their own pain levels on the VAS without
any intervention applied. During the second period,
one of the two applications (placebo massage or aro-
matherapy massage) was applied. In the third men-
strual period, those participants who had previously
received aromatherapy massage received placebo mas-
sage; and those who had received placebo massage
received aromatherapy massage through the same
means. Following each application, the severity of
pain was noted on the VAS. To maintain the study as
unbiased, the VAS evaluation was conducted by a re-
searcher who did not know the study groups. On com-
pletion of the study, three VAS scores had been
obtained for every participant (1 before intervention
and 2 after intervention [with aromatherapy and with
Massage was provided to the participants at a fixed
time of the day by the same massager on a bed in a spe-
cial quiet room where the temperature was between
2Apay et al.
23 C and 25 C (73.4F and 77F). Massage was ap-
plied while the participants were lying in a supine po-
sition. A cushion was placed under the subject’s knees
to keep the abdomen relaxed. Massage was applied on
the abdomen, on the region above the pubic symphy-
sis and above the umbilicus. The researcher had
washed and dried her hands and waited for them to
warm before applying the massage. The first re-
searcher , depending on the type of massage, poured
2 mL of lavender oil or liquid petrolatum into her
hands and applied the massage with clockwise circular
movements (effleurage). The researcher’s left hand
was placed on the right hand and both hands were
placed on the abdomen. Overpressure was not applied
on the abdominal region during massage. Each mas-
sage session lasted 15 minutes. After the massage, the
participant’s abdomen was cleaned with a clean and
dry paper towel. The second researcher recorded
VAS scores.
Data Analysis
The data were evaluated using SPSS version 11.0 com-
puter software for analysis using descriptive statistics,
and ttest pvalue of .05 was considered to be statisti-
cally significant. The significance level was set at .05.
Power analysis was based on a two-sided alpha of
.05, with a power of .90 when calculated at the end
of the study.
Ethical Approval
Legal permission was received from the related institu-
tion before the research. Participant students were
briefed regarding the purpose of the research and
they were told that the intervention had no known
side effects. After students were given information on
the method of the research they gave their written in-
formed consents. Moreover, students were told that
they could quit the study at any time during the data
collection period.
The average age of the participants was 20.31 1.09
years, average age of menarche was 13.38 1.38 years,
average menstruation period was 6.29 1.09 days, and
average period of time between menstruation periods
was 26.77 3.16 days.
When the effect of aromatherapy and placebo
massage on dysmenorrhea was observed, a statistically
significant difference was found between the partici-
pants’ preapplication and postapplication VAS scores
(p<.001). Likewise, a statistically significant differ-
ence (p<.001) was found between the preapplication
and postapplication VAS scores for the placebo mas-
sage group (Table 1).
When the aromatherapy massage and the placebo
massage groups were compared, the participants’ VAS
score of the lavender massage group were found to be
significantly lower (p<.001) than the placebo group
(Table 2).
Women who experience dysmenorrhea may need to
get help from health care professionals when it has
negative effects on their lives. In the present study,
the effects of aromatherapy were examined in young
women who had declared that they suffered from dys-
menorrhea and who were studying midwifery and
nursing in Turkey.
The participants reported a serious level of dys-
menorrhea before the intervention, as shown by the
mean rating of dysmenorrhea of 82.38 10.86 on
the 100-point VAS. Menstruation periods can be so
painful that it can negatively affect women’s daily life
activities. Earlier researchers have shown that women
had reported intensely painful menstruation periods.
According to a study conducted by Vicdan et al.
(1993), 78.06% of adolescents suffered from pain and
20.43% of them did not. Although 74.83% of those re-
porting pain suffered from mild pain, 25.6% of them
were frequently absent from class owing to moderate
Comparison of Impact of Aromatherapy and Placebo Massage Groups on Dysmenorrhea (Visual Analog
Scale Scores)
Group Before After
Test values
Aromatherapy massage 82.38 10.86 51.13 24.91 8.21 43 <.001
Placebo massage 82.38 10.86 74.31 11.08 7.63 43 <.001
3Aromatherapy Massage and Dysmenorrhea
or severe pain. Only 0.39% of the adolescents with dys-
menorrhea had consulted their doctor regarding their
pain. Dysmenorrhea was experienced by 83.13% of
18-year-olds and 75% of 13-year-olds. In a study by
Aykut et al. (2007), the frequency of dysmenorrhea
was 70.3% for the research group. Moreover, in a study
conducted by Eryılmaz and O
¨zdemir (2009), dysmen-
orrhea was experienced by 81.7% of subjects.
In the present study, dysmenorrhea decreased
from 82.38% to 51.13% after aromatherapy massage;
and from 82.38% to 74.31% after placebo massage. It
is thought that massage has soothing, relaxing, and
tension-reducing effects, because of the lower pain
score averages reported by both groups. Massage ther-
apy has been shown to be highly beneficial in relieving
pain, tension, and stress. In a study performed by Kim
et al. (2005), where they examined the effect of ab-
dominal massage on those suffering from dysmenor-
rhea, they found that massage had a statistically
significant effect on reducing dysmenorrhea and men-
strual cramps. In Eryilmaz and O
¨zdemir’s (2009) study,
applying massage to relieve pain in adolescents who
had dysmenorrhea was effective in 11% of the subjects.
In the present study, it was clear that the aromatherapy
massage group’s average pain scores are lower than the
placebo massage group’s average pain scores. Thus,
the use of both massage and aromatherapy was more
effective than only massage.
It is known that both massage therapy and the use
of essential oils are beneficial; to combine the two can
be even more synergistically beneficial than either
therapy separately (Poulton, 2006). In an earlier study
that examined the impact of aromatherapy massage on
the symptoms of dysmenorrhea, it was found that aro-
matherapy massage decreased pain (Han et al., 2006).
The present study provides empirical data for
evidence-based nursing research. The results of this
study have practical implications in nursing practice
for adolescents who suffer from dysmenorrhea.
The present study is limited by its small sample size,
and results cannot be generalized to a wider popula-
tion. Future research should be conducted with a larger
The results of the study have demonstrated that mas-
sage was effective in reducing dysmenorrhea. In addi-
tion, this study also demonstrated that the effect of
aromatherapy massage on pain was higher than that
of placebo massage. The results showed that the
method could be applied by nurses and patients in
a safe manner, because it had no side effects and it
was cheap and easily applicable. As the results of the
study suggest, nurses should recommend the use of
aromatherapy massage to those experiencing dysmen-
orrhea, informing them of its benefits.
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5Aromatherapy Massage and Dysmenorrhea
... Primary dysmenorrhea refers to menstrual pain,which is not due to any evident pathology.On the other hand, secondary dysmenorrhea is defined as menstrual pain due to pelvic pathology.Prevalence of dysmenorrhea ranges between 60 and 73% in developed countries, 2, and between 34 and 89.6% amongst women of ther eproductive age groupin India. 3,4 Primary dysmenorrhea is the more common type of dysmenorrhea with prevalence ranging from 25 to 90% throughout the world 5 and 70.2% in India. 6 Primary dysmenorrhea usually begins within the first 6 to12 months after menarche,once a regular ovulatory cycle has been established 7 and can persist upto 30 years, with peak prevalence occurring in the late teens or early twenties. ...
... J West Bengal Univ Health Sci | Vol.3 | Issue 3 | January 2023 J West Bengal Univ Health Sci | Vol. 3 | Issue 3 | January 2023 24. Phatak SR. ...
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Background: Primary dysmenorrhea refers topainful menstruation in the absence of any pelvic pathology.Itis a common and often debilitating gynaecological complaint among adolescent and adult females, affecting their quality of life. According to homeopathic philosophy, medicines are prescribed based on individualization as per the totality of symptoms. However, different literature also shows the clinical utility ofMagnesiumphosphoricum (MP) in lowering pain of primary (spasmodic) dysmenorrhea, especially in 6X potency. We aimed to evaluate the effectiveness of MP 6X against individualized homeopathic medicines (IHMs).
... Alternative treatment methods are also used in the management of dysmenorrhea symptoms due to the side effects of the drugs. Dysmenorrhea can also be treated using complementary therapies, such as essential fatty acids, vitamins, acupuncture, herbal remedies, aromatherapy, reflexology, acupressure, massage therapy, and exercise (Abbaspour et al., 2006;Apay et al., 2012;Iorno et al., 2008). ...
... The decrease in pain intensity was greater in the massage group compared with the isometric exercise and control groups after the intervention (Azima et al., 2015). There are other studies in the literature reporting that abdominal massage reduces the severity of pain and is not similar to our finding (Apay et al., 2012;Bakhtshirin et al., 2015;Beiranvand et al., 2015;Shahr et al., 2015;Sut & Kahyaoglu-Sut, 2017). Although the main mechanism of massage in reducing pain is still unknown, one of the theories is the gate control theory. ...
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In this study the researchers aimed to determine the effect of abdominal massage and stretching exercises on the severity of pain, dysmenorrhea symptoms and menstrual blood lost in university students. In this single-blind randomized controlled clinical trial 63 university students were included. Participants were randomly assigned into massage group, exercise and control groups. Our findings showed that the 2nd cycle scores related to abdominal-back pain and fatigue in the massage group and 2nd cycle scores related to mood change in the exercise group were significantly lower than those of the massage and control groups. However, there was no difference between groups in terms of the Visual Analogue Scale scores and blood lost. Our evidence indicates that massage was effective on abdominal-back pain and weakness, and exercise was effective on mode change.
... This study shows that massage is effective in reducing dysmenorrhea. In addition, this study showed that the effect of aromatherapy massage on pain was higher than that of placebo massage (Apay et al., 2012). ...
One of the complaints during menstruation is dysmenorrhea. The way of healing to reduce the symptoms of dysmenorrhea in addition to pharmacological therapy is by giving acupressure using aromatherapy. This community service activity uses the Community Development method (community empowerment). The activity will be held in April 2022. The location of the activity is in Pegadingan Village, Kramatwatu District, Serang Regency. The target of this community service activity is 26 teenagers. This activity is an outreach and training on acupressure using aromatherapy. The pretest and post-test scores showed a change in the form of an increase in the number of participants who understood from 20 participants (77%) at the time of the pre-test then an increase in the number of participants who understood as many as 26 people (100%). There is an increase in post-test results showing that training on acupressure using aromatherapy can improve adolescents' knowledge and skills about acupressure using aromatherapy to treat dysmenorrhea.
... 10,16 CAM treatments can be chosen as medical interventions to prevent or alleviate PD. 17 Recent studies introduced several CAM treatment modalities for PD, including acupuncture, acupressure, moxibustion, 18,19 muscle relaxation, 20 nutritional functional foods, 21 and aromatherapy. [22][23][24] A study suggested that acupuncture can more effectively reduce PD and relevant symptoms compared to NSAIDs and that the therapeutic effects are retained in the short term. 25 According to Akiyama's five-year study utilizing the Japan Health Insurance (JMDC) database from 2009, 26 patients had approximately one day of therapy (DOT) for every 45 days due to dysmenorrhea (ICD-10 code N94.4, ...
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Purpose: This study is a retrospective, cross-sectional study aiming to present basic data on the treatment modalities and cost of care for primary dysmenorrhea (PD) by analyzing healthcare utilization and patient distributions using the 2010 to 2018 Health Insurance Review and Assessment Service (HIRA) data. Patients and methods: We used the HIRA-National Patient Sample (NPS) data to analyze medical service utilization for PD (ICD-10 code: N94.4, N94.6) in Western medicine (WM) or Korean medicine (KM) care between January 2010 and December 2018. Results: There were 41,139 patients diagnosed with PD who utilized Western medicine (WM) or Korean medicine (KM) care at least once during the study period. The number of claims and patients steadily rose over the years from 7430 claims for 3989 patients in 2010 to 11,523 claims for 6226 patients in 2018. The predominant age group was 15 to 24 years. Regarding the frequency of service categories for PD in the claims, consultation was the most common and costly service category in WM (72,120 cases, 47.89%; 631,912 USD, 69.74%), while injection and analogous treatments was the most common and costly service category in KM (97,157 cases, 72.41%; 314,696 USD, 55.86%). Regarding the drug prescriptions, nonsteroidal anti-inflammatory drugs (NSAIDs) (26,617 cases, 40.47%) were the most frequently prescribed drug for PD in pharmacies and hospitals. Conclusion: The result shows an annual increase in healthcare utilization for PD with the fastest rate in individuals aged 15 to 24 years. This study provides data on the current utilization of WM and KM care for PD for policymakers. Furthermore, we analyzed the frequency and cost of common treatment modalities in WM and KM, which would be useful data for clinicians and researchers.
... Abdominal bölgeye uygulanan masajın dismenoreyi azalttığı ve lavanta yağı ile yapılan aromaterapik masajın ise ağrıyı azaltmakta daha etkili olduğu ayrıca masajın endorfin salınımını artırarak ağrı eşiğini yükselterek daha az ağrı hissi yarattığı sonucuna varılmıştır. 1 Yapılan başka bir çalışmada da masajın dismenore üzerinde etkili olduğu belirtilmiştir. 21 ABD EL-azeem ve arkadaşlarının yaptığı bir çalışmada akupresür uygulamasının dismenore ağrısını azalttığı ve menstrüasyon döneminde analjezik kullanımının azaldığı bildirilmiştir. 22 Alp Yılmaz ve Başer'in yaptıkları çalışmada refleksoloji ve plasebo ayak masajının dismenoreyi azaltmada etkili oldugȗ görülmüştür. ...
... On the other hand, a person who has digestive problems should take the drug under the supervision of a specialist. Daniels One study reviewed the effect of massage on dysmenorrhea in the third cycle [30], [43]. Massage with lavender essential oil affects the reduction of dysmenorrhea pain. ...
This chapter will cover a theory-based cognitive behavior therapy (CBT) approach for young women's menstrual pain management. This chapter will help people understand menstrual pain management and its potential for improving pain management knowledge and promoting the adoption of wellness-focused coping methods to manage pain in everyday settings. There is substantial evidence for treating mental health issues using cognitive-behavioral techniques and menstrual pain for young women based on this meta-inclusion analysis of RCTs with solid study designs in this chapter.
A total of 97 female students, 50 in the intervention group and 47 in the control group, were included in this pretest-posttest design randomized controlled study. Massage and progressive relaxation exercises are self-administered practices that are easy to adopt, with no side effects, and have beneficial effects on pain, sweating, fatigue, and gastrointestinal and central nervous system signs. So, it can be asserted that when applied together, massage and progressive relaxation exercises could be more effective in reducing menstrual symptoms than applying them separately.
Background: Since the 1990's aromatherapy has been a popular adjunct to nursing and midwifery care in a variety of health care settings. Objective: The scoping review seeks to identify and confirm the benefits of incorporating aromatherapy into holistic nursing and midwifery practice Design: A scoping review using PRISMA-ScR of experimental studies where care is provided to the patient by a registered nurse or midwife. Settings and participants: Any health care setting where nurses or midwives provide care. Review Methods: A multi- engine search using a range of MeSH and non-MeSH terms with the Boolean search [AND]. Inclusion criteria were; publication date from 2005–2021, study involved aromatherapy as an intervention, conducted in a clinical nursing or midwifery environment and the published article is available in full in English. Excluded were; single patient cases, animal studies, in vitro studies, use of essential oils internally or a whole plant extract was used or use was non-nursing/midwifery related. Results: 124 studies met the inclusion criteria (n = 19188), classified into seven themes. Conclusion: The evidence supports the use of aromatherapy within a range of nursing and midwifery practices enhancing a holistic model of care. Impact: This scoping review contributes evidence to support the inclusion of aromatherapy into holistic nursing and midwifery practice.
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Purpose: This investigation was carried out in order to determine the prevalence of dysmenorrhoea among the women in the 10–50 age group in Kayseri and the impact of some factors on the prevalence of dysmenorrhoea.Material and Methods: A total of 1200 women in the 10–50 age group were selected randomly. The women were visited at home and a questionnaire including 40 questions was administered via a face to face interviewing method. Additionally, height and weight, measurements were taken. Chi square test and logistic regression analysis were used to investigate the impacts of various biological, socio-demographic and nutritional factors on the prevalence of dysmenorrhoea.Results: The prevalence of dysmenorrhoea was 70.3%. Dysmenorrhoea was more prevalent among in the younger women, nullipare and those who ate chocolate. The women who had abnormal feelings at menarche had higher prevalence. The impacts of a job, marital status, educational level, age at menarche, menstrual irregularity, having information about menstruation prior to menarche and the consumption of tea, coffee, cola and diary products, and overweight on the prevalence of dysmenorrhoea were not significant.Conclusion: The prevalence of dysmenorrhoea was approximately 70%. Age, parity, consumption of chocolate and abnormal feelings at menarche were found to be significant predictors of the prevalence of dysmenorrhoea.
PIP A review of the clinical features, diagnosis and management of primary and secondary dysmenorrhea updates some old views. Dysmenorrhea is painful menstruation, either cramps with no visible cause, primary dysmenorrhea, or secondary to specific pelvic pathology. Primary dysmenorrhea occurs in as many as 50% of young women, only in ovulatory cycles, and usually limited to the first 48 or 72 hours of menstruation. Secondary dysmenorrhea can be caused by any of a dozen or so disorders such as endometriosis, pelvic inflammatory disease, IUDs, irregular cycles or infertility problems, ovarian cysts, adenomyosis, uterine myomas or polyps, intrauterine adhesions or cervical stenosis. Psychological factors are now known not to cause dysmenorrhea, only to add to the reactive component of the pain. The pain is due to uterine cramps, hypoxia or ischemia, due to overproduction of prostaglandins, leukotrienes or vasopressin. Thus, primary dysmenorrhea can be treated with oral contraceptives if the women wishes to take pills for contraception and they are not contraindicated, or with non-steroidal antiinflammatory agents for the full 72 hours after pain begins. Calcium channel-blockers are also used on a research basis; transcutaneous electrical nerve stimulation is sometimes effective. If these treatments are not effective, investigation for causes of secondary dysmenorrhea is indicated, preferably for laparoscopy.
Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1–3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.
colon; To determine the effectiveness of a single treatment with acupuncture-like transcutaneous electrical nerve stimulation (TENS) for relief of primary dysmenorrheic pain, 20 women received either one placebo sugar pill or 30 min of acupuncture-like TENS at four acupuncture points bilaterally. Pain levels were measured using the visual analogue scale and McGill pain rating index for up to 150 min following treatment. Results showed that the experimental groups attained a statistically significant (p < 0.05) amount of pain relief and the control group did not. The results of this study indicate that acupuncture-like TENS could be an alternative for relief of menstrual pain. (C) Lippincott-Raven Publishers.
We evaluated approaches taken by Northeastern Turkish adolescents to cope with menstrual pain. The questionnaire was prepared according to the facial pain rating scale and applied to 1,408 female high school students (16.05 +/- 1.05 years of age). We investigated the characteristics of dysmenorrhea in adolescents, dysmenorrhea management strategies used by adolescents, and use of medication. We evaluated the relationships among pain duration, severity, and duration of dysmenorrhea experience using the chi-squared test. Dysmenorrhea was considered to be painful menstruation during the past three cycles and was experienced by 81.7% of subjects. It mostly occurred during the past 1-3 years (65.6%). Pain was mostly initiated a day before (38.8%) or at the beginning of (45.8%) menstrual flow and lasted for 1-3 days. It was felt in multiple locations but most commonly in the lower abdomen and lumbar region. Major symptoms associated with dysmenorrhea were sweating, low appetite, headache, distraction, nausea, vomiting, and dizziness, as well as varying degrees of pain severity. Approaches taken to deal with dysmenorrhea were: consulting a health professional (8.9%), medication (46.1%), nonmedicinal activities, and other empirical strategies (24.4%). Medication was recommended mostly by mothers (39.0%) and was taken when pain became unbearable (65.5%). More than one-third of the subjects did not know which drug they took. Major nonpharmacologic measures were: heating pad use (36.5%), sleeping (31.0%), walking (11.3%), and massaging (11.0%). Seeing a physician (p < .001), taking medication (p < .001), and applying empirical strategies to prevent dysmenorrhea (p < .01) were associated with prolonged dysmenorrhea. Medication was associated with shortening pain duration during one menstrual cycle. Except for empirical strategies to prevent dysmenorrhea, all other methods used to prevent dysmenorrhea were related to pain duration and severity. Adolescents should be encouraged to consult a physician and should be prescribed medication in addition to other measures to alleviate menstrual pain and shorten its duration. Moreover, school curriculum should be redesigned to address proper management strategies for adolescent problems. School nurses can also provide consultation services and arrange informative seminars to increase public awareness of this issue.
The purpose of this study was to replicate a previous study to determine the effectiveness of acupuncture-like transcutaneous electrical nerve stimulation in treating primary dysmenorrhea. Twenty-one women with dysmenorrhea received a placebo pill or 30 minutes of acupuncture-like TENS. All subjects completed two pain questionnaires before treatment; immediately posttreatment; 30, 60, 120, and 180 minutes posttreatment; and the next morning upon awakening. Each woman also participated in a separate study measuring electrical resistance at four auricular acupuncture points before and immediately after treatment. The data were analyzed with a two-factor repeated-measures analysis of variance, which revealed statistical significance over time but not for group or interaction between group and time. Results revealed an average pain relief of at least 50% immediately posttreatment, indicating that acupuncture-like TENS may be useful for dysmenorrheic pain. This study also suggests that auriculotherapy via acupressure may relieve the pain of primary dysmenorrhea.
The effectiveness of acupuncture in managing the pain of primary dysmenorrhea was investigated in a randomized and controlled prospective clinical study. Forty-three women were followed for one year in one of four groups: the Real Acupuncture group was given appropriate acupuncture and the Placebo Acupuncture group was given random point acupuncture on a weekly basis for three menstrual cycles; the Standard Control group was followed without medical or acupuncture intervention; the Visitation Control group had monthly nonacupuncture visits with the project physician for three cycles. In the Real Acupuncture group, 10 of 11 (90.9%) women showed improvement; in the Placebo Acupuncture group, 4 of 11 (36.4%); in the Standard Control group, 2 of 11 (18.2%); and in the Visitation Control group 1 of 10 (10%). There was a 41% reduction of analgesic medication used by the women in the Real Acupuncture group after their treatment series, and no change or increased use of medication seen in the other groups.
There is widespread belief that the use of aromatherapy and massage in an intensive care environment offers a means of increasing the quality of sensory input that patients receive, as well as reducing levels of stress and anxiety. Despite a wealth of anecdotal evidence in support of these claims, there have been few objective studies to evaluate the effects of these therapies. In this experimental study 122 patients admitted to a general intensive care unit were randomly allocated to receive either massage, aromatherapy using essential oil of lavender, or a period of rest. Both pre- and post-therapy assessments included physiological stress indicators and patients' evaluation of their anxiety levels, mood and ability to cope with their intensive care experience. Ninety-three patients (77%) were able to complete subjective assessments. There were no statistically significant differences in the physiological stress indicators or observed or reported behaviour of patients' ability to cope following any of the three interventions. However, those patients who received aromatherapy reported significantly greater improvement in their mood and perceived levels of anxiety. They also felt less anxious and more positive immediately following the therapy, although this effect was not sustained or cumulative.