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Medicinal Plants for Primary Dysmenorrhoea: A Systematic Review
Abstract
Objectives
Primary dysmenorrhoea is a common complaint experienced by many females in their reproductive years. The use of medicinal plants in the treatment of various gynaecological conditions is on the increase, despite the limited evidence available regarding efficacy and safety of their use. The aim of this systematic review was to synthesise the most recent evidence relating to the treatment of primary dysmenorrhoea with medicinal plants.
Methodology
A thorough database search was conducted using defined search terms, and randomised controlled trials (RCTs) published in English between 2008 and 2016, pertaining to the use of medicinal plants (single use) for the treatment of primary dysmenorrhoea, were assessed. Studies evaluating dysmenorrhoeal pain and associated symptoms as a primary or secondary outcome were considered and assessed by two reviewers independently of each other, using the JADAD scale and the Cochrane risk of bias tool,.
Results
22 RCTs were included in the review; 9 were placebo-controlled trials and 13 were comparative studies to pharmacological treatment or nutritional supplements. Most of the evaluated medicinal plants showed evidence of efficacy in relieving menstrual pain in at least one RCT. The low or unclear quality of the majority of these studies however warrants caution in interpreting these results.
Conclusion
This review adds to the knowledge-base on the use of these medicinal plants in the treatment of primary dysmenorrhoea. Further research is needed before definitive conclusions can be made regarding the efficacy and safety of the use of these medicinal plants.
... Along with NSAIDS (Barcikowska et al., 2020) and surgical treatment (Salehi, Marzban, & Amini, 2019) other contemporary therapy currently includes; warm compress (Alghamdi et al., 2019;Armour, Smith, Steel, & Macmillan, 2019), exercise (Armour et al., 2019), vitamin K, D andE (Saei Ghare Naz et al., 2020), nicotinic acid (vitamin B3), thiamine (B1), magnesium and calcium (Werbach, 2004). Herbal medicines like Rosa Damascena (Lee et al., 2018) ginger (Pellow & Nienhuis, 2018), bilberry (European blue berry, blue berry, huckleberry) (Ulbricht et al., 2009), Peppermint dried leaves (Heshmati et al., 2016) and vegan meal (Addison, 2019), chamomile, thyme, cinnamon and fennel (Shahbazi et al., 2020). Studies from Iran, China and Tehran reported the effectiveness of ginger in relieving pain (Pellow & Nienhuis, 2018). ...
... Herbal medicines like Rosa Damascena (Lee et al., 2018) ginger (Pellow & Nienhuis, 2018), bilberry (European blue berry, blue berry, huckleberry) (Ulbricht et al., 2009), Peppermint dried leaves (Heshmati et al., 2016) and vegan meal (Addison, 2019), chamomile, thyme, cinnamon and fennel (Shahbazi et al., 2020). Studies from Iran, China and Tehran reported the effectiveness of ginger in relieving pain (Pellow & Nienhuis, 2018). Peppermint dried leaves have been utilized for the remedy of nausea, vomiting, morning sickness, respiratory infections, and menstrual disorders (Alghamdi et al., 2019). ...
... Similarly several studies have evidenced the use of peppermint in management of symptoms related with primary dysmenorrhea (Alghamdi et al., 2019;Amoueeroknabad & Sarafraz, 2011;Lee et al., 2018); especially different researches conducted in Iran, China reported the effectiveness of ginger in relieving pain (Pellow & Nienhuis, 2018). Our study is supported by result reported in literature; where peppermint has been reported to lower the severity of pain but it did not show impact on duration of pain (Heshmati et al., 2016). ...
Present study was aimed to explore the impact of ginger and peppermint in adolescents suffering with primary dysmenorrhea. For that purpose, 150 adolescents, aged 13-22 years, with regular menstruation suffering with moderate to severe dysmenorrhea (scoring 3-5 on pain scale) and preferably not taking any medication were enrolled and randomly divided into three groups i.e. control, ginger and peppermint. Baseline data was collected with help of self-administered questionnaire. To determine comparative analgesic effect of ginger and peppermint, capsules were formulated, and each group received total number of 15 capsules in a month (3 capsules/day for consecutive 5 days). Compared with baseline data, ginger was found more effectual than peppermint in releasing dysmenorrhea i.e. observed scoring in case of ginger was reduced from mean value of 4.13 ± 0.63 to 2.10 ± 1.52 (p = 0.001). Similarly, ginger intervention exhibited gradual betterment of 10% in symptoms of dysmenorrhea but also affected blood pressure positively (p < 0.05). However, blood hemoglobin and serum calcium levels acted as independent variables in ginger and peppermint groups (p > 0.05), not affected by any mode of intervention. It was concluded that ginger exhibited superior impact in lowering pain as compared to peppermint and control groups.
... [66][67][68] People consider herbal medicines as the safest methods to consume, and research has shown that there is a widespread usage of herbs by women for dysmenorrhoea. 69 Our result showed that some of the herbs like dill seeds; cumin are capable of producing an analgesic effect for menstrual symptoms. 56 A review conducted by Xu et al. suggested using herbs like ginger and cinnamon, also known as warm medicines, for dysmenorrhoea. ...
... 46 In addition, a systematic review done to analyse the efficacy of medicinal plants use in primary dysmenorrhoea found various medicinal plants like Zingiber officinale, Mentha piperita, Cinnamomum zeylanicum, Mellisa officinalis, Thymus vulgaris, Tecrium polium were safe in reliving menstrual pain. 69 Prior researchers have found that substances like gingerol, protein, and free fatty acid present in ginger have properties similar to NSAIDs, which inhibits the biosynthesis of components inducing pain like leukotrienes and prostaglandins through inhibition of cyclooxygenase (COX). [34][35][36] The current review has shown the potential effectiveness of ginger, various medicinal herbs and complementary therapies like massage and exercises to reduce pain in menstruation. ...
Problem considered
The empirical evidence suggested the usage of ginger (zingiber officinale), complementary therapies and Non-steroidal anti-inflammatory drugs (NSAIDs) for dysmenorrhoea compared to self-administration of NSAIDs alone in alleviating the symptoms of dysmenorrhoea. However, there is a need for strong evidence to compare the effectiveness of ginger to that of complementary therapies like exercise, herbs (other than ginger) and NSAIDs. Thus, this systematic review aimed to compare the effectiveness of ginger with NSAIDs and other complementary therapies and suggests an effective dose of ginger in oral form that can be taken during dysmenorrhoea.
Methods
A systematic literature search was conducted using electronic databases, namely MEDLINE via PubMed, Cochrane central, Scopus, CINHAL, EBSCOhost, ProQuest Central, and Google Scholar search engine. The search terms were combined keywords related to menstrual pain, complementary therapy, NSAIDs, and ginger. Randomized or quasi-randomized controlled trials that included ginger as a comparator to assess the effect on primary dysmenorrhea were included in this systematic review. Data were extracted, and the findings were narratively synthesised.
Result
An initial search from the electronic database identified 394 studies, of which eleven studies met the eligibility criteria, where seven were randomised controlled trials, and four were quasi-experimental studies. There was no significant difference between ginger and NSAIDs in decreasing pain intensity during menstruation. Ginger and exercises like muscle relaxation techniques, stretching, and sub-maximal aerobic exercise effectively reduce pain when combined. Dill seeds (Anethum graveolens, an aromatic herb used for flavouring and medical purposes) and ginger alone were effective in dysmenorrhoea, but no effect of valerian, peppermint and cumin (spices) seeds were observed. The effect of ginger was inclusive compared to placebo.
Conclusion
The usage of ginger up to two grams per day in divided doses of powder or dietary form for three days from the first day of the menstrual cycle can be used safely for primary dysmenorrhoea. Ginger can be combined with complementary therapies like exercise for increased effectiveness in relieving menstrual pain. The alternative therapy can reduce dependency on synthetic drugs for controlling dysmenorrhoea. However, there is a need to carry out rigorous randomized controlled trials of longer duration to evaluate the effectiveness of ginger and auxiliary therapies other than ginger in controlling menstrual pain.
... Studies show that many medicinal plants are reported to have therapeutic effects in relieving symptoms through their analgesic, antispasmodic, prostaglandin-inhibiting, or anti-inflammatory actions. [9] In Ayurveda, primary dysmenorrhea is termed as Kashtartava and it has been described as a symptom of some gynecological conditions, such as Udavartini and Vatala. [10] Rajapravartani Vati is a herbo-mineral formulation indicated in Kashtartava. ...
BACKGROUND
Primary dysmenorrhea is one of the major public health concerns that affects about 50%–90% of women. Even though the condition is associated with psychosomatic symptoms, conventional management is mainly focused on reducing pain only. This study is designed to evaluate the potential of Ayurvedic management in dysmenorrhea, addressing both physical and psychosomatic aspects of the condition.
OBJECTIVE
The study aims to assess the effectiveness and tolerability of Rajapravartani Vati and Saraswatarishta in dysmenorrhea.
MATERIALS AND METHODS
This study is a prospective, single-arm, open-label, and multicenter clinical study involving 10 centers. According to pre-defined selection criteria, a total of 460 participants with primary dysmenorrhea in the age range of 14–25 years will be enrolled from the study sites. All participants will receive Rajapravartani Vati 500 mg twice daily orally starting from 7 days before the expected date of the menstrual cycle up to the third day of menstruation for three consecutive menstrual cycles. Saraswatarishta will be given, a 10 mL dose with 20 mL of lukewarm water at bedtime for 84 days. The participants will be followed for further 3 months to assess the sustained effect of the intervention. The change in pain, disease-specific symptoms, and psychosomatic status will be assessed for three consecutive cycles by using the Visual Analog Scale score, Working Ability, Location, Intensity, Days of pain, Dysmenorrhea score, and Moos Menstrual Distress Questionnaire, respectively. The tolerability of the drugs will be assessed through the occurrence of treatment-emergent adverse events during the study period, and compliance to study interventions.
DISCUSSION
This study will help in providing evidence-based scientific data related to the clinical evaluation and tolerability of Rajapravartani Vati and Saraswatarishta in dysmenorrhea.
TRIAL REGISTRATION
CTRI/2023/07/054617 dated July 3, 2023.
... Many previous trials on primary dysmenorrhea have used alternative therapies, such as herbal remedies, behavioral interventions, exercise, and acupuncture, which showed improvement in menstrual pain; however, many of the studies had unclear protocols or low methodological quality; hence, their results were inconclusive. [26][27][28] Their assessments were also largely based on pain scores, and many did not assess the quality of life using specific questionnaires, such as those used in this study. [29][30][31] Other studies that assessed the quality of life of patients with primary dysmenorrhea were limited to observational studies and used different questionnaires. ...
Background
Primary dysmenorrhea is associated with poorer quality of life; however, the causal mechanism remains unclear. A vast body of literature supports the use of oral probiotics for relief from the symptoms of endometriosis; however, to our knowledge, no study has prescribed probiotics for primary dysmenorrhea.
Objective
The aim of this study is to investigate the effects of 3-month supplementation with oral probiotics on quality of life and inflammatory markers in women with primary dysmenorrhea.
Design
Randomized placebo-controlled trial.
Methods
A total of 72 patients (36 patients in each arm) were randomized to receive either oral sachets containing 5 billion colony-forming units each of Lactobacillus acidophilus BCMC (BCrobes Microbial Cells) 12130, Lactobacillus casei subsp BCMC 12313, Lactobacillus lactis BCMC 12451, Bifidobacterium bifidum BCMC 02290, Bifidobacterium longum BCMC 02120, and Bifidobacterium infantis BCMC 02129 each or placebo twice daily for 3 months. Main outcome measures were visual analog scale, verbal rating scale, physical and mental health scores using Short-Form 12-Item version 2 questionnaire, frequency of nonsteroidal anti-inflammatory drug use, and changes in inflammatory markers (interleukin-6, interleukin-8, and tumor necrosis factor alpha) before and after treatment.
Results
There was no significant difference in the quality of life scores between the probiotic and placebo groups. Both groups showed significant improvement in pain (visual analog scale) and severity (verbal rating scale) scores but the probiotic group had much lower nonsteroidal anti-inflammatory drug use (odds ratio: 0.69, 95% confidence interval: 0.26–1.83) and better mental health scores (mean change: 6.5, p = 0.03 versus 6.1, p = 0.08) than the placebo group. There was a significant confounding effect of nonsteroidal anti-inflammatory drug use on quality of life scores. No significant difference was found in inflammatory cytokines.
Conclusion
Tested oral probiotics improved mental health and potentially reduced the use of nonsteroidal anti-inflammatory drugs; however, there was no significant change in inflammatory markers. Further research with a larger sample size is needed to confirm the findings.
Registration
This study is registered under ClinicalTrials.gov (NCT04119011).
... 4,5 Hiện nay đau bụng kinh chủ yếu được điều trị bằng phương pháp nội khoa sử dụng các thuốc giảm đau như NSAIDs, thuốc tránh thai… 2 Tuy nhiên, những thuốc này có thể gặp các tác dụng phụ như viêm loét dạ dày -tá tràng, rối loạn tiêu hóa và rối loạn kinh nguyệt. Bên cạnh các thuốc này, các dược liệu có nguồn gốc tự nhiên cũng đã được sử dụng trong điều trị đau bụng kinh theo kinh nghiệm dân gian như Hương phụ, Đương quy… 6,7 ...
Nghiên cứu được tiến hành nhằm đánh giá tác dụng lên cơ trơn tử cung của viên nén An Nguyệt Khang trên thực nghiệm. Tác dụng lên cơ trơn tử cung của viên nén An Nguyệt Khang được đánh giá trên mô hình tử cung cô lập trên chuột cống trắng chủng Wistar và mô hình gây đau bụng kinh bằng oxytocin trên chuột nhắt chủng Swiss. Kết quả nghiên cứu trên mô hình tử cung chuột cống cô lập cho thấy viên nén An Nguyệt Khang cả 2 liều 132,4 mL/100ml Tyrod và 264,8 mg/100 mL Tyrod làm giảm rõ rệt tần số và biên độ co bóp của tử cung cô lập. Trên mô hình gây đau bụng kinh trên chuột nhắt trắng, viên nén An Nguyệt Khang liều 1,3 g/kg/ngày uống liên tục trong 7 ngày có xu hướng làm giảm cơn đau bụng trên chuột nhắt; trong khi viên nén An Nguyệt Khang liều 2,6 g/kg/ngày uống liên tục trong 7 ngày thể hiện tác dụng rõ rệt làm giảm cơn đau bụng trên chuột nhắt trắng. Như vậy, viên nén An Nguyệt Khang là sản phẩm có nguồn gốc từ dược liệu thể hiện tác dụng giảm co thắt cơ trơn tử cung và giảm đau do co thắt cơ trơn tử cung trên mô hình tử cung cô lập và mô hình đau bụng kinh trên thực nghiệm.
... Before drawing any conclusions on the effectiveness and safety of using these medicinal plants, the study suggested more research. [7] To present the preliminary findings of a pilot study on the level of gynecological prevention knowledge among minors sent to a juvenile attendance center by court orders, a survey study was carried out. Participants in health preventive classes in late 2010 and early 2011 filled out an anonymous survey form. ...
... The therapeutic properties of fenugreek include anti-atherosclerosis, anti-inflammatory, anti-spasm, anti-cancer, and pain-relieving [20]. Fenugreek seeds may have a positive effect on the severity of primary dysmenorrhea and the duration of the pain due to its properties of reducing the amount of prostaglandins, relaxing the smooth muscle cells, and having magnesium, zinc, vitamin B1, and vitamin E [21,22]. The anti-inflammatory and analgesic effects of fenugreek are due to the presence of biologically active substances, such as flavonoids, saponins, unsaturated linoleic acids, and linolenic acid [23]. ...
Introduction:
Dysmenorrhea is the most common periodic pain, which affects more than 50% of women with regular menstruation. Fenugreek is one of the medicinal plants with analgesic properties. This study aimed to determine the effect of fenugreek application in the severity of dysmenorrhea and its side effects in women with dysmenorrhea. PICO: population: women with dysmenorrhea; intervention: fenugreek; comparison: control groups; and outcome: reduction in the severity of dysmenorrhea and its side effects Methodology: English database (PubMed, Cochrane Library, Scopus, and Web of Science) and Persian database [SID (Scientific Information Database) and Magiran] were used for research until February 11, 2023, using the keywords "Dysmenorrhea [Mesh]," "Foenum [Mesh]," "fenugreek [Mesh]," and "Trigonella [Mesh]." The reference list of the selected articles was also checked. The quality assessment was conducted through the Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. The RevMan 5.3 software was used to analyze and report the data of the entered studies. Meta-analysis results were reported with the standardized mean difference (95% confidence interval). A subgroup analysis was performed based on the type of control groups. The quality of evidence was assessed using the GRADE approach.
Results:
After removing duplicates and ineligible cases, four articles were included in the systematic review out of the 1526 records obtained. The results showed that the pain intensity caused by primary dysmenorrhea decreased with fenugreek compared to placebo (pooled result SMD: -2.21; 95% CI: -3.26 to -1.17; Z: 4.17; P <0.001). There was no significant difference between fenugreek with mefenamic acid (SMD: 0.05; 95% CI: -0.57 to 0.67; Z: 0.17; P = 0.86) and fenugreek with Chandrasura churna (SMD: 0.06; 95% CI: -0.56 to 0.68; Z: 0.19; P = 0.85). Bias, in terms of incomplete outcome data and selective reporting, was low risk in all studies, and the available evidence was low quality according to the GRADE approach.
Conclusion:
The results showed that the effect of fenugreek on pain intensity in dysmenorrhea is highly uncertain. The true effect is likely to be substantially different from the estimate of effect. Regarding the importance of the health and quality of life of women of reproductive age and the low quality of evidence of the studies, clinical trials with stronger methodology are suggested in this field.
... 8 Diclofenac is an effective NSAID which has both anti-inflammatory and analgesic properties. Literature shows that it relieves severe pain, like dysmenorrhoea, 13 and renal colic. 14 Studies also show that it reduces opioid use after orthopaedic abdominal and gynecological surgery. ...
Objective: To compare the mean post-operative pain after intramuscular versus rectal Diclofenac Sodium in post-caesarean
patients.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Obstetrics & Gynaecology, Benazir Bhutto Hospital, Rawalpindi Pakistan, from
May to Nov 2017.
Methodology: A total of 60 women, aged 18–45 years, undergoing elective caesarean section were selected. Patients in Group-A
were given, Diclofenac 75mg intramuscularly in the gluteal area every 8 hours, while patients in Group-B received a
Diclofenac Sodium suppository every 8 hours post-operatively. All patients were followed for pain post-operatively, and final
post-caesarean pain was noted at 24 hours post-operatively using a visual analogue scale.
Results: The mean age of patients in the Group-A was 29.27±4.68 years, and in Group-B was 30.57±4.80years. The range of
gestational age in the study was from 37 to 41 weeks, with an average age of 39.07±1.26 weeks. Mean post-operative pain in
Group-A (Intramuscular Diclofenac Sodium-Group) was 1.13±0.43 minutes, whereas in Group-B (Rectal Diclofenac sodium group), was 2.16±0.83 (p-value = 0.001).
Conclusion: Mean post-operative pain after using intramuscular Diclofenac sodium is less than Diclofenac Sodium
administered rectally in post-operative patients in caesarean sections.
Keywords: Caesarean section, Diclofenac Sodium, Post-operative pain.
... These are the mainstay of drugs used in clinical practice with other medicines and non-medical therapies being investigated by research teams, but none yet found to be more effective than current practice. The alternative pathways being investigated for analgesic properties include use of medicinal plants [21], exercise [22] and acupuncture [23], amongst other homeopathic pathways. ...
Dysmenorrhoea effects up to 90% of women of reproductive age, with medical management options including over-the-counter analgesia or hormonal contraception. There has been a recent surge in medicinal cannabis research and its analgesic properties. This paper aims to critically investigate the current research of medicinal cannabis for pain relief and to discuss its potential application to treat dysmenorrhoea. Relevant keywords, including medicinal cannabis, pain, cannabinoids, tetrahydrocannabinol, dysmenorrhoea, and clinical trial, have been searched in the PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library (Wiley) databases and a clinical trial website (clinicaltrials.gov). To identify the relevant studies for this paper, 84 papers were reviewed and 20 were discarded as irrelevant. This review critically evaluated cannabis-based medicines and their mechanism and properties in relation to pain relief. It also tabulated all clinical trials carried out investigating medicinal cannabis for pain relief and highlighted the side effects. In addition, the safety and toxicology of medicinal cannabis and barriers to use are highlighted. Two-thirds of the clinical trials summarised confirmed positive analgesic outcomes, with major side effects reported as nausea, drowsiness, and dry mouth. In conclusion, medicinal cannabis has promising applications in the management of dysmenorrhoea. The global medical cannabis market size was valued at USD 11.0 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 21.06% from 2022 to 2030. This will encourage academic as well as the pharmaceutical and medical device industries to study the application of medical cannabis in unmet clinical disorders.
... These medications work by lowering prostaglandin synthesis, which leads to muscular spasm relaxation and also alters hormone levels. Some anti-spasmodic plants include black haw, cramp bark, flaxseed, squaw vine, green tea, and others that include tannins, glycosides, lignans, alkaloids, and bitter glycosides as active ingredients [86,87]. ...
In the current scenario, dysmenorrhea is a very frequent gynecological condition among women. At least one in every four women suffers from severe abdominal cramps, which are referred to as dysmenorrhea or menstrual cramps. Hence, in this review we compile the data from several reviews and research papers about dysmenorrhea, its pathogenesis, along with all treatment approaches. It was found in a survey that normally women treated these cramps with non-steroidal anti-inflammatory medicines or oral contraceptives, but lately it was found that these medications have a 20% to 25% failure rate as well as unpleasant side effects. Hereby, in this review, we concluded all the possible treatments, including pharmacological treatment, non-pharmacological treatment, and herbal treatments for dysmenorrhea. Many women are looking for alternatives to conventional treatments, such as the use of herbs, vitamins, minerals, nutritional supplements, analgesics, anti-inflammatory agents, and aromatherapy agents, which can have a significant impact when taken on a regular basis. The active constituents of these medicinal plants help the body fight cramps and pain associated with menstruation, as well as alleviate these issues in the most calming and effective way possible.
... These medications work by lowering prostaglandin synthesis, which leads to muscular spasm relaxation and also alters hormone levels. Some anti-spasmodic plants include black haw, cramp bark, flaxseed, squaw vine, green tea, and others that include tannins, glycosides, lignans, alkaloids, and bitter glycosides as active ingredients [86,87]. ...
... Low levels of FSH and LH may lead to decreased follicle production and diminished serum levels of sex hormones (Parandin and Yousofvand, 2019). It was indicated that trans-anethole estrogenic properties can affect inflammation and improve ovulation processes, thus, it was recommended for treatment of primary dysmenorrhea (Pellow and Scott, 2018) . Moreover, it was shown that F. vulgare extract can increase serum concentrations of FSH and decrease LH and testosterone in PCOS rats (Karampoor et al., 2014). ...
Objective:
The effect of trans-anethole and metformin on biochemical and hormonal changes of testosterone-induced Polycystic ovary syndrome (PCOS) in rats was investigated.
Materials and methods:
Female Wister rats (n=48) were randomly divided into six groups: control; PCOS; PCOS+metformin (300 mg/kg); and PCOS+trans-anethole (20, 40, and 80 mg/kg). PCOS was induced by intraperitoneal injection of testosterone (1 mg/kg/day) for 35 days. After induction of PCOS, trans-anethole and metformin were given orally for 30 days. Finally, blood sugar, insulin, lipid profile, and testosterone and dehydroepiandrosterone (DHEAS) as well as animals' weight, and water and food intake were determined.
Results:
In all treated and untreated PCOS groups, serum testosterone levels were significantly increased compared to the control group (p<0.001 for all groups). Treatment of rats with trans-anethole or metformin significantly reduced serum levels of cholesterol, insulin, triglycerides, testosterone and DHEAS (only in PCOS+trans-anethole groups) compared to the PCOS group (p<0.01-p<0.001). Weight gain in the PCOS animals increased significantly compared to the control group (p<0.001), while in the metformin- and trans-anethole (40 and 80)-treated animals it decreased significantly compared to the PCOS group (p<0.01-p<0.001).
Conclusion:
These results showed that trans-anethole significantly decreased serum levels of insulin, DHEAS and blood lipids. It can be concluded that trans-anethole ameliorates PCOS biochemical and hormonal change in PCOS rats; therefore, it might be suggested as a beneficial remedy for further clinical evaluations in PCOS patients.
... Several complementary therapies like acupuncture [13], behavioural interventions [14], dietary supplements [15], herbal medicines [16], transcutaneous electrical nerve stimulation (TENS) [17], exercise [18], and laparoscopic presacral neurectomy (LPSN) [19] are being used in PD without conclusive evidences. Homeopathy has worldwide recognition and is considered as one of the top five alternative therapies [20]. ...
Objective: Homeopathic treatment is claimed to be beneficial for primary dysmenorrhoea (PD); still, systematic research evidences remain compromised. This study was undertaken to examine the efficacy of individualized homeopathic medicines (IH) against placebo in the treatment of PD.
Methods: A double-blind, randomized, placebo-controlled trial was conducted at the gynecology outpatient department of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, West Bengal, India. Patients were randomized to receive either IH (n=64) or identical-looking placebo (n=64). Primary and secondary outcome measures were 0-10 numeric rating scales (NRS) measuring intensity of pain of dysmenorrhea and verbal multidimensional scoring system (VMSS) respectively; all measured at baseline, and every month, up to 3 months. Group differences and effect sizes (Cohen’s d) were calculated on intention-to-treat (ITT) sample.
Results: Groups were comparable at baseline (all P>0.05). Attrition rate was 10.9% (IH: 7, Placebo: 7). Differences between groups in both pain NRS and VMSS favoured IH over placebo at all time points (all P< 0.001, unpaired t-tests and two-ways repeated measures analysis of variance) with medium to large effect sizes. Natrum muriaticum and Pulsatilla nigricans (n=20 each; 15.6%) were the most frequently prescribed medicines. No harms, serious adverse events and intercurrent illnesses were recorded in either of the groups.
Conclusion: Homeopathic medicines acted significantly better than placebo in the treatment of PD. Independent replication is warranted. Trial registration: CTRI/2018/10/016013.
... The CH 3 protons gave a singlet at δ 1.43, which is inappropriate for an acetate ester, with the 13 CH 3 signal at δ 23.9. 2-Bond HMBC linked this CH 3 to the orthoester 13 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), of the product 21 of pyrolysis of 19-acetylgnaphalin 27 , and of previously isolated teulepicephin 22 15 . The numbering of the carbon atoms is shown on 1. www.nature.com/scientificreports/ of these signals must have been due to the orthoester carbon (four bonds from H 2 -18) and the other due to acetal carbon C-5 (three bonds from H 2 -18). ...
Teucrium yemense, a medicinal plant commonly grown in Saudi Arabia and Yemen, is traditionally used to treat infections, kidney diseases, rheumatism, and diabetes. Extraction of the dried aerial parts of the plant with methanol, followed by further extraction with butanol and chromatography, gave twenty novel neoclerodanes. Their structures, relative configurations and some conformations were determined by MS and 1-D and 2-D NMR techniques. Most were fairly conventional but one contained an unusual stable orthoester, one had its (C-16)–(C-13)–(C-14)–(C-15) (tetrahydro)furan unit present as a succinic anhydride and one had a rearranged carbon skeleton resulting from ring-contraction to give a central octahydroindene bicyclic core, rather than the usual decalin. Mechanisms are proposed for the biosynthetic formation of the orthoester and for the ring-contraction. Four novel neoclerodanes increased the glucose-triggered release of insulin from isolated murine pancreatic islets by more than the standard drug tolbutamide, showing that they are potential leads for the development of new anti-diabetic drugs.
... 12,20 Fennel originated by Umbelliferae contains anethole, fenchone, and limonene, which act as dopamine-like agents. 21 prostaglandins. 3 Thus, fennel supplements decrease pain perception in these patients. ...
Objective
This narrative review aims to identify alternative ways to improve the symptoms of primary dysmenorrhea (PD).
Background
PD refers to endometrial painful cramps during the premenstrual period. This condition affects a lot of women worldwide and is accompanied with absenteeism and high economic costs, thus, risk-free, and effective therapeutic approaches are needed. Pharmacological agents such as non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which are widely prescribed for these women, demonstrate adequate efficacy in alleviating pain and discomfort. The long natural course of the disease dictates remedies that focus on lifestyle changes and on improvement of Quality-of-Life (QoL) for women suffering with PD.
Materials and Methods
Five major search engines, namely MEDLINE, PubMed, EMBASE, and Cochrane Library were searched for articles published prior to October 2020 focused in PD. A total of 74 paper were included.
Discussion
Physical activity, for instance yoga, aromatherapy massage, and other forms of relaxation, vitamins and dietary changes, acupressure and acupuncture,a and some psychological interventions are just few of the proposed health behavior targeted approaches in cases of PD. This review focuses on lifestyle changes and alternative methods that could potentially result in minimizing symptoms of PD and in improving overall QoL for these patients, by providing current scientific evidence on their efficacy.
Conclusion
Complementary and alternative medicine practices (CAM) are widely accepted by women. International literature provides controversial scientific evidence, thus further studies need to be conducted in order to prove or disregard their efficacy in cases of PD.
... 4 In Saudi Arabia, they have been used in folk medicine to treat diabetes but several other therapeutic activities have been reported in different countries. [4][5][6][7] Plants of this genus have been shown to contain diterpenoids, avonoids, iridoids, tannins, saponins, alkaloids, sterols, coumarins and glycosides. 4,8−10 One species, T. yemense (De .), is a medicinal plant commonly grown in Saudi Arabia. ...
Teucrium yemense , a medicinal plant commonly grown in Saudi Arabia and Yemen, is traditionally used to treat infections, kidney diseases, rheumatism, and diabetes. Extraction of the dried aerial parts of the plant with methanol, followed by further extraction with butanol and chromatography, gave twenty novel neoclerodanes. Their structures, relative configurations and some conformations were determined by MS and 1-D and 2-D NMR techniques. Most were fairly conventional but one contained an unusual stable orthoester, one had its (C-16)-(C-13)-(C-14)-(C-15) (tetrahydro)furan unit present as a succinic anhydride and one had a rearranged carbon skeleton resulting from ring-contraction to give a central octahydroindene bicyclic core, rather than the usual decalin. Mechanisms are proposed for the biosynthetic formation of the orthoester and for the ring-contraction. Four novel neoclerodanes increased the glucose-triggered release of insulin from isolated murine pancreatic islets by more than the standard drug tolbutamide, showing that they are potential leads for the development of new anti-diabetic drugs.
... However, the effect of probiotics was never tested in the population of women with primary dysmenorrhea. Many other trials on primary dysmenorrhea used alternative therapy such as herbal remedies, behavioural interventions, exercise, acupuncture, which showed improvement in menstrual pain but many of the studies were of unclear or low methodological quality (13)(14)(15). ...
... The use of these medicinal plants could become a suitable alternative to treat dysmenorrhoea, particularly in cases where the patients did not tolerate the conventional medicines well and the use of such medicines are contraindicated. However, the way these medicinal plants work in relieving these symptoms is not well understood and needs to be studied further [8]. ...
... The Jadad Scale is a simple, reliable, and validated tool for assessing scientific rigor of reports [20]. This tool has been used elsewhere [21,22] and contains one question on reporting of withdrawals, and two questions each on randomization and blinding where inappropriate methods can attract a negative score. Although not as detailed as other scales, the Jadad scale has advantages in the simplicity of assessment questions and ease of assessment performance, which is important when comparing trials of considerable heterogeneity, particularly when much of the literature predates established reporting standards. ...
Background: Phytoadaptogens are considered to be herbal medicines with a multi-target effect that strengthen organ systems compromised by stress. Although animal and laboratory studies have identified numerous molecular targets associated with adaptogenic activity, the non-specific characteristic of these herbal medicines has meant there is no known methods to accurately determine efficacy of adaptogens in humans. This critical review of the evidence aims to identify domains which have been used to measure the effect of adaptogens in humans, in order to create pathways for translating laboratory, animal, and clinical studies on adaptogens into practical applications in the future. Methods: EMBASE, AMED, PubMed, Cochrane Library, and WHO ICTRP databases were searched for randomized trials which examined known physiological actions of adaptogens. Results: Twenty-four studies were identified and critically appraised using the Jadad scale. The findings identified three broad categories of outcome measures, including cognitive, mood and biological measures. Conclusions: There was a great heterogeneity in data making it difficult to draw conclusions as to the most effective measurement tools to capture the holistic activity in humans. Cognitive measures hold promise as a reliable measurement tool when used in conjunction with other relevant tools. Further investigation is necessary to determine the most appropriate and diverse tools to measure the complex multi-target action of adaptogens.
... Commonly used drugs include non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCP). Herbs have been used to manage this problem, but there is insufficient evidence of the efficacy of herbal remedies for treating primary dysmenorrhea (7,8). On the other side, other complementary and alternative medicines are used for treating dysmenorrhea (9,10). ...
Context: Dysmenorrhea is a common problem in women.
Objectives: This study aimed to summarize the results of all relevant clinical trials to draw a conclusion regarding the effect of Foeniculum vulgareon primary dysmenorrhea (PD).
Methods: In this study, we searched 19 databases (including Medline/PubMed, Scopus, ISI Web of Science) for the effects of Foeniculum vulgareon primary dysmenorrhea up to November 2016. The reference lists of the reviews and related articles were consulted to identify eligible articles. Studies investigating combinations of fennel and other products, without a control group, addressing premenstrual syndrome (PMS) and bleeding as the primary outcomes, and not being a randomized clinical trial (RCT) were excluded. A meta-analysis was performed to obtain a pooled estimate of effectiveness. The methodological quality was assessed using the modified Jadad scale. The registration number of this study is 95-01-65-11733.
Results: Our search identified nine relevant articles for inclusion. The meta-analysis showed favorable effects of Foeniculum vulgareon primary dysmenorrhea for fixed effect (n = 727, OR = 0.573, 95% CI: 0.414 to 0.793, P = 0.001) and random effect (n = 727, OR = 0.141, 95% CI: 0.027 to 0.742, P = 0.021). The analysis also revealed a remarked heterogeneity (Q value = 198.318, P = 0.000, I 2= 95.96, τ 2= 6.065).
Conclusions: We found that the fennel extract is effective for primary dysmenorrhea. However, due to the heterogeneity of various findings, we were unable to find the effective dosage and concentration of this herbal medicine. We recommend multicenter clinical trials worldwide for evaluating the effectiveness of fennel in primary dysmenorrhea.
The enhanced efficacy of vinegar‐processed Cyperus rotundus (VCR) in treating primary dysmenorrhea (PD) has been observed. However, the active components and potential mechanisms of synergy are still unclear. The objective of this study was to develop a method that combines bionic technology, plant metabolomics and network pharmacology to discover the active components and potential mechanisms underlying the enhanced therapeutic effects of VCR for PD. Vinegar processing alters the flavor of C. rotundus , leading to changes in its properties. The acidic nature of vinegar enhances the selectivity of the medicine toward the liver, thereby improving its ability to soothe the liver, regulate qi and provide pain relief. Through gas chromatography–mass spectrometry and multivariate statistical analysis, 30 key differential components between raw C. rotundus and VCR have been screened and identified. These differential components primarily exert their therapeutic effects in treating PD by modulating targets such as interleukin‐6, TNF, TP53 and PTGS2, as well as pathways including the estrogen signaling pathway, ovarian steroidogenesis, the TNF signaling pathway and the HIF‐1 signaling pathway. The findings of this study serve as a reference for the application of VCR in compound formulas and clinic practiceal. Furthermore, the methodology employed in this study provides research insights for the processing of other Chinese medicines.
Background
The words "nutrition" and "pharmaceutical" are combined to form the phrase "nutraceutical." Nutraceuticals are foods or dietary components that have an important role in regulating and sustaining normal physiological function in humans. For the treatment of dysmenorrhoea, a variety of pharmacological medications are available, however, they all have significant side effects. Dietary supplements and lifestyle management, on the other hand, were found to have a major influence on the occurrence and control of dysmenorrhea.
Objective
The objective of this paper is to study a comprehensive review of the dietary and nutritional supplements with special emphasis on dysmenorrhea. This paper focuses on understanding and interpreting the details of menstrual pain and its effective nutritional diet that can be used as a treatment for avoiding menstrual discomfort.
Methods
The selection of data has been done by studying a combination of various research and review papers from different databases like PubMed, NCBI, Science Direct, WHO, Cochrane Library, and Web of Science from the year 2000-2022.
Results
Based on various papers and literature reviews, we have concluded about various dietary supplements and herbs that can be used to avoid pain during mensuration followed by its all-daily requirement of nutrition on different age groups and efficacy of treatments.
Conclusion
According to current evidence, young women should be instructed in the proper use of dietary supplements, nutrition, and vitamins, as well as the inclusion of effective diet and lifestyle changes such as exercise and a well-balanced diet with adequate nutrition, as these are likely to reduce the negative effects of dysmenorrhea.
The aim of this study was to present information about the traditional use and phytochemistry of T. polium, to discuss contradictory views about chemotaxonomy and its toxic effect on liver and kidneys, and to make suggestions about controversial areas and gaps in the literature. Literature data showed that T. polium has toxic effect on kidney tissue. Moreover, in some of the studies on the liver and in all clinical reports, T. polium has also been proven to have toxic effect on the liver. The components responsible for toxicity are thought to be neo-clerodane diterpenoids. However, it has been reported that flavonoids and some polyphenols in the plant also show antioxidant and anti-inflammatory effects. It has been concluded that more attention should be paid to the use of this plant. More clinical studies are needed to better understand the effects of T. polium on the liver. The effects of the plant on blood serum parameters and histological changes on the liver tissue should be documented in more detail. It was also concluded that that regular consumption of T. polium should be avoided for long periods of time.
A substantial proportion of adults and children in the United States use complementary and alternative health practices, including homeopathy. Many homeopathic therapies are readily available over the counter, and many individuals access and self-administer these therapies with little or no guidance from health care practitioners. In addition, patients and health care providers are often confused by terminologies associated with complementary practices and may be unable to distinguish homeopathy from naturopathy, herbalism, holistic medicine, Ayurveda, traditional Chinese medicine, or other forms of health care. Compared with European and Asian countries, education in the United States about complementary and alternative health practices is not typically found within traditional nursing, midwifery, or medical education curricula. Given this lack of education and the broad acceptance and popularity of homeopathy, it is necessary for health care practitioners to improve their knowledge regarding similarities and differences among therapies so they can fully inform and make appropriate recommendations to patients. The intent of this article is therefore to examine the state of existing science of homeopathy, distinguish it from other complementary methods, and provide midwives and women's health care providers with an introduction to common homeopathic therapies that may be recommended and safely used by persons seeking midwifery care. This review also presents the evidence base, pharmacology, manufacturing, and regulation of homeopathic therapies. We also consider controversies and misunderstandings regarding safety and efficacy of homeopathic remedies relevant to women and birthing persons. Examples of practical applications of homeopathic therapies for use in midwifery practice are introduced. Implications for practice and sample guidelines are included.
Menstruation is the frequent discharge of blood into the cervix and out of the vagina from the uterus, and it is often called a' period.’ Dysmenorrhea is characterized as the occurrence during menstruation of aching cramps in uterus that arise and is one of the most general causes of menstrual disorder and pelvic pain. Objectives: To compare the effect of ginger and vitamin E on pain Severity among females with dysmenorrhea. To compare the effect of ginger and vitamin E on quality of life among females with dysmenorrhea-A randomized controlled trial. Methods: A randomized controlled trial was carried out in the Gynae and obstetrics departments at Sir Ganga Ram Hospital, Lahore for 9 months. 90 patients divided into 3 groups (Vitamin E, Ginger Tea and Placebo) were selected through non probability purposive sampling technique. Data was collected through Pre tested questionnaire, Visual analogue scale and Quality of life questionnaire. The data was tabulated and analyzed by SPSS version 21.0. Results: The results shows that there is a significant correlation in the results of Vas scale throughout the study. The level of significance indicates that the VAS scale of pain showed various results in the pain levels of patients having ginger tea and vitamin E capsules for the pain management of menstruation of females. There is also a significance noticed in the placebo group which may lead us to believe that the mental satisfaction of patients also matters a lot. Conclusion: It is concluded that Ginger tea and vitamin E supplements have a large effect on pain and Quality of Life among the females with Dysmenorrhea.
Menstruation is the frequent discharge of blood into the cervix and out of the vagina from the uterus, and it is often called a' period.’ Dysmenorrhea is characterized as the occurrence during menstruation of aching cramps in uterus that arise and is one of the most general causes of menstrual disorder and pelvic pain. Objectives: To compare the effect of ginger and vitamin E on pain Severity among females with dysmenorrhea. To compare the effect of ginger and vitamin E on quality of life among females with dysmenorrhea-A randomized controlled trial. Methods: A randomized controlled trial was carried out in the Gynae and obstetrics departments at Sir Ganga Ram Hospital, Lahore for 9 months. 90 patients divided into 3 groups (Vitamin E, Ginger Tea and Placebo) were selected through non probability purposive sampling technique. Data was collected through Pre tested questionnaire, Visual analogue scale and Quality of life questionnaire. The data was tabulated and analyzed by SPSS version 21.0. Results: The results shows that there is a significant correlation in the results of Vas scale throughout the study. The level of significance indicates that the VAS scale of pain showed various results in the pain levels of patients having ginger tea and vitamin E capsules for the pain management of menstruation of females. There is also a significance noticed in the placebo group which may lead us to believe that the mental satisfaction of patients also matters a lot. Conclusion: It is concluded that Ginger tea and vitamin E supplements have a large effect on pain and Quality of Life among the females with Dysmenorrhea.
The effect of warm-water footbath in improving dysmenorrhoea has been rarely investigated. The study aimed to examine whether a warm-water footbath effectively reduces dysmenorrhoea pain and improves the autonomic nervous system (ANS) activity. The randomised controlled trial was registered at ClinicalTrials.gov. (NCT04071028) We enrolled college students with dysmenorrhoea in Northern Taiwan from December 1 2013 to June 30 2014, and randomised them into footbath (n = 35, median age 19 years) and control groups (n = 33, 18 years). Pain visual analogue scale and Short-Form McGill Pain Questionnaire were used for pain assessment, while heart rate variability (HRV) was measured to assess ANS function. After the interventions, the footbath group significantly improved ANS activity and reduced pain severity comparing to the control group. Furthermore, the changes in HRV positively correlated with the improvement of pain severity. In conclusion, a warm-water footbath is beneficial in improving the pain severity among college students with dysmenorrhoea.
• Impact Statement
• What is already known on this subject? Dysmenorrhoea is the most common gynaecological condition affecting 34–94% of young women. The existing conventional therapeutic strategies for dysmenorrhoea have potential adverse events. Among the complementary therapies for pain, the warm-water footbath is a widely used thermal therapy in improving peripheral neuropathy symptoms and improving patients’ quality of life. The subjects with dysmenorrhoea associate with significantly altered autonomic nervous system (ANS) activity. However, the association among warm-water footbath, menstrual pain and ANS was rarely investigated previously.
• What the results of this study add? The randomised controlled trial enrolling 68 college students with dysmenorrhoea found warm-water footbath improved ANS activity and reduced pain severity. Furthermore, the changes in heart rate variability positively correlated with pain severity improvement.
• What the implications are of these findings for clinical practice and/or further research? A warm-water footbath for 20 minutes on menstruation days 1 and 2 is beneficial in improving pain among college students with dysmenorrhoea.
Background
One of the most common complaints for women is dysmenorrhea. Several studies investigated the treatment effects of medicinal plants on primary dysmenorrhea.
Objectives
This systematic review and meta-analysis investigates the effect of Foeniculum vulgare (Fennel) on pain in primary dysmenorrhea in comparison to non-steroidal anti-inflammatory drugs such as mefenamic acid.
Methods
PubMed, EMBASE, EBSCO Web of Science, Scopus, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, ProQuest, ISI Web of Science, Google Scholar, Magiran, SID, Iran Medex, and Irandoc were searched up to January 2019. Quality assessment of clinical trials was conducted using Jadad scoring system. Totally, 12 studies were entered in the meta-analysis. I ² was calculated to determine heterogeneity. Fixed effects and/or random effects models were applied.
Results
Meta-analysis of these trials showed that F. vulgare intake decreased significantly the intensity of dysmenorrhea compared to the placebo (SMD −0.632; CI: −0.827 to −0.436; p<0.001; heterogeneity p=0.807; I ² =0%; fixed effect model; seven articles). However, the effect of Mefenamic acid with F. vulgare was not different from each other (SMD=−0.214; CI: −0.446 to 0.017; p=0.07; heterogeneity p=0.58; I ² =0%; fixed effect model; six trials).
Conclusion
The F. vulgare alleviates dysmenorrhea. Regarding the same effect of F. vulgare with NSAIDs, it is highly recommend to the women suffered from dysmenorrhea specifically the ones who have high tendency toward herbal medicine.
Primary dysmenorrhea is a prevalent gynecological disorder that severely affects the quality of life in women. Yuanhu Zhitong oral liquid (YZOL) is a standardized herbal preparation frequently used in clinical practice and is a promising alternative therapy for primary dysmenorrhea. The findings of previous studies show that YZOL exhibits significant analgesic and spasmolytic effects, however, the involved mechanism remains unclear. Herein, we performed an untargeted plasma metabolomic analysis on a mouse model of oxytocin-induced primary dysmenorrhea to investigate the underlying mechanism of YZOL. We used multivariate and pathway-driven analyses to uncover the treatment targets linked with YZOL therapy and verified the possible mechanisms through biochemical assays. Therefore, we identified 47 plasma biomarkers primarily associated with sphingolipid metabolism, amino acid metabolism, arachidonic acid metabolism, and biosynthesis of steroid hormone as well as primary bile acid. We established that the analgesic effect of YZOL on primary dysmenorrhea relies on multiple constituents that act on multiple targets in multiple pathways. Our correlation analysis showed significant correlations between the biomarkers and biochemical indicators, which is of considerable significance in elucidating the YZOL mechanisms. Moreover, we identified some novel prospective biomarkers linked to primary dysmenorrhea, including bile acids. Collectively, these data provide new insights into the mechanism of YZOL and provide evidence for the analgesic effect of YZOL in the treatment of primary dysmenorrhea.
Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen.
Sexual Maturation and pubertal development is the period of adolescence from childhood to adult life. Adolescence is a transition from girl to motherhood that is accompanied by various changes in Cognition, Pubertal development, changes in Hormones, Physical development, Psychological and physiological changes occur simultaneously. Hence, "menarche is the onset of puberty in adolescent girl characterized by excessive bleeding, irregular menstruation, face problems such as acne and dysmenorrhoea". So, to identify Relevant Randomized Controlled Trials (RCTs), Cochrane Menstrual Disorders, Scopus, Dysmenorrhoea Group Register of controlled trials, PubMed, Google Scholar and Medline were some of the electronic searches. Therefore, to treat primary dysmenorrhoea or to prevent herbal medicine can be used alone or with other therapies (pharmaceutical, nutritional, and hydrotherapy).
Inclusion complexes of three flavonoids including taxifolin (TFL), quercetin (QCT) and morin hydrate (MH) with propanediamine-β-cyclodextrin (DP-β-CD) were prepared by saturated aqueous solution method. Formation of the complexes were characterized by SEM, FT-IR, XRD, ¹HNMR and 2D NMR (ROESY). The UV-Spectrometric titration method indicated that DP-β-CD can form 1:1 inclusion complexes with TFL, QCT and MH, and the stability constants were 585.7, 209.9 and 1419.2 M⁻¹, respectively. The molecular modelling demonstrated the most stable inclusion model of three complexes. The water solubility of TFL, QCT and MH was increased 70–102 times after resulting inclusion complex with DP-β-CD. In addition, the antioxidant activity of DP-β-CD/TFL complex is better than that of TFL. This satisfactory water solubility and high antioxidant activity of the DP-β-CD/flavonoids complexes, will be potentially useful for their application as herbal medicine or healthcare products.
Abstract:
Background: Menstrual cramps is the occurrence of labor-like pain in the lower abdomen, accompanied by symptoms like nausea, vomiting, diarrhea, headache and dizziness. A natural approach towards the treatment of painful menstruation is the need of the hour to be imparted in mind/body practices to be considered for long term relief from the pain of menstrual cramp forever.
Objective: The current research is aimed at the review of the various aspects of plant alternates serving in different ways to relieve the cramps occurring in menstruation.
Materials and Methods: The herbal alternates as relievers were categorized on the basis of the respective role being played by them as nutritional supplements, analgesics, anti-inflammatory and as aromatherapy agents.
Results: There are various plant sources which are mild as well as effective reliever of menstrual cramps. This review highlights the various plants which have been proven to be useful in dealing the various issues of painful menstruation. They deal with all the complications and issues, arising during this time.
Conclusion: These herbs are potent source of active medicaments that strengthens the body to overcome the cramps and pain occurring in menstruation. The demand of the present hour is to rely on the beneficial effects of various herbs, which relieve these complications in the most soothing and efficacious manner.
Keywords: dysmenorrhea, cramps, herbs, pain, reliever, menstruation
Ethnopharmacological relevance:
Compound Muniziqi granule (CMG) is usually used as a traditional Uighur medicine to treat acne, chloasma, skin inflammation, primary dysmenorrhea (PDM), and menopausal syndrome. However, there are no sufficient data to support the clinic uses of CMG in PDM.
Aim of the study:
This work aims to examine the effect of CMG as a treatment for PDM and reveal its possible therapeutic mechanism.
Materials and methods:
In vivo and in vitro mouse PDM models were utilized in this study. The mouse uterine contraction was induced by oxytocin after progynova or estradiol benzoate pretreatment. CMG, alkaloid extracts from seeds of Peganum harmala (AEP), and 10% and 95% ethanol extracts from seeds of Nigella glandulifera (EEN10 and EEN95) were given to mice in three doses by gavage. The writhing times within 30min after oxytocin treatment were recorded to evaluate the analgesic effect, and the glutathione peroxidase (GSH-Px), malondialdehyde (MDA), 6-keto-prostaglandin F1α (6-k-PGF1α), prostaglandin F2α (PGF2α), thromboxane B2 (TXB2), and nitric oxide (NO) levels in uterine tissues and PGF2α and MDA in serum were determined. The effects (contractile curve) of CMG, AEP, EEN10, and EEN95 on uterus contraction induced by oxytocin in isolated mouse uterus were recorded.
Results:
In contrast to the control group, CMG, AEP, N10, and N95 could display analgesic activities dose dependently by reducing the writhing response of the PDM model mice. CMG, AEP, EEN10, and EEN95 could also remarkably decrease the level of PGF2α, 6-k-PGF1α, TXB2, NO and MDA in uterine tissues and PGF2α and MDA in serum, whereas the activity of GSH-Px in uterine tissues was increased. Furthermore, CMG, AEP, EEN10, and EEN95 could significantly inhibit the frequency and amplitude of isolated uterus induced by oxytocin in a concentration-dependent manner.
Conclusions:
CMG exhibited a significant protective effect on experimental PDM. The mechanisms are probably associated with abating lipid peroxidation and over-inflammatory reaction, and alleviating the contraction of isolated mouse uterus. The seeds of P. harmala and N. glandulifera in the CMG may play an important role in exerting protective effects on PDM. This study provides pre-clinic proof to the use of CMG in clinical practice of PDM.
Background
To assess the prevalence of cyclic perimenstrual pain and discomfort and to detail the pattern of complementary and alternative (CAM) use adopted by women for the treatment of these symptoms.
Methods
Data from the 2012 national Australian Longitudinal Study of Women’s Health (ALSWH) cross-sectional survey of 7427 women aged 34–39 years were analysed to estimate the prevalence of endometriosis, premenstrual syndrome (PMS), irregular or heavy periods and severe dysmenorrhoea and to examine the association between their symptoms and their visits to CAM practitioners as well as their use of CAM therapies and products in the previous 12 months.
Results
The prevalence of endometriosis was 3.7 % and of the perimenstrual symptoms assessed, PMS was most prevalent at 41.2 % whilst irregular bleeding (22.2 %), heavy periods (29.8 %) and severe period pain (24.1 %) were reported at lower levels. Women with endometriosis were more likely than non-sufferers to have consulted with a massage therapist or acupuncturist and to have used vitamins/minerals, yoga/meditation or Chinese medicines (p < 0.05). PMS sufferers were more likely to consult with an osteopath, massage therapist, naturopath/herbalist or alternative health practitioner and to have used all forms of CAM therapies except Chinese medicines than women who had infrequent PMS (all p < 0.05). Women with irregular periods did not have different patterns of CAM use from non-sufferers and those with heavy periods did not favour any form of CAM but were less likely to visit a massage therapist or use yoga/meditation than non-sufferers (p < 0.05). For women with severe dysmenorrhoea there was no difference in their visits to CAM practitioners compared to non-sufferers but they were more likely to use aromatherapy oils (p < 0.05) and for more frequent dysmenorrhoea also herbal medicines, Chinese medicines and other alternative therapies compared to non-sufferers (all p < 0.05).
Conclusions
There is a high prevalence of cyclic perimenstrual pain and discomfort amongst women in this age group. Women were using CAM differentially when they had specific symptoms of cyclic perimenstrual pain and discomfort. The use of CAM needs to be properly assessed to ensure their safe, effective use and to ascertain their significance as a treatment option enabling women with menstrual problems and their care providers to improve their quality of life.
Background
The Cochrane risk of bias tool for randomized clinical trials was introduced in 2008 and has frequently been commented on and used in systematic reviews. We wanted to evaluate the tool by reviewing published comments on its strengths and challenges and by describing and analysing how the tool is applied to both Cochrane and non-Cochrane systematic reviews. MethodsA review of published comments (searches in PubMed, The Cochrane Methodology Register and Google Scholar) and an observational study (100 Cochrane and 100 non-Cochrane reviews from 2014). ResultsOur review included 68 comments, 15 of which were categorised as major. The main strengths of the tool were considered to be its aim (to assess trial conduct and not reporting), its developmental basis (wide consultation, empirical and theoretical evidence) and its transparent procedures. The challenges of the tool were mainly considered to be its choice of core bias domains (e.g. not involving funding/conflicts of interest) and issues to do with implementation (i.e. modest inter-rater agreement) and terminology. Our observational study found that the tool was used in all Cochrane reviews (100/100) and was the preferred tool in non-Cochrane reviews (31/100). Both types of reviews frequently implemented the tool in non-recommended ways. Most Cochrane reviews planned to use risk of bias assessments as basis for sensitivity analyses (70 %), but only a minority conducted such analyses (19 %) because, in many cases, few trials were assessed as having “low” risk of bias for all standard domains (6 %). The judgement of at least one risk of bias domain as “unclear” was found in 89 % of included randomized clinical trials (1103/1242). Conclusions
The Cochrane tool has become the standard approach to assess risk of bias in randomized clinical trials but is frequently implemented in a non-recommended way. Based on published comments and how it is applied in practice in systematic reviews, the tool may be further improved by a revised structure and more focused guidance.
Peppermint oil (PO) has shown promise as an IBS therapy, but previous trials have demonstrated variable efficacy and tolerability results.
To evaluate the efficacy and tolerability of a novel formulation of PO designed for sustained release in the small intestine in patients with IBS-M and IBS-D.
This is a 4-week, randomized, double-blind, placebo-controlled clinical trial of PO or identical placebo 3 times daily in patients fulfilling Rome III criteria for IBS-M or IBS-D. The primary endpoint was the change from baseline in the Total IBS Symptom Score (TISS) after 4 weeks of treatment.
Seventy-two patients (mean age 40.7 years, 75 % female, 77.8 % white) were randomized to PO (n = 35) or placebo (n = 37). At 4 weeks, PO was associated with a 40 % reduction in the TISS from baseline (mean change -1.16, SD ± 0.807), superior to the 24.3 % decrease (mean change -0.70, SD ± 0.737) observed with placebo (P = 0.0246). The decrease in the TISS of 19.6 % (mean change -0.55, SD ± 0.613) in the PO group at 24 h was also significantly larger than placebo (-10.3 %, mean change -0.27, SD ± 0.342) (P = 0.0092). At trial completion, patients in the PO group experienced greater improvement in multiple individual gastrointestinal symptoms as well as in severe or unbearable symptoms, compared to placebo. PO was well tolerated with few adverse events.
A novel PO formulation designed for sustained release in the small intestine is a safe, effective treatment capable of providing rapid relief of IBS symptoms.
Fenugreek with the scientific name of Trigonella foenum-graceum L and with leaves consisting of 3 small obovate to oblong leaflets is an annual herbaceous plant of the Fabaceae family. It is native to the eastern Mediterranean but is cultivated worldwide. This plant has medicinal alkaloids, steroid compounds, and sapogenins and many uses have been mentioned for this plant in traditional medicine. This plant has been used to ease childbirth, to aid digestion, and as a general tonic to improve metabolism. Trigonelline is considered as the most important metabolite of fenugreek, which is very effective in treating diabetes and decreasing blood cholesterol. Diaszhenin is another important compound in seeds of this plant, which is used in producing medicinal steroids like contraceptive pills. Many studies have been performed on the therapeutic effects and identification of chemical compounds of this plant. In this article, the most important biological effects and reported compounds about fenugreek seed are re...
This is a controlled, prospective study which compares the effects of a low-dose heat patch for self-medication on the reduction of pain symptoms in dysmenorrhea.
The sample group included female sophomore students studying at a university in Istanbul, Turkey, between 2007 and 2008. These female participants completed the Dysmenorrhea Identification Form to determine the sample group, and a total of 193 female students possessed the eligible criteria. The research control group consisted of 66 patients, the analgesia group consisted of 61, and the heat patch group consisted of 66. The control group did not use any treatments, while the self-medication group used analgesic medication (single dose), and the heat patch group applied a heat patch on the lower abdomen, against the skin, for an application period of 2 menstrual cycles. Using a visual analog scale (VAS), the pain severity was recorded at the baseline, after 4 hours of intervention, and after 8 hours of intervention. The data were examined using ANOVA.
There were significant differences between the groups in terms of pain severity after 8 hours of application (P < .001). All groups had similar pain levels at baseline and during the fourth and eighth hours, with no significant differences between the groups during the first and the second menstrual cycles (P > .05).
The authors conclude that the heat patch is an effective method for reducing dysmenorrhea.
Peptic ulcer disease is a gastrointestinal disorder defined by mucosal damage and free oxygen radicals associated with peptic ulcer and gastritis. Cinnamon is a traditional herb used for many diseases and it has also effects as an antioxidant, anti-inflammatory, antispasmodic and anti-ulcerative. Our research is based on oxidative stress and effects of Oleum cinnamomi on stomach, liver and kidney disorders induced by ethanol. In our experiment, 2-3 month old male Sprague-Dawley rats were used. One hour before the mucosal damage induced by 70 % ethanol, O. cinnamomi (2.5 ml/kg) was added into the groups. Gastric pH, analysis of gastric mucus and ulcer index were calculated from samples obtained from the stomach. Superoxide dismutase (SOD), malondialdehyde and catalase (CAT) levels were determined in stomach, liver and kidney homogenates and erythrocyte hemolysate. Histopathological examination of stomach, liver and kidney were determined with H&E staining. The non-treated ulcerative group showed higher scores than the control group which was treated with O. cinnamomi, when ulcer scores, gastric mucus and pH level of stomach are compared. Increased lipid peroxidation levels were observed in the liver, kidney and erythrocyte hemolysate. SOD activity was decreased in liver whereas increased in stomach of ethanol treated ulcerative groups. CAT levels were increased in stomach and liver of ethanol treated rats. Histopathological findings showed that ethanol treatment cause multiply organ damage such as stomach, liver and kidney injury. O. cinnamomi treatment protected these tissues from ethanol-induced damage. Consequently, the current investigation shows that O. cinnamomi has protective effects on ethanol-induced oxidative and mucosal damage.
To determine the prevalence of dysmenorrhea among Turkish university students and to evaluate the effects of sociodemographic characteristics on the condition.
A cross-sectional survey of 857 students conducted by questionnaire in April 2007 at a university in Turkey. A visual analogue scale was used to assess the severity of dysmenorrhea. Data were analyzed using the chi(2) test and logistic regression analysis.
The prevalence of dysmenorrhea was 55.5% (444 out of 800 women). Risk of dysmenorrhea was approximately 1.5-times higher in women with a satisfactory spending allowance (OR 1.49; 95% CI, 1.05-2.13); 3.5-times higher in women with a family history of dysmenorrhea (OR 3.48; 95% CI, 2.54-4.78); 1.5-times higher in women who were underweight compared with overweight/obese women (OR 1.52; 95% CI 0.99-2.33); 1.6-times higher in women who reported a history of smoking (OR 1.57; 95% CI, 1.10-2.25); and 1.8-times higher in women with an excessive sugar intake (OR 1.77; 95% CI, 1.15-2.72).
The high prevalence of dysmenorrhea among Turkish university students is a significant health problem that requires attention.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
This study reports the chemical composition, antioxidant and anti-inflammatory properties of Anethum graveolens essential oil and its main compounds. The essential oil was obtained from the aerial parts of the plant by hydrodistillation and analysed by using GC/MS. α-Phellandrene (19.12%), limonene (26.34%), dill ether (15.23%), sabinene (11.34%), α-pinene (2%), n-tetracosane (1.54%), neophytadiene (1.43%), n-docosane (1.04), n-tricosane (1%), n-nonadecane (1%), n-eicosane (0.78%), n-heneicosane (0.67%), β-myrcene (0.23%) and α-tujene (0.21%) were found to be the major constituents of the oil. A. graveolens oil exhibit a higher activity in each antioxidant system with a special attention for β-carotene bleaching test (IC50: 15.3 μg/mL) and reducing power (EC50: 11.24 μg/mL). The TLC-bioautography screening and fractionation resulted in the separation of the main antioxidant compounds, which were identified as limonene (45%) and sabinene (32%). The essential oil and its main compounds exhibited a potent NO-scavenging effect and inhibited the expression of inducible NO synthase.
In this study, the volatile compounds, lipid composition, thermal behavior, and structure of wheat germ oil were analyzed. Forty-four volatile compounds, mainly alcohols, esters, alkenes, and aldehydes, were isolated by headspace solid phase micro extraction. The major constituents were found to be hexanal (15.97%), 2-methyl-2-butene (10.43%), 2,4-heptadienal (8.53%), and limonene (6.83%). The oil was rich in unsaturated fatty acid (83.45%), especially in linoleic acid (64.82%), and there were 75.49% unsaturated fatty acid distributed in Sn-2 position. The main content of unsaponifiable matters was sterol, especially β-sitosterol (64.64%). The thermogravimetric analysis results showed one major regime of weight loss over a temperature range of 280–500°C and an exothermic behavior was observed by the differential scanning calorimetry data.
This study was conducted to determine the following among a group of female university students: the prevalence of dysmenorrhea; pain severity ratings; methods used to manage dysmenorrhea; and the effect of dysmenorrhea on daily activities, school attendance, and ability to communicate with friends. This cross-sectional study was conducted between December 2009 and February 2010 at a public university located in Istanbul, in the northwest area of Turkey. The study group included 1515 female students. Data were collected from the female students in the study group using a self-report questionnaire; the severity of dysmenorrhea was determined with the visual analog scale. The data were examined with mean, percentages, chi-square analysis, and logistic regression. The prevalence of dysmenorrhea in the study group was 85.7%. Of this group of subjects with dysmenorrhea, 30.4% described their menstrual pain as severe, 49.8% as moderate, and 19.8% as mild. The mean severity of pain among the students was 6.33 ± 2.32 on the VAS. The majority of participants who experienced moderate or severe pain regularly used analgesics for pain management, and participants who experienced severe pain used analgesics before the beginning of menstruation. Participants who experienced moderate pain used herbal tea, massage, heat application, rest, and distraction for pain management. Participants who experienced severe pain consulted a physician and that a significant difference existed between the dysmenorrhea rating groups in this regard (p < .001). Severe pain was significantly associated with school absenteeism and limitations in social activities/functioning (p < .001). Dysmenorrhea is highly prevalent among university students and is related to school absenteeism, ability to participate in and enjoy daily activities, and limitations in social activities/functioning.
Context:
The health benefits and medicinal properties of herbal food products are known since antiquity. Fenugreek [Trigonella foenum-graecum Linn. (Fabaceae)], a seed spice used to enhance flavor, color and texture of food, is employed for medicinal purposes in many traditional systems. A number of epidemiological studies and laboratory research have unraveled the biological actions of fenugreek.
Objective:
Research on fenugreek in recent years has identified a number of health benefits and physiological attributes in both experimental animals as well as clinical trials in humans. In this study we have reviewed the available scientific literature on fenugreek.
Methods:
This review article summarizes and reviews published experimental studies and scientific literature from the databases including PubMed, Google and local library searches.
Results:
The information available in the literature on the health benefits and pharmaceutical effects of Trigonella accounts for its known medicinal properties and adds new therapeutic effects in newer indications. Besides its known medicinal properties such as carminative, gastric stimulant, antidiabetic and galactogogue (lactation-inducer) effects, newer research has identified hypocholesterolemic, antilipidemia, antioxidant, hepatoprotective, anti-inflammatory, antibacterial, antifungal, antiulcer, antilithigenic, anticarcinogenic and other miscellaneous medicinal effects of fenugreek. Although most of these studies have used whole seed powder or different forms of extracts, some have identified active constituents from seeds and attributed them medicinal values for different indications.
Conclusion:
The resarch on Trigonella exhibits its health benefits and potential medicinal properties in various indications and has little or no side effects, suggesting its pharmaceutical, therapeutic and nutritional potential.
To evaluate the prevalence, impact and treatment of primary dysmenorrhea among Mexican university students.
A multiple-choice questionnaire was administered to 1539 students in six university programs: medicine, nursing, nutrition, dentistry, pharmacy and psychology. Data on the presence, severity, symptoms, treatment and limitations caused by dysmenorrhea were obtained and analyzed.
The mean+/-SD age of the women was 20.4+/-2.0 years; the mean age of menarche was 12.3+/-1.5 years. A total of 64% of the women experienced dysmenorrhea. Dysmenorrhea was more prevalent among nutrition and psychology students than among medicine, pharmacy and dentistry students (p<0.05). Dysmenorrhea was mild in 36.1% of women, moderate in 43.8% and severe in 20.1%. Nursing students showed an intensity of pain that was significantly higher than that of medicine and dentistry students (p<0.05). Sixty-five percent of the women with dysmenorrhea reported that it limited their daily activities, and 42.1% reported school absenteeism (SA) as a result. Of those who experienced dysmenorrhea, 25.9% consulted a physician, and 61.7% practiced self-medication (SM). The most common medications used were an over-the-counter (OTC) medication with paracetamol (an analgesic), pamabrom (a diuretic), and pyrilamine (a histamine antagonist), another OTC with metamizol (a non-steroidal anti-inflammatory drug [NSAID]) plus butylhioscine (an antispasmodic drug) and naproxen (a NSAID). Of those women using prescribed medications, 18.4% reported complete remission of their symptoms, while 78.1% reported little to moderate alleviation, and 3.6% reported no effect on their menstrual distress. Similarly, of the women who practiced SM, 23.4% reported complete relief, 75.5% reported little to moderate effectiveness, and 1.0% reported no efficacy.
The prevalence of dysmenorrhea among Mexican university students is high, and the pain that these women suffer can be severe, disabling and result in short-term SA. The pain is often not completely relieved despite the use of medication. It is necessary to improve the therapeutic options for relief of pain caused by dysmenorrhea and to minimize the impact of dysmenorrhea on social, economic and school activities.