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Archive of SID
Volume 14, No. 53, Winter 2015
Journal of Medicinal Plants
Herbal Medicine in the Treatment of Primary Dysmenorrhea
Kashani L (M.D.)1, Mohammadi M (M.D.)1, Heidari M (M.D.)2, Akhondzadeh S (Ph.D.)3*
1- Infertility ward, Arash Hospital, Tehran University of Medical Sciences, Tehran,
Iran
2- Iranian Academic Center for Education, Culture & Research (ACECR), Tehran,
Iran
3- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical
Sciences, Tehran, Iran
* Corresponding author: Psychiatric Research Center, Roozbeh Hospital, South
Kargar Street, Tehran 13337, Iran
Tel: +98-21-88281866, Fax: +98-21-55419113
Email: s.akhond@neda.net
Received: 21 Jan. 2015 Accepted: 17 March 2015
Abstract
Dysmenorrhea is called "primary" when there is no specific abnormality and "secondary" when
the pain is caused by an underlying gynecological problem. It is believed that primary
dysmenorrhea occurs when hormone-like substances called "prostaglandins" produced by
uterine tissue trigger strong muscle contractions in the uterus during menstruation. However, the
level of prostaglandins does not seem to have anything to do with how strong a woman's cramps
are. Some women have high levels of prostaglandins and no cramps, whereas other women with
low levels have severe cramps. This is why experts assume that cramps must also be related to
other things (such as genetics, stress, and different body types) in addition to prostaglandins.
Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the
pelvis. In this article we focus on herbal medicine in the treatment of primary dysmenorrheal.
Keywords: Herbal Medicine, NSAIDs, Primary dysmenorrhea
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Archive of SID
Journal of Medicinal Plants, Volume 14,
No. 53, Winter 2015
Herbal Medicine in …
Introduction
Dysmenorrhea refers to the symptom of
painful menstruation. It can be divided into 2
broad categories: primary (occurring in the
absence of pelvic pathology) and secondary
(resulting from identifiable organic diseases)
[1]. Primary dysmenorrhea is common
menstrual cramps that are recurrent (come
back) and are not due to other diseases. Pain
usually begins 1 or 2 days before, or when
menstrual bleeding starts, and is felt in the
lower abdomen, back, or thighs. Pain can
range from mild to severe, can typically last 12
to 72 hours, and can be accompanied by
nausea, vomiting, fatigue, and even diarrhea
[2-4]. Common menstrual cramps usually
become less painful as a woman ages and may
stop entirely if the woman has a baby.
Secondary dysmenorrhea is pain that is caused
by a disorder in the woman's reproductive
organs, such as endometriosis, adenomyosis,
uterine fibroids, or infection. Pain from
secondary dysmenorrhea usually begins earlier
in the menstrual cycle and lasts longer than
common menstrual cramps. The pain is not
typically accompanied by nausea, vomiting,
fatigue, or diarrhea. Some of the risk factors
for primary dysmenorrhea include an early
onset of menstrual periods (before the age of
12), heavy or prolonged menstrual flow, a
prior family history of dysmenorrhea, obesity,
or a history of smoking [5, 6]. The risk factors
for secondary dysmenorrhea include the
presence of fibroid tumors, pelvic
inflammatory disease, tubo-ovarian abscesses,
endometriosis, IUD, or ovarian torsion.
Primary dysmenorrhea can affect up to 50
percent of all women who have menstrual
periods, and up to 15% of these women will
have a level of pain that interferes with their
daily lives. Typically, dysmenorrhea begins
during adolescence, although occasionally it
can begin later in a woman's life. The
prevalence of dysmenorrhea is estimated to be
up to 90% in adolescents, and, in fact, is the
most common reason for school absence.
Dysmenorrhea can be crippling, both
physically and psychologically [5, 6].
Several drugs can lessen or completely
eliminate the pain of primary dysmenorrhea.
The most popular choice is the nonsteroidal
anti-inflammatory drugs (NSAIDs), which
prevent or decrease the formation of
prostaglandins. These include aspirin,
ibuprofen, and naproxen. These drugs are
usually begun at the first sign of the period and
taken for a day or two. There are many
different types of NSAIDs, and women may
find that one works better for them than the
others [6-9].
If an NSAID is not available,
acetaminophen may also help ease the pain.
Heat applied to the painful area may bring
relief, and a warm bath twice a day also may
help. While birth control medications will ease
the pain of dysmenorrhea because they lead to
lower hormone levels, they are not usually
prescribed just for pain management unless the
woman also wants to use them as a birth
control method. This is because these
medications may carry other more significant
side effects and risks [6-9].
Dietary recommendations to ease cramps
include increasing fiber, calcium, and complex
carbohydrates, cutting fat, red meat, dairy
products, caffeine, salt, and sugar. Smoking
also has been found to worsen cramps. Recent
research suggests that vitamin B supplements,
primarily vitamin B6 in a complex,
magnesium, and fish oil supplements (omega-
3 fatty acids) also may help relieve cramps.
Other women find relief through visualization,
concentrating on the pain as a particular color
and gaining control of the sensations.
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Kashani et al.
Aromatherapy and massage may ease pain for
some women. Others find that imagining a
white light hovering over the painful area can
actually lessen the pain for brief periods [6-9].
Herbal medicine has an important role in
women health [10-14]. There are a number of
herbal remedies for treatment of depression
and PMS in women and the most famous one
is saffron. In addition, there are a number of
herbal remedies for treatment of primary
dysmenorrheal [15-21].
Ginger (Zingiber officinale Rosc.): Ginger
has been traditionally used to treat ailments
such as arthritis, colic, diarrhea, and heart
conditions. Ginger can be consumed by
boiling it in water and drinking the water at
least 3 times a day to get relief from
dysmenorrhea. Research and clinical trials
conducted by Ozgoli et al, from Iran, show
that ginger has the same effect on killing pain
as mefenamic acid or ibuprofen, so it can be
used as one of the home remedies for
dysmenorrheal [22].
Parsley (Pteroselenium hortense Hoffm.):
Parsley has menstrual cycle-regulating
properties and pain relieving properties.
Parsley can be consumed as a juice mixed with
various vegetables such as carrots, beetroots,
cucumbers, and tomatoes for good results [23].
Mint (Mentha longifolia L.): Mint has
been used to treat many ailments, including
stomach disorders, indigestion, nausea, and
vomiting. Consumption of mint tea helps in
alleviating the associated pain of
dysmenorrheal [24].
Coriander (Coriandrum sativum L.): The
use of coriander has been traditionally
mentioned by Ayurvedic practices in India as a
remedy for dysmenorrhea. It can be consumed
by boiling a few stems of fresh coriander in
water. This is known to reduce dysmenorrheal
[24].
Cinnamon (Cinnamum camphora (L.)
Nees & Eberm.): Cinnamon is one of the
oldest spicies known to man. This spice also
has medicinal properties which include pain
relieving during menstrual cramps, apart from
other remedies such as the reduction of LDL
cholesterol, blood sugar levels, heart disease,
and cancer fighting properties [22].
Cramp Bark & Black Haw (Viburnum
opulus L. and Viburnum pranifolium L.):
These are probably the most effective herbs
for reducing uterine spasm and cramping.
These sister herbs bring relief of pain and
muscle spasm in the uterus. Cramp bark and
Black haw have been shown safe for use for
several days prior to onset on menses in
anticipation and prevention of painful cramps.
I can attest to these plants wonderful pain
relieving action. I personally feel these herbs
are one of the best herbs to have on hand at all
times for any sort of menstrual pain, I prefer it
over NSAID’s. There is also no risk of liver
damage from this herb like there are with
NSAID use [8, 10].
Black Cohosh (Actea racemosa L.): This
plant is very anti-inflammatory and wonderful at
reducing spasm in both the smooth muscles, but
also the skeletal muscles associated with pain
that radiates to the lower back and down the
thighs [8, 10].
Chamomile (Matricaria chamomilla L.):
This sweet little flower is both anti-
inflammatory and antispasmodic. It is also
helpful for women with digestive constipation
contributing to pain. Because this herb is also
a nervine and mild sedative it may help to
reduce stress, relax the nervous system and
induce a restful state in the body. This can be
very useful when experiencing menstrual
cramping accompanied by anxiety and
irritability. Chamomile is best sipped as a tea
during menstruation [8, 10].
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Journal of Medicinal Plants, Volume 14,
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Herbal Medicine in …
References
1. Latthe PM, Champaneria R.
Dysmenorrhoea. BMJ Clinical Evidence.
2014; 2014. pii: 0813.
2. Chen CX, Kwekkeboom KL and Ward SE.
Self-report pain and symptom measures for
primary dysmenorrhoea: A critical review.
European Journal of Pain. 2015; 19 (3): 377 -
91.
3. Osayande AS and Mehulic S. Diagnosis and
initial management of dysmenorrhea.
American Journal of Family Physician 2014;
89 (5): 341 - 6.
4. Harada T. Dysmenorrhea and endometriosis
in young women. Yonago Acta Medica 2013;
56 (4): 81 - 4.
5. Ju H, Jones M and Mishra G. The
prevalence and risk factors of dysmenorrhea.
Epidemiological Review 2014; 36: 104 - 13.
6. Sultan C, Gaspari L and Paris F. Adolescent
dysmenorrhea. Endocrine Development. 2012;
22: 171 - 80.
7. Lethaby A, Duckitt Ka and Farquhar C.
Non-steroidal anti-inflammatory drugs for
heavy menstrual bleeding. Cochrane Database
Systematic Reviwew. 2013; 1: CD000400.
8. Yu A. Complementary and alternative
treatments for primary dysmenorrhea in
adolescents. Nurse Practice 2014; 39 (11): 1 -
12.
9. Altshuler AL and Hillard PJ. Menstrual
suppression for adolescents. Current Opinion
in Obstetrics and Gynecol. 2014; 26 (5): 323 -
31.
10. Park KS, Park KI, Hwang DS, Lee JM,
Jang JB and Lee CH. A review of in vitro and
in vivo studies on the efficacy of herbal
medicines for primary dysmenorrhea.
Evidence Based Complementary and
Alternative Medicine 2014; 2014: 296860.
11. Akhondzadeh S, Ahmadi-Abhari SA,
Assadi SM, Shabestari OL, Kashani AR and
Farzanehgan ZM. Double-blind randomized
controlled trial of baclofen vs. clonidine in the
treatment of opiates withdrawal. Journal of
Clinical Pharmacy and Therapeutics 2000; 25
(5): 347 - 53.
12. Akhondzadeh S, Malek-Hosseini M,
Ghoreishi A, Raznahan M and Rezazadeh SA.
Effect of ritanserin, a 5HT2A/2C antagonist,
on negative symptoms of schizophrenia: a
double-blind randomized placebo-controlled
study. Progress in Neuropsychopharmacology
and Biological Psychiatry 2008; 32 (8): 1879 -
83.
13. Akhondzadeh S. The 5-HT hypothesis of
schizophrenia. IDrugs. 2001; 4 (3): 295 - 300.
14. Rezaei V, Mohammadi MR, Ghanizadeh
A, Sahraian A, Tabrizi M, Rezazadeh SA and
Akhondzadeh S. Double-blind, placebo-
controlled trial of risperidone plus topiramate
in children with autistic disorder. Progress in
Neuropsychopharmacology and Biological
Psychiatry 34 (7): 1269 - 72.
15. Agha-Hosseini M, Kashani L, Aleyaseen
A, Ghoreishi A, Rahmanpour H, Zarrinara AR
and Akhondzadeh S. Crocus sativus L.
(saffron) in the treatment of premenstrual
syndrome: a double-blind, randomised and
placebo controlled trial. BJOG. 2008; 115 (4):
515 - 9.
16. Noorbala AA, Akhondzadeh S, Tamacebi-
pour N and Jamshidi AH. Hydro-alcoholic
extract of Crocus sativus L. versus fluoxetine
in the treatment of mild to moderate
4
www.SID.ir
Archive of SID
Kashani et al.
depression: A double-blind, randomized pilot
trial. Ethnopharmacol. 2005; 97: 281 - 4.
17. Akhondzadeh S, Fallah Pour H, Afkham K,
Jamshidi AH and Khalighi-Cigarodi F.
Comparison of Crocus sativus L. and
imipramine in the treatment of mild to
moderate depression: a pilot double-blind
randomized trial [ISRCTN45683816]. BMC
Complementary and Alternative Medicine
2004; 4: 12.
18. Akhondzadeh S, Tamacebi-pour N,
Noorbala AA, Amini H, Fallah Pour H,
Jamshidi AH and Khani M. Crocus sativus L.
in the treatment of mild to moderate
depression: A double-blind, randomized and
placebo controlled trial. Phytotherapy
Research 2005; 19: 25 - 9.
19. Akhondzadeh Basti A, Moshiri E,
Noorbala AA, Jamshidi AH, Abbasi SH and
Akhondzadeh S. Comparison of petal of
Crocus sativus L. and fluoxetine in the
treatment of depressed outpatients: a pilot
double-blind randomized trial. Progress in
Neuropsychopharmacology and Biological
Psychiatry 2007; 31: 439 - 42.
20. Modabbernia A, Sohrabi H, Nasehi AA,
Raisi F, Saroukhani S, Jamshidi A, Tabrizi M,
Ashrafi M and Akhondzadeh S. Effect of
saffron on fluoxetine-induced sexual
impairment in men: randomized double-blind
placebo controlled trial. Psychopharmacology
2012; 223 (4): 381 - 8.
21. Kashani L, Raisi F, Saroukhani S, Sohrabi
H, Modabbernia A, Nasehi AA, Jamshidi A,
Ashrafi M, Mansouri P, Ghaeli P and
Akhondzadeh S. Saffron for treatment of
fluoxetine-induced sexual dysfunction in
women: randomized double-blind placebo-
controlled study. Human Psychopharmacol.
2013; 28 (1): 54 - 60.
22. Ozgoli G, Goli M and Moattar F.
Comparison of effects of ginger, mefenamic
acid, and ibuprofen on pain in women with
primary dysmenorrhea. Journal of Alternative
and Complementary Medicine 2009; 15 (2):
129 - 32.
23. Mirabi P, Alamolhoda SH, Esmaeilzadeh S
and Mojab F. Effect of medicinal herbs on
primary dysmenorrhoea- a systematic review.
Iranian Journal of Pharmaceutical Research
2014; 13 (3): 757 - 67.
24. Flores KE and Quinlan MB.
Ethnomedicine of menstruation in rural
Dominica, West Indies. Journal of
Ethnopharmacol. 2014; 153 (3): 624 - 34.
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