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SUMMARY
Dysmenorrhea is a disorder characterized by lower abdominal pain that
occurs during menstruation, however, the pain may start 2 or more days
before it. It is sometimes associated with headache, nausea, vomiting, diffuse
abdominal pain, backache, general malaise, weakness, and other
gastrointestinal symptoms. It is classified into two categories: primary and
secondary dysmenorrhea. Primary dysmenorrhea (spasmodic) is a common
gynecological complaint that may affect as many as 50 % of women. Where
10% of them may suffer severely enough to render them incapacitated for one
to three days each menstrual cycle. Higher prevalence rates up to 90% are
seen in women less than 25 years. On the other hand, secondary (congestive)
dysmenorrhea is menstrual pain associated with underlying pelvic pathology.
It starts in the 20s or 30s years of age, after relatively painless menstrual
cycles in the past.
Treatment approaches for primary dysmenorrhea include the use of
nonsteroidal anti-inflammatory drugs (NSAIDs) to block the production and
action of prostaglandins, which are responsible for the cramping and pain.
Hormonal contraceptives may also be a useful treatment. These
pharmacological treatment approaches may not be entirely effective and has
side-effects for some cases. In addition, women/girls with primary
dysmenorrhea may show resistance or unwillingness to take any medications.
Thus, there is a need to identify easy and effective methods to ease their
discomfort and improve their quality of life during menses.
Aromatherapy is one of the alternative therapies used for management
of primary dysmenorrhea. It refers to the use of essential fragrant oils (the
pure volatile portion of aromatic plant normally extracted by distillation) for
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therapeutic or medical purposes. Among the recommended essential oils
which have sedative effect is ginger oil. Ginger, the rhizome of Zingiber
officinale, is a traditional medicine with anti-inflammatory and
anticarcinogenic properties. It is a botanical generally recognized as safe by
The United States Food and Drug Administration (FDA).
Ginger has been widely used and administered in Traditional Chinese
Medicine for more than 2500 years as an anti-inflammatory agent in
musculoskeletal disorders. Its use for dysmenorrhea depends on its two
compounds: [6]-Gingerol and Gingerdiones. They are potent inhibitors of
prostaglandines by blocking cyclooxygenase. However, to the best of our
knowledge, there are few reports of randomized controlled studies about the
use of ginger in dysmenorrhea.
Aim of the study:
This study aimed to determine the effect of ginger oil on symptoms of
primary dysmenorrhea among Faculty of nursing students.
Materials and method
Research design
A Randomized, Controlled clinical trial was utilized.
Setting
It was conducted at the Faculty of Nursing- Alexandria University (obstetric
& gynecological skill lab).
Subjects (appendix III)
The study subjects included 80 female nursing students who were
equally randomly assigned to either one of two groups: A study group (A)
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entailed those who received aromatherapy massage with ginger oil. A control
group (B) included those who received massage with placebo oil.
Tools for data collection
2 tools were used
Tool I: Basic Menstruation assessment structured questionnaire
This tool was developed by the researcher to collect data in the primary
survey for identification of the accessible population from whom the study
sample was pulled out. It contains 3 sections:
Section 1: Socio-demographic and health profile data:
a. Socio-demographic data such as: age, academic year....etc
b. Health profile data such as: the presence of any disease, and
medications use.
Section 2: Menstrual history assessment sheet (MAS):
a. Nature of the menstrual cycle such as age at menarche, duration,
interval, and amount of blood loss.
b. The presence, frequency and severity of dysmenorrhea.
Section 3: Verbal multidimensional scoring system (VMSS) for
assessment of dysmenorrhea severity.
It was developed by Andersch and Milson (1982). This part was used to
pick up those with moderate or severe dysmenorrhea. It grades pain as
none, mild, moderate, or severe. It also takes into account the effect of
pain on daily activity, systemic symptoms, and analgesic requirement.
Tool II: Pain assessment structured questionnaire (PASQ): It was used
to determine the severity of menstrual pain among the study subjects, its
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associated symptoms and its effects on activities of daily living before and
after the intervention.
The main findings of the present study were:
I. General characteristics:
• Around three-fourths (72.5%) of the study group were 21or 22 years old,
compared to 50% of the control group. Slightly more than one-third
(37.5%) of study group were in the third academic year, compared to
57.5% of the control group.
II. History of primary dysmenorrhea:
• No statistically significant differences between the study & control groups
were detected in relation to their history of primary dysmenorrhea. Three
quarters (75%) of the study & 80% of the control groups had reported that
their pain usually starts just before menses. Close percentages (72.5% &
80%) in the study and control groups, respectively, had experienced the
pain at lower abdomen radiating to lower back. About one half (45%
&55%) of each group had moderate dysmenorrheal pain. A close
percentage in each group (80% & 82.5%) had associated systemic
symptoms.
• Only 5% and 10% from the study and control groups – respectively - had
consulted a physician for management of their primary dysmenorrhea. As
for use of medications, 60% of the study group and 40% of the control
group had used analgesics for pain relief.
III. Pain intensity progress before and after the intervention.
• Almost half (55%) of the study and control (45%) groups had severe pain
before the intervention with no statistically significant difference between
them.
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• After 30 minutes from the intervention, there was a statistically significant
difference (P<0.01) between the study and control groups in favor of the
former. Where only 15% of the study group had moderate pain compared
to as much as 40% of the control group.
• After 12 hours, a statistically significant difference (P=0.01) had appeared
between the two groups in the favor of the study group .Where only 5% of
the study group had severe pain compared to 12.5% of the control group.
The same profile had persisted after 24 hours, where pain was completely
absent in almost half (47.5%) of the study group compared to only 12.5%
of the control group.
IV. PD associated symptoms before and after the intervention
• As much as 28.1% of the study & 39.4% of the control group had
moderate nausea and vomiting before the intervention with no statistically
significant difference between them (MCP = .368).
• After 12 hours from the intervention, there was a statistically significant
difference (p=0.004) between the study and control group in favor of the
former. Where 6.1% of the control group had moderate nausea and
vomiting compared to none of the study group.
• As regards diarrhea, there was no statistically significant difference
between the two groups before or after the intervention. After 8 hours from
the intervention, diarrhea was absent among the majority of both groups
(84.4% and 84.8%). By 12 hours, it was absent among almost all subjects
in both groups (90.6% and 87.9%).
• As regards headache, before the intervention there was no statistically
significant difference between the two groups. By 24 hours from the
intervention, there was a statistically significant difference (FETp= 0.02)
between the two groups in the favor of the study group. Where, all the
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study group had reported absence of headache compared to only 84.8% of
the control group.
• No statistically significant difference was observed between the severity of
dizziness or edema among the two groups either before or after the
intervention.
• However, the picture in relation to anorexia was different. Where a
statistically significant difference (MCP =0.05) was observed between its
severity among the two groups in favor of the study group after 8 hours.
Where, almost all of them (93.7%) had absence of anorexia compared to
only about three fourths (78.8%) of the control group.
• There were no statistically significant differences between the severity of
mood swings among the two groups before the intervention. By 24 hours,
none of both groups had this symptom.
• No statistically significant difference was also observed between the
severity of weakness among the two groups either before or after the
intervention. By 12 hours, only 3.1% of the study group complained from
this moderate symptom which disappeared later on.
V. Adverse effects of PD on daily life activates before and after the
intervention
• Before the intervention, both groups had an almost equal negative
effect on all aspects of their daily life activities with no statistically
significant difference.
• At the end of the intervention, there was a statistically significant
difference between the study and control groups in favor of the
former. The most significant difference was observed in social life
activities (p=0.006) and home responsibilities (p=0.007).
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• By the end of the intervention, the effect of primary dysmenorrhea on
the three parameters of daily life activities (academic productivity,
colleagues relationships and family relationships) had equally
completely disappeared among the majority (81.3%) of the study
group compared to around one-half (54.2% , 50% and 54.2%) of the
control group.
VI. Subjects satisfaction with the received nursing intervention.
• The majority of the study group (80%) was satisfied with the nursing
intervention, compared to only 55% of the control group.
Based on the findings of the present study, the following
recommendations are suggested:
Academic preparation of maternity nurses may consider the
incorporation of aromatherapy and herbal medicine within their
curricula. Especially, the management of primary dysmenorrhea with
such therapies specifically ginger.
Maternity health care settings need to contemplate the possibility of
integrating the use of aromatherapy in their polices, and hence the
clinical practice.
Nurses at maternity and child health centers could provide their clients
with information about the natural management of primary
dysmenorrhea (with complementary and alternative therapies).
Researches about different herbs should be encouraged among maternity
nurses to evaluate their effectiveness and risks.
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Further studies
Replication of the present study under different circumstances (sampling,
setting, measurement, and doses) is recommended to ensure ginger
effectiveness for management of PD.
Specialized studies are needed to explore the effect of ginger on the
management of different painful gynecological and reproductive
conditions as: premenstrual syndrome, child birth and after pain.