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From the *Department of Midwifery,
Faculty of Health Sciences, Atatu
¨rk
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@
hotmail.com
Received September 30, 2009;
Revised April 21, 2010;
Accepted April 22, 2010.
1524-9042/$36.00
Ó2010 by the American Society for
Pain Management Nursing
doi:10.1016/j.pmn.2010.04.002
Effect of Aromatherapy
Massage on
Dysmenorrhea in
Turkish Students
---Serap Ejder Apay, MSc,
*
Sevban Arslan, PhD,
†
Reva Balci Akpinar, PhD,
†
and Ayda Celebioglu, PhD
†
-ABSTRACT:
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
¨zdemir,
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;
Lewers,Clelland,Jackson,Varner,&Bergman,1989).
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.
METHOD
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.
Participants
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.
Intervention
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
randomly.
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
placebo]).
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.
ARTICLE IN PRESS
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.
RESULTS
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).
DISCUSSION
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
TABLE 1.
Comparison of Impact of Aromatherapy and Placebo Massage Groups on Dysmenorrhea (Visual Analog
Scale Scores)
Group Before After
Test values
tdfpvalue
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
ARTICLE IN PRESS
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.
Limitations
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
sample.
CONCLUSIONS
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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