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Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
THIEME
64 Original Article
Ginger Tea on Dysmenorrhoea Among Nursing
Students
Sheetal Crasta1 Philomena Fernandes2 Shynee Paul2
1Prime Medical Center, Dubai, United Arab Emirates
2Nitte Usha Institute of Nursing Sciences, Mangaluru, Karnataka,
India
received
August 1, 2019
accepted after revision
September 5, 2019
Address for correspondence Philomena Fernandes, MSc (Nursing),
Nitte Usha Institute of Nursing Sciences, Deralakatte, Mangaluru,
Karnataka, India (e-mail: philomena@nitte.edu.in).
Background Dysmenorrhea is a common problem which can alter the daily routines
of females. Primary dysmenorrhea affects 40 to 90% women. Dysmenorrhea sufferers
account for 3 among 4 women as per evidences. Traditional remedies are chosen to
get some relief because of their least side effects. These remedies have a favorable
effect in reducing dysmenorrhea. Ginger is used since ancient times as various forms
of alternative medicine. One of the traditional uses of ginger is for pain relief, including
menstrual pain. The aim of this study was to identify the effectiveness of ginger tea in
dysmenorrhea.
Objectives The objectives of this study are (1) Assess the level of dysmenorrhea
among nursing students. (2) Determine the effectiveness of ginger tea on dysmenor-
rhea among nursing students. (3) Find the association between level of dysmenorrhea
before the administration of ginger tea and demographic variables.
Methodology A quantitative research approach with quasi-experimental design was
considered. The sample comprised of 50 students with moderate and severe menstru-
al pain as per numerical pain rating scale. The baseline data was collected. Ginger tea
was prepared by the researcher and administered 120 mL to the subjects; on the first
2 days of menstruation in the morning and night after breakfast and dinner, respec-
tively. Level of different aspects of pain was assessed before the administration as well
as 2 hours after administration of ginger tea using Pain Quality Assessment Scale.
Pre- and post-test were taken before as well as 2 hours after administering the drink.
A total of four doses are given and ratings were measured eight times. Data was ana-
lyzed using descriptive and inferential statistics.
Results The present study revealed that the median score of all seven characteristics
of pain was higher in the preintervention when compared with postintervention. Mann–
Whitney U test showed that there was a significant difference in level of pain between
the experimental and control groups (p < 0.05). Wilcoxon signed-rank test showed that
there was a significant difference in pain measurements before and after the admin-
istration of ginger tea (p < 0.05). These findings indicate that ginger tea was effective
in reducing menstrual pain. Chi-square test and likelihood ratio were used to find the
association between baseline dysmenorrhea with demographic and clinical variables.
It was found that there is no significant association (p > 0.05). The responses given by
Abstract
Keywords
►ginger tea
►effectiveness
►dysmenorrhea
►nursing students
DOI https://doi.org/
10.1055/s-0039-1700705
Copyright ©2019 Nitte University
(Deemed to be University)
J Health Allied Sci NU 2019;9:64–75
Published online: 2020-02-10
65Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
Journal of Health and Allied Sciences NU Vol. 9 No. 2/2019
Introduction
In India, woman is considered as a weaker section of the soci-
ety. The physical makeup of a woman has also contributed
in underestimating a woman. The pain and associated symp-
toms a woman experiences during her periods are one of the
common problems experienced by many adolescent girls.
Dysmenorrhea affects the quality of life of women espe-
cially of those who are working and studying. One in 13
sufferers is incapacitated for 1 to 3 days per month, affect-
ing work and school attendance and making dysmenorrhea
the leading cause of school absenteeism among adolescents.
Symptoms may differ in each individual: it includes dizziness
and syncope, cramping, nausea, vomiting, diarrhea, head-
aches, and fatigue; and may last up to 72 hours.3
Women begin to depend on medications as a solution for
this problem. Because of the drastic physical growth that
occurs during adolescence, most of them do not want to
depend solely on pharmacologic treatments.1
Alternative therapies have gained importance in this
context. There are many home remedies known to get
relief from primary dysmenorrhea (PD). Some of them are
dietary modifications, heat application, yoga, exercises,
herbs. Numerous researches are being performed which
focuses on complementary and alternative interventions for
dysmenorrhea. This includes the use of muscle relaxation
therapy, magnetic therapy, reflexology, hand acupuncture,
aroma therapy, acupressure, etc. In one large study, as many
as 48% of women reported use of complementary and alter-
native medicine as an alternative to prescription medica-
tion or to enhance the effectiveness of their prescription
medications.2,3
Ginger is the world’s most gifted, evidence-based nat-
ural health remedy. Ayurvedic texts consider ginger as the
queen of herbs available, as it is a complete medicine molded
in itself. Ginger contains “gingerol,” which is a highly potent
anti- inflammatory compound responsible for alleviating
joint and muscle pain. Ginger helps women effectively reduce
the pain associated with dysmenorrhea. A research study in
Iran divided 70 female students into two groups. One group
was administered ginger capsules and the other was given a
placebo—each for the first 3 days of their menstrual cycles.
The researchers found that 82.85% of the women taking gin-
ger capsules reported improvements in pain symptoms, com-
pared with 47.05% of those on placebo.4
Background
Menarche is the attainment of womanhood. In the Indian
scenario, it is a significant event which determines a girl’s
maturity and labels her fit for marriage. There are many
physiological and psychological changes happening to a
girl during menstruation. Pain, fatigue, nausea, vomiting,
anxiety, depression, cramps, etc. are experienced during
menstruation.5
Painful menstruation without any pathologic conditions
is called dysmenorrhea. One in every two women who have
their periods suffers from dysmenorrhea, or intense pain
and cramping during menstruation.6 There are two types of
dysmenorrhea: primary and secondary. PD is characterized
by painful menstrual cramps without any evident patholo-
gy.7 Secondary dysmenorrhea is the occurrence of painful
menstruation in the presence of a pelvic pathology, such as
endometriosis, adenomyosis, or chronic pelvic inflammatory
disease.8
PD is seen in women of all ages but usually begins at ado-
lescence, with an estimated prevalence of 40 to 50%.7 PD typ-
ically begins in the adolescent years roughly 6 to 12 months
after menarche, usually with the establishment regular ovu-
latory cycles.9 Overall, PD may affect 40 to 90% of women.10
PD is seen in 3 out of 4 women. One in 4 women with
dysmenorrhea has a secondary form caused by an underlying
gynecological condition. In an estimate, 5 to 15% of women
with PD suffer from pain that hinders their general routines.11
In a study conducted among students attending college, at
Indore city of central India, dysmenorrhea was reported in
84.2% (261) girls, and 15.8% (49) reported no dysmenorrhea
of which 34.2% of girls experienced severe pain, 36.6% mod-
erate pain, and 29.2% had mild pain.6
PD occurs in the absence of anatomic abnormalities or
pelvic pathologic disorders in which pain begins at the onset
of the menstrual flow and lasts for 12 to 48 hours. PD is the
occurrence of a physiologic alteration and it usually appears
6 to 12 months after menarche, when ovulation is estab-
lished. Secondary dysmenorrhea is acquired menstrual pain
that develops after 25 years. It is associated with pathologic
disorders.12
Traditional remedies are gaining dominance over the
pharmacological management due to its least side effects.
Home remedies for dysmenorrhea include regular exer-
cise, yoga, and consumption of mint, ginger, parsley, basil,
the experimental and control group was mentioned separately. Ginger tea effects and
experience were verbalized by the experimental group alone. This supported the sta-
tistical finding that ginger tea is effective in reducing dysmenorrhea.
Conclusion Findings revealed that the administration of ginger tea can bring a sud-
den relief among the subjects with dysmenorrhea. The awareness about alternative
therapies must be created among public.
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Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
cinnamon, asafetida, and aloe vera. Eating a wholesome
diet on a regular basis that includes proteins, vitamins,
minerals, and antioxidants is also a good home remedy.
These home remedies have a direct and positive effect on
dysmenorrhea and help curing the causes without adverse
side effects.13
Ginger is one among the healthiest (and most delicious)
spices on the planet. It is nourished with nutrient compounds
that have powerful benefits for the body and brain. Ginger
has a very long history of use in various forms of traditional/
alternative medicine. It aids in digestion, reduce nausea, and
help to treat flu and common cold. One of the traditional uses
of ginger is for pain relief, including menstrual pain.14
Need for the Study
Dysmenorrhea is a common problem affecting majority of
women. Pain during menstruation or dysmenorrhea occurs
in 50% of menstruating women and approximately 10% are
incapacitated for 1 to 3 days each month. In the first year
after menarche, 38% of girls develop dysmenorrhea, and in
the second and third year after menarche, 20% experience
pain related to menstruation. About 80% of women who
develop dysmenorrhea do so within 3 years of menarche.
Over the age of 25 years the cause of dysmenorrhea is usually
secondary to other pelvic problems.15
Adolescents consulting for dysmenorrhea are very few and
they prefer over-the-counter medicines or home remedies.
Therefore, statistics about prevalence of menstrual problems
or dysmenorrhea and their causes are poorly available due to
underreporting. Recently, it has become an important pub-
lic health problem among the female population; prevalence
rate reported from different regions of India appears to be as
follows: Delhi 63.75%16 and Chennai 61%17 in certain regions,
prevalence rate is reported to be as high as 71 to 93%; differ-
ence can be attributed to region-specific environment, age of
participants, and study protocol.18
A study conducted in Western Turkey to evaluate the
prevalence of dysmenorrhea and determine its effect on
health-related quality of life among a group of female uni-
versity students revealed that dysmenorrhea is a common
health problem, having negative effects on the health- related
quality among university female students. The study also
found a high prevalence of dysmenorrhea (72.7%) being
reported among female students.19
It is the responsibility of health care professionals to cre-
ate awareness among the female population regarding the
common reproductive diseases and its available remedies.
Dysmenorrhea has many nonpharmacological interven-
tions among which ginger is one which has proved to be
effective in various studies. According to modern scientific
researches, ginger possesses numerous therapeutic prop-
erties including antioxidant effects, an ability to inhibit the
formation of inflammatory compounds, and direct anti-
inflammatory effects. One theory believes that increased
prostaglandin levels produce increased myometrial con-
tractility, uterine ischemia, and sensitization of pain fibers,
which lead to pelvic pain. Women with PD have higher levels
of endometrial prostaglandins F2-a and E2 and leukotrienes
than non- dysmenorrheic women.20
A systematic review done in U.S. evaluates the current evi-
dence for the effectiveness of ginger for treating PD and the
study concluded by proving the evidence for the effective-
ness of 750 to 2,000 mg ginger powder during the first 3 to
4 days of menstrual cycle for PD.21
Review of Literature
Review of literature is an assessment of the entire body of
literature as well as critiques of distinctive studies.22 Review
of literature gives an insight about previous researchers’ pros
and cons about their study. This helps the present research-
er to prepare well in advance to avoid the deficiency in his
study.23
In the present study, review of literatures is divided into
three subheadings
• Studies related to prevalence of dysmenorrhea.
• Studies related to use of contemporary therapies for
dysmenorrhea.
• Studies related to effectiveness of ginger on dysmenorrhea.
Literatures Related to Prevalence of Dysmenorrheal
A study was conducted on female students in Saveetha
University to find the burden of dysmenorrhea and men-
orrhagia. The study results showed that dysmenorrhea was
estimated to be 70.4%. Severe dysmenorrhea was present in
9.5% of girls while 24.6 and 36.5% experienced moderate and
mild dysmenorrhea, respectively.
Although 70.4% of girls experienced dysmenorrhea, only
3.6% used pharmacotherapy due to fear of side effects. The
study concluded that the burden of dysmenorrhea was found
much more than menorrhagia and irregular cycles in their
university. They have suggested that dysmenorrhea should
be considered a target for reproductive health program.24
To study the variations of dysmenorrhea during stress in
college going girls, a study was conducted in Belagavi city,
Karnataka, India. The prevalence of dysmenorrhea in India
varies. It is stated that, in India, prevalence of dysmenorrhea
varies from 33 to 79.67%. The study proved that body mass
index (BMI) was an independent risk factor among dysmen-
orrheic girls with the onset of symptoms occurring mostly
among the early age group, that is, 20.9 years. The study also
proved that there was a positive and significant corelation
between each component taken in the Moos Menstrual Dis-
tress Questionnaire, with the mean values peaking mostly in
the stress group than in the nonstress group. The study con-
cluded that there was a significant variation in dysmenorrhea
during stress and nonstress condition in college going girls.25
A comprehensive review was performed in the Centre for
Longitudinal and Life Course Research, Australia, with large
community-based samples to accurately determine the prev-
alence and risk factors of dysmenorrhea. The study results
showed that, the prevalence of dysmenorrhea varies between
16 and 91% in women of reproductive age, with severe pain
in 2 to 29% of the women studied. Women’s age, parity, and
use of oral contraceptives were inversely associated with
67Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
Journal of Health and Allied Sciences NU Vol. 9 No. 2/2019
dysmenorrhea, and high stress increased the risk of dysmen-
orrhea. Family history of dysmenorrhea strongly increased
its risk. Inconclusive evidence was found for modifiable
factors such as cigarette smoking, diet, obesity, depression,
and abuse. Dysmenorrhea is a significant symptom for a
large proportion of women of reproductive age. This review
confirms that dysmenorrhea improves with increased age,
parity, and use of oral contraceptives and is positively associ-
ated with stress and family history of dysmenorrhea.26
A cross-sectional study was performed among 311 under-
graduate female students aged 18 to 27 years in Isfahan
University of Medical Sciences, Iran, to investigate the prev-
alence of PD and to determine the factors associated with its
intensity. Sociodemographic characteristics and menstrual
factors were obtained through interviews with the help of
a pretested questionnaire. The prevalence of PD was 89.1%.
Residing at home, younger age, lower number of years of
formal education for the mother, positive family history of
dysmenorrhea, higher severity of bleeding, and shorter men-
strual period intervals were significantly associated with
the higher intensity of PD. PD is a common health concern
among young women.27
A cross-sectional descriptive study was conducted in a
medical college in Karnataka, India, on 560 female medical
students with an objective to evaluate the menstrual char-
acteristics, prevalence, and severity of dysmenorrhea and its
effects on the quality of life, particularly absenteeism from
college. Three medical colleges in Mangalore (Karnataka,
India) were studied. Besides menstrual characteristics, the
questionnaire included gradation of pain and quality of life
based on the American Chronic Pain Association. Chi-square
test and logistic regression were used for statistical analyses.
The study showed a significant association of dysmenorrhea
with the age of menarche, family history, and both physical
and psychological premenstrual symptoms. The most signifi-
cant conclusion of the study was found to be high prevalence
of dysmenorrhea, having a significant effect on the routine
activities, and a detrimental effect on the quality of life. The
alarming prevalence of self-medication in the form of non-
steroidal anti-inflammatory drugs (NSAIDs), easily available
over the counter, was also highlighted in the study. There is
a significant association between quality of life and severity
of dysmenorrhea.28
Literatures Related to Use of Contemporary Therapies
for Dysmenorrhea
A cross-sectional research was conducted in 586 female
students at a college in southern Taiwan to determine the
affected factors of dysmenorrhea and evaluate the self-
perceived efficacy of relief methods. Data was analyzed using
a t-test, one-way analysis of variance, and Scheffe test. The
results showed that traditional Chinese medicine pattern
related significantly to dysmenorrhea frequency perception.
Using Shenghua decoction, siwu, and pig blood decoction,
Angelica drink, ginger, Ziziphus jujube, brown sugar tea, and
analgesics all related significantly to dysmenorrhea relief
efficacy. Strategies found to help relieve dysmenorrhea lev-
el perception include increasing the duration and regularity
of sleep and avoiding the consumption of pungent foods.
The study suggests that dysmenorrhea-relief courses should
be improved in hospitals and schools to assist women to
self-manage dysmenorrhea more effectively.29
A study for evaluating the efficacy of yoga as an alterna-
tive therapy for PD and stress was conducted in Siddhartha
Institute of Medical Sciences And Research Foundation, India.
Note that 113 medical students, unmarried girls, with PD
and stress, were randomly assigned to the study and control
group. Semistructured questionnaire, the Numerical Rating
Scale for pain, and the Perceived Stress Scale were admin-
istered at baseline and after 3 months. The study group was
subjected to yoga intervention. The results showed a signif-
icant (p < 0.0001) reduction in the perceived pain after yoga
intervention in the study group. Eighty-eight percent of the
study group reported complete pain relief and 12% reported
mild pain, and students with yoga intervention demonstrat-
ed significant improvement in perceived stress (p < 0.0001).
Eighty-two percent of the study group reported complete
stress relief. After yoga intervention, absenteeism dropped
to 10% and improvement in daily activity was observed in
the study group. The study conclusion was that with yogic
exercises stress and pain of dysmenorrhea was controlled
indicating the benefits of yoga in PD. Yoga lessens psychoso-
cial stress levels, so it should be implemented among college
students to augment their menstrual well-being.30
A true experimental research was conducted in a Higher
Secondary School at Chrompet, Chennai, India, to assess the
effectiveness of acupressure on dysmenorrhea among ado-
lescent girls. Sixty girls who had moderate and severe pain
during menstruation and aged between 12 and 16 years who
fulfilled the inclusive criteria were divided equally, 30 in the
experimental group and 30 in the control group. Probabil-
ity simple random sampling technique using lottery meth-
od was used to select the samples for the experimental and
control group. The data analysis revealed that in the experi-
mental group the overall mean difference was 3.2 with stan-
dard deviation (SD) of 1.5 and t-test value was 11.9 at the
level of p < 0.001. Similarly in the control group, the overall
mean difference was 0.1 with SD of 0.5 and t-test value was
1.1. It showed statistically significant difference between
the experimental and control group. Hence, the acupressure
therapy was found to be effective in reducing dysmenorrhea
among adolescent girls.31
A study was conducted in Puducherry, India, to assess
the effect of music therapy during dysmenorrhea in sub-
jects during menstrual phases of menstrual cycle. Thirty
young adolescent girls suffering from PD were includ-
ed in the study. Day 1 of menstrual cycle, a premenstru-
al syndrome (PMS)–dysmenorrhea questionnaire was
administered. Heart rate variability (HRV) was tested for all
subjects. Music therapy was administered for 1 week prior
to the next expected date of menstruation. Raga Malkauns
and Yaman by flute were used for music therapy. Day 1 of
next cycle, HRV was repeated and a PMS-dysmenorrhea
questionnaire was readministered. The intragroup data
was analyzed using paired t-test. The results showed that
mean dysmenorrhea score before administering music
68
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Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
therapy was 63.4 ± 5.3 compared with postmusic thera-
py dysmenorrhea score, that is, 57.6 ± 8.49. Among HRV
parameters, high-frequency domain showed significant
difference between pre-MT (music therapy) (42.3 ± 13) and
post-MT (50.14 ± 15.7) with a p-value of 0.04. There was a
significant difference in the shift of sympathovagal balance
after music therapy toward parasympathetic activity.32
A study was conducted in Lucknow, Ut tar Pradesh, India, to
assess the effect of Yoga Nidra as a treatment in the patients of
menstrual disorders with somatoform symptoms. One hun-
dred and fifty female patients with menstrual disorders from
the Department of Obstetrics and Gynecology, CSM Medical
University (erstwhile KGMU), Lucknow, Uttar Pradesh, India,
were randomly divided into two groups: (1) intervention
group: 75 subjects (Yoga Nidra intervention and medica-
tion) and (2) control group: 75 subjects (without Yoga Nidra
intervention, only medication). Schedule for clinical assess-
ment in neuropsychiatry tool was used. There was significant
improvement in pain symptoms (p < 0.006), gastrointestinal
symptoms (p < 0.04), cardiovascular symptoms (p < 0.02),
and urogenital symptoms (p < 0.005) after 6 months of Yoga
Nidra therapy in the intervention group in comparison to the
control group. The results indicate that somatoform symp-
toms in patients with menstrual disorder can be decreased
by learning and applying a program based on yogic interven-
tion (Yoga Nidra).33
A study was conducted to assess the beneficial effects
of using a far-infrared (FIR) belt on the management of
patients with PD in Taiwan. A parallel-arm randomized
sham- controlled and double-blinded design with objective
physical evidence and psychometric self-reports was used.
Fifty-one Taiwanese women with PD were enrolled in the
study. Results indicate that there was an increased abdom-
inal temperature of 0.6°C and a 3.27% increase in abdominal
blood flow in the FIR group (wearing FIR belt) compared with
those in the control group (wearing sham belt). These results
demonstrate that the use of a belt made of FIR ceramic mate-
rials can reduce PD.34
A semiempirical clinical trial was conducted in Iran to
assess the effects of massage therapy on endometriosis
caused dysmenorrhea. Twenty-three patients suffering
from endometriosis were picked as the sample through a
simple method. The visual analog scale and McGill ques-
tionnaires were used once before and twice after the end
of intervention for each patient. The intervention con-
sisted of twenty 20-minute sessions of massage on some
specific points of abdomen, sides, and the back (sacrum)
of patients. There was a statistically significant difference
between the intensity of pain before the intervention
started, immediately after, and also 6 weeks after the ther-
apy (p < 0.001). According to the results, massage thera-
py can be a fitting method to reduce the menstrual pain
caused by endometriosis.35
Literatures Related to Effectiveness of Ginger on
Dysmenorrhea
A study was conducted to assess the effectiveness of ginger
tea upon dysmenorrhea among students in Apollo College of
Nursing, Chennai, Tamil Nadu, India. Forty students with dys-
menorrhea were selected by purposive sampling technique.
Level of dysmenorrhea was assessed in two menstrual cycles.
First menstrual cycle was taken as pretest to assess level of
dysmenorrhea and the next cycle was posttest in which gin-
ger tea was administered daily as 50 mL in morning after
breakfast and 50 mL at night after dinner for 5 days starting
from 2 days before menstruation. The findings of the study
was that before administration of ginger tea the pain level
was high (mean = 6.60, SD = 1.59) in comparison with the
pain scores of after administering ginger tea (mean = 2.47,
SD = 1.11). The difference was found to be statistically sig-
nificant at p-value of < 0.001. The study indicates that non-
pharmacological intervention was needed for dysmenorrhea
which is a major health problem.36 An experimental study
was conducted among adolescent girls in Erode, Tamil Nadu,
India, to assess the effectiveness of ginger powder on dysmen-
orrhea. Thirty adolescent girls with dysmenorrhea fulfilling
the inclusion criteria were selected. A one-group pretest and
posttest pre-experimental design was adopted. A pretest was
conducted by using symptoms assessment scale. Immediate-
ly after pretest, 1 g ginger powder was given two times a day
for 7 days and posttest was conducted. The results show that
the pretest mean score was 65.12 (SD = 8.74) and posttest
mean score was 43.24 (SD = 6.72) with paired t value of
23.02, which was significant at 0.01 level.
This showed that ginger was effective. The study implies
on the need for educating adolescent girls on effective man-
agement of dysmenorrhea.37
A study was conducted in Egypt to evaluate the effect of
fresh ginger usage as a home remedy on pain relief for dys-
menorrhea. A quasi-experimental design was used and using
convenient sampling 120 female students were selected. The
total number of samples was divided into two equal groups.
The first group (control) was instructed not to take anything
during menstruation, while the intervention group (60)
was instructed to take one table spoon of fresh ginger over
200 mL warm water by average three cups daily starting 3 days
before menstruation and continue use for the first 2 days
during menstruation . The results of the study showed that
regarding the severity of dysmenorrhea 60% had moderate
dysmenorrhea before intervention which changed into 31.7%
postintervention. In light of this study, importance of use of
fresh ginger as a home remedy to relive PD was highlighted.38
A quantitative study was performed at Sree Mookambika
College of Nursing, Kanyakumari, Tamil Nadu, India, to find
out the effectiveness of ginger tea on dysmenorrhea among
college students. Nonequivalent pretest–posttest control
group design with quantitative evaluative approach was
undertaken. Purposive sampling technique was used to
select 60 college students with dysmenorrhea, 30 in the
experimental group and 30 in the control group. Analyses by
descriptive and inferential statistics indicated that the pre-
test mean value for the experimental group (7.03 ± 1.09) was
almost equal to the control group (6.96 ± 1.06). The posttest
mean value for the experimental group (3.36 ± 1.54) was
less than that of the control group (6.26 ± 1.17). The mean
difference was 3.66. The calculated t value was 15.19, which
69Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
Journal of Health and Allied Sciences NU Vol. 9 No. 2/2019
is higher than the table value of 2.05. There was a signifi-
cant difference between pre- and posttest values (p > 0.05).
Hence, ginger tea was found to be effective in reducing dys-
menorrhea among the students.39
A systematic review done in the United States examined
the efficacy of oral ginger for dysmenorrhea. Randomized
controlled trials (RCTs) comparing oral ginger against place-
bo or active treatment in women with dysmenorrhea were
included. Six trials were identified. A narrative synthesis of
all six studies and exploratory meta-analyses of three studies
comparing ginger with placebo and two studies compar-
ing ginger with a NSAID was completed. Ginger appeared
more effective in reducing pain severity than placebo. The
weighted mean difference on a 10-cm visual analogue scale
was 1.55 cm (favoring ginger) (95% confidence interval [CI]
0.68–2.43). No significant difference was found between gin-
ger and mefenamic acid (an NSAID). The standardized mean
difference was 0 (95% CI –0.40 to 0.41). Available data suggest
that oral ginger could be an effective treatment for menstrual
pain in dysmenorrhea.40
A quasi-experimental, evaluative research was conduct-
ed in Vadodara, Gujarat, India, to compare the effective-
ness of dietary ginger versus active exercise on PD among
adolescent girls. Using nonprobability convenience sam-
pling, 40 adolescent girls who were in the age group of
17 to 19 years were selected. The tool consisted of section
A: demographic tool, B: universal pain assessment tool,
C: Menstrual Distress Questionnaire, D: preparation and
administration of dietary ginger, and E: preparation and
administration of active exercise. Results showed a mean
difference in the ginger and exercise groups, which were
5.90 (59%) and 4.15 (41.5%), respectively. According to the
Menstrual Distress Questionnaire scores, mean difference in
both groups were 80.85 (67.4%) and 69.70 (58.1%). It proves
that dietary ginger is more effective than active exercise. The
study concluded that dietary ginger and active exercise both
are effective, but dietary ginger appears to be more effective
than active exercise on PD.41
An RCT was conducted in North Khorasan University of
Medical Science, Iran, to compare the effect of ginger, zinc
sulfate, and placebo on the severity of PD in young women.
One hundred and fifty high school students were recruited.
The participants were divided into three groups. The first
group received ginger capsules, the second group received
zinc sulfate capsules, and the third group received placebo
capsules. All participants took the medications for 4 days,
from the day before the commencement of menstruation to
the third day of their menstrual bleeding. The severity of dys-
menorrhea was assessed every 24 hours by the pain visual
analog scale. The severity of pain was significantly different
between, before, and after the intervention in both the gin-
ger and the zinc sulfate groups (p < 0.001). Compared with
the placebo receiving group, participants receiving ginger
and zinc sulfate reported more alleviation of pain during the
intervention (p < 0.05). Ginger and zinc sulfate had similar
positive effects on the improvement of PD pain in young
women.42
Conceptual Framework
A conceptual framework is an interpretive grid with sev-
eral variations and contexts. It is used to make conceptual
distinctions and organize ideas in an easier way. A well-
built conceptual framework projects something real and it
explains the relation between key factors, concepts, or vari-
ables which are associated with the subject. A conceptual
model broadly grants an apprehension of the phenomenon
of interests and mirrors the assumptions and philosophical
views of the model’s designer.43
Conceptual models are usually a diagrammatic or graphic
illustration of interpretations or concepts which are system-
atically arranged in virtue of their relevance to the theme.
The conceptual framework used in this study is the modifica-
tion of Karl Ludwig von Bertalanffy’s general system theory.44
Statement of the Problem
Effectiveness of ginger tea on dysmenorrhea among the nurs-
ing students in a selected nursing college at Mangaluru.
Objectives
• To assess the level of dysmenorrhea among nursing
students.
• To determine the effectiveness of ginger tea on dysmenor-
rhea among nursing students.
• To find the association between level of dysmenorrhea
before the administration of ginger tea and demographic
variables.
Hypotheses
The following hypothesis will be tested at 0.05 level of
significance:
H1: There will be significant difference in level of pain
after the intervention.
H2: There will be a significant difference in level of pain
between the experimental and control groups after
the intervention.
H3: There will be a significant association between dys-
menorrhea before the treatment and selected baseline
variables.
Methods
Methodology explains the various means and tactics used to
execute data collection. It comprises the theoretical analy-
sis of the body of methods and principles associated with a
branch of knowledge.45
Research Approach
A quantitative research approach was taken up in this study.
The researcher evaluated the effect of ginger tea on reduc-
ing dysmenorrhea during menstruation in a group of nursing
70
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Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
students. To find out the effect, ginger tea was prepared and
administered to the subjects by the researcher and the effect
was analyzed by comparing the mean of baseline aspects of
pain using pain quality assessment scale and the mean after
administration of the drink for four times.
Research Design
It explains the overall plan specifying the methods and pro-
cedures for collecting and analyzing the needed data in a
research study.45 In this study, quasi-experimental design
was adopted to find out the effect of ginger tea on dysmen-
orrhea among nursing students in a selected nursing college
hostel at Mangaluru.
The study was conducted in a selected nursing college
girl’s hostel at Mangaluru, named NUINS Nursing College
hostel at Paneer. The setting was ideal for the availability of
samples that are homogeneous, and was feasible for conduct-
ing the research. Hence, researcher selected the particular
setting.
Accessible populations were the students with moderate
or severe dysmenorrhea who met the inclusion criteria. The
sample consists of 50 nursing students who has moderate or
severe pain during menstruation and who is residing in the
selected nursing college hostel.
Variables
Variables are attributes such as qualities, quantities, prop-
erties, or characteristics of people, things, or situations that
change or vary.46
Independent variable: Variables that are deliberately
manipulated by the researcher is independent variables.46 In
this study, ginger tea is the independent variable.
Dependent variable: Variables that change as the indepen-
dent variable is molded by the researcher. It is sometimes
called the criterion variables.46 In this study, dysmenorrhea
level after the administration of ginger tea is the dependent
variable.
Sampling Technique
Sampling is the method of choosing a cluster of the popula-
tion to represent the gross population.14 Purposive sampling
technique was used in this study. It is a nonprobability sam-
pling method in which the researcher selects participants
based on personal judgment about which ones will be most
informative; sometimes called judgmental sampling.14
Fifty nursing students who met the inclusion criteria
were selected. They were then allocated to the experimental
group and control group conveniently by the researcher. In
this method, the researcher makes use of his knowledge and
chooses samples according to his convenience.
After the pilot study, the research proposal was found to
be feasible, and hence the main study was performed. Ethical
clearance was also obtained. Permission for carrying out the
study was obtained from the concerned authorities of NUINS
college and the hostel warden. The subjects were selected
based on the inclusion criteria and were explained about the
procedure.
Subject information sheet was explained and handed over
to the subjects. During the data collection period, ginger tea
was prepared by the researcher and 120 mL was adminis-
tered on the first 2 days of menstruation in the morning and
night after breakfast and dinner, respectively, to the subjects.
Level of different aspects of pain was assessed before the
administration as well as 2 hours after administration of gin-
ger tea using the Pain Quality Assessment Scale. Pretest and
posttest were taken before as well as 2 hours after adminis-
tering the drink. A total of four doses were given and ratings
were measured eight times.
Results
For this study, 50 participants were identified based on the
inclusion and exclusion criteria. From each subject, demo-
graphic characteristics, clinical characteristics, and baseline
pain and different characteristics of pain were measured.
Purposive sampling technique was used to select the sam-
ples. They were divided equally into experimental (25) and
control (25) group. Intervention was given only to the exper-
imental group. The collected information was analyzed, sum-
marized, and presented (►Tables 1–3).
Ginger Tea Experience Shared by the
Participants
The responses given by the experimental and control groups
were mentioned separately. Ginger tea effects and experi-
ence were verbalized for the experimental group alone.
The associated physical symptoms and premenstrual
symptoms mentioned by the participants were severe back
pain, leg pain, body pain, stomach pain, inflammation, severe
abdominal pain, weakness, nausea and vomiting, giddiness,
fatigue, radiating leg pain, pain in back and thighs, pimples,
constipation, and pain in nipples and breast.
Emotional changes were short temper, irritation, and sad-
ness. Social behaviors included sensitivity to touch. Psycho-
logical symptoms were depression, short temper, and getting
disturbed very fast, and social behaviors were feeling to be
alone, talk minimum, unable to concentrate, and do not feel
to go out.
The ginger tea experience shared by the participants in
the experimental group were relaxation, feel of freshness, no
need for other measures of pain relief, spicy taste, and able to
perform activities. This information developed at the time of
data collection supported the statistical finding of the study
that ginger is effective in reducing dysmenorrhea.
This finding was supported by another study conducted
by Aziato et al. The onset and duration of pain was varied and
the intensity of pain was severe. Pain was associated with
several other signs and symptoms such as headache, diar-
rhea, anorexia, and nausea and vomiting.
This study also aimed to explore the effects of dysmenor-
rhea on participants. It was realized that dysmenorrhea led to
activity intolerance, and severe pain resulted in absenteeism
71Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
Journal of Health and Allied Sciences NU Vol. 9 No. 2/2019
Table 1 Distribution of sample characteristics between experimental and control groups
Characteristics Groups Mean SD Mean difference t n = 50
p-Value
(95% CI)
Age Experimental 19.60 1.414 1.52 (0.941–2.01) 5.274 < 0.001*
Control 18.08 0.277
Height (cm) Experimental 156 4.86 –0.640 (–3.22 to 1.94) –0.499 0.620
Control 157 4.18
Weight (kg) Experimental 49.36 5.24 –0.640 (–3.364 to 2.084) –0.472 0.639
Control 50 4.29
Age at menarche (y) Experimental 13.04 1.241 0.280 (–0.384 to 0.944) 0.847 0.401
Control 12.76 1.091
Duration of menstrua-
tion (d)
Experimental 5.0 1.080 –0.280 (–0.878 to 0.318) 0.942 0.351
Control 5.28 1.021
Interval of cycle (d) Experimental 29.52 1.388 0.440 (–0.496 to 1.376) 0.945 0.349
Control 29.08 1.869
Duration of pain (d) Experimental 2.68 0.557 0.400 (0.110–0.690) 2.774 0.008*
Control 2.68 0.458
Abbreviations: CI, confidence interval; SD, standard deviation.
Note: The table shows that the calculated t value for characteristics such as “age” and “duration of pain” is more than the table value, which is 2.014
at 5% level of significance. Also, the p-value for these characteristics is < 0.05. This shows that there is a significant difference in age and duration of
pain between experimental and control groups. For all other comparisons, the p-value is > 0.05 and the calculated values are less than the t table value
(2.014) which shows there was no difference in these characters between experimental and control groups.
Table 2 Comparison of pain between the experimental and control groups by using Mann–Whitney U test (n = 50)
ZMorning ZNight
p-Value p-Value
Intensity Day 1 –3.101 0.002a–4.244 < 0.001a
Day 2 –3.838 < 0.001a–4.677 < 0.001a
Sharpness Day 1 –3.072 0.002a–4.478 < 0.001a
Day 2 –4.636 < 0.001a–4.548 < 0.001a
Hot Day 1 –2.996 0.003a–3.911 < 0.001a
Day 2 –4.075 < 0.001a–3.660 < 0.001a
Numbness Day 1 –3.632 < 0.001a–4.088 < 0.001a
Day 2 –4.035 < 0.001a–4.349 < 0.001a
Cramping Day 1 –3.819 < 0.001a–4.164 < 0.001a
Day 2 –4.466 < 0.001a–4.506 < 0.001a
Radiating Day 1 –3.758 < 0.001a–3.884 < 0.001a
Day 2 –3.884 < 0.001a–4.496 < 0.001a
Unpleasant Day 1 –4.120 < 0.001a–4.740 < 0.001a
Day 2 –4.693 < 0.001a–4.435 < 0.001a
Note: Mann–Whitney U test was used to identify the effectiveness of intervention between experimental and control groups in each measurements of
pain. Table above shows that the posttest p-values for both the days of interventions of various pain characteristics, namely intensity, sharpness, hot,
numbness, cramping, radiating, and unpleasant are less than the 0.05 level of significance. Hence, it is concluded that there was a significant difference
between the groups after the intervention. This shows that ginger tea is effective in relieving dysmenorrhea. Hence, the research hypothesis H1 is
accepted.
aIndicates significance.
72
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Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
from work and school. It resulted in reduced work output and
inattentiveness in class. The sufferers became moody, irrita-
ble, and were not able to interact effectively with other peo-
ple. The pain contributed to sleeplessness and restlessness.47
Discussion
Major Findings of the Study
Description of Demographic and Clinical Characteristics
The participants’ age ranged between 18 and 24 years (mean
18.84 ± 1.27). The height (cm) of the participants was within the
range of 149 to 169 cm with a mean height of 157.24 ± 4.5 cm.
The mean weight of the participants was 49.68 ± 4.75 kg,
with 39 kg being the minimum weight and 59 kg was the
maximum weight.
Nursing students had a minimum BMI value of
15.62 kg/m2 and a maximum value of 25.78 kg/m2, with a
mean of 20.20 kg/m2 ± 2.5.
Minimum age at which menarche was attained is 11 years
and maximum was 15 years, with a mean age of 12.9 years ±
1.17. Nursing students had minimum of 3 days of menstrua-
tion and maximum of 7 days, mean 5.14 ± 1.05.
Minimum of 25 days of menstruation and maximum of
32 days, with mean of 29.3 ± 1.65, was the interval of cycle of
menstrual period in nursing students.
The above findings were supported by a study conducted
by Naik et al which had average age of all the participants
as 20.9 ± 1.8 years. In the study, the average mean height
of participants was 159.9 ± 7.0 cm and mean weight was
55.03 ± 9.7 kg and the BMI of participants in various courses
was 21.4 ± 3.5 kg/m2.25 The results are almost similar to the
current study’s demographic characteristics with regard to
age, height, weight, and BMI.
Another study done by Charu et al also had similar demo-
graphic characters. The average age of the participants was
20.57 ± 1.208 years (ranging from17 to 24 years) and the
mean BMI of the participants was 21.69 ± 3.27 kg/m2 ( ranging
from 14.7 to 33.54 kg/m2). Regarding menstrual character-
istics, the average age of menarche was 12.67 ± 1.10 years
(9–16 years) and the average interval of menstrual cycle of
the participants in the study group was 29.52 ± 3.37 days.28
The result supports the current study findings.
In context to the duration of menstruation, the partici-
pants had minimum of 3 days of menstruation and maximum
of 7 days, with a mean of 5.14 ± 1.05 days. This finding was
supported by findings of Kavuluru, which says majority of
the adolescent girls, that is, 36.6% have 96 hours, followed by
30% having 48 hours, followed by 25% having 72 hours, and
least number, that is, 8.3% adolescent girls, having 120 hours
and above duration of menses.48
Table 3 Comparison of pain between the pre- and post-values of experimental and control groups by using Wilcoxon signed-
rank test (n = 50)
Experimental Control
Morning Night Morning Night
Z p-Value Z p-Value
Z p-Value Z p-Value
Intensity Day 1 –4.117 < 0.001a–4.309 < 0.001a–2.246 0.025a–1.006 0.314
Day 2 –4.360 < 0.001a–4.360 < 0.001a–2.714 0.007a–0.302 0.763
Sharpness Day 1 –4.392 < 0.001a–4.414 < 0.001a–3.066 0.002a–1.185 0.236
Day 2 –4.408 < 0.001a–4.417 < 0.001a–0.302 0.763 –0.905 0.366
Hot Day 1 –4.031 < 0.001a–4.038 < 0.001a–2.654 0.008a–2.111 0.035a
Day 2 –4.036 < 0.001a–4.080 < 0.001a–0.690 0.490 –1.642 0.101
Numbness Day 1 –3.938 < 0.001a–4.038 < 0.001a–1.945 0.052 –1.081 0.279
Day 2 –4.055 < 0.001a–4.086 < 0.001a–1.134 0.257 –0.707 0.480
Cramping Day 1 –4.303 < 0.001a–4.315 < 0.001a–2.066 0.039a–1.508 0.132
Day 2 –4.278 < 0.001a–4.260 < 0.001a–0.632 0.527 –0.333 0.739
Radiating Day 1 –4.211 < 0.001a–4.223 < 0.001a–2.919 0.004a–1.897 0.058
Day 2 –4.229 < 0.001a–4.220 < 0.001a–2.178 0.029 –0.302 0.763
Unpleasant Day 1 –4.385 < 0.001a–4.411 < 0.001a–1.814 0.070 –0.544 0.957
Day 2 –4.400 < 0.001a–4.408 < 0.001a< 0.001 1.0 –0.741 0.458
Note: This table identifies statistically the difference in pain before and after the intervention in the experimental and control groups separately. From
the above table it is clear that p-values for various pain characteristics in the experimental group is < 0.05 for 2 days of morning and night interventions.
Hence, there was a significant difference in these measurements before and after the administration of ginger tea. Whereas p-value is found to be
> 0.05 for pain characteristics in majority of the subjects in the control group, except for day 1 morning measurement of radiating, cramping, sharp-
ness, both the days morning measurement of intensity, and day 1 morning and night measurement of hot. It indicates that ginger tea was effective in
reducing menstrual pain.
aIndicates significance.
73Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
Journal of Health and Allied Sciences NU Vol. 9 No. 2/2019
Distribution of Level of Pain Experienced by Nursing
Students Using Descriptive Statistics
In the present study, 50 participants were selected who were
having moderate and severe pain based on numerical pain
rating scale. Among them most of the participants 34 (68%)
had severe pain. Rest of them had moderate pain 16 (32%).
Majority of the participants who had severe pain belonged to
the experimental 18 (36%) and control group16 (32%).
This result was supported by another study conducted by
Latha and colleagues which stated that in the pretest major-
ity of participants in the experimental and control groups
had severe pain 56.67 and 53.33%, respectively, and the rest
of them had moderate pain (experimental group 43.33% and
control group 46.67%).39
In contrast, a descriptive study conducted in four resi-
dential schools of Udupi district to identify dysmenorrhea,
characteristics, and associated symptoms showed that
majority had moderate pain77 (33%), 41 (17.6%) had severe
pain, and 28 (12%) had mild pain out of 233 samples, during
menstruation.49
The participants had experienced several symptoms asso-
ciated with menstruation other than dysmenorrhea. Fatigue
was seen in majority of the participants 35 (70%), 19 (38%)
had headache which was the next common symptom. Nau-
sea and vomiting was seen in 16 (32%) participants, followed
by diarrhea occurrence in 14 (28%) of the nursing students.
Fainting 13 (26%) and dizziness 10 (20%) was the next fre-
quently occurring symptoms. Insomnia was seen in 9 (18%)
participants, constipation in 6 (12%), and disorientation only
in 1 (2%) subject. Hypersensitivity to sound was experienced
by 14 (28), light by 9 (18%), touch by 7 (14%), and smell by
5 (10%) nursing students. Other symptoms that was identi-
fied were back pain 3 (6%) and appearance of pimples 3 (6%).
Body pain, breast tenderness, leg pain, and urinary infection
were the other symptoms which occurred in single partici-
pants respectively 1 (2%).
The above findings were supported by another study
conducted by Singh et al from India, which explained that
the participants suffering from dysmenorrhea (n = 79), pre-
sented with following symptoms, that is, backache (62.0%),
headache (26.58%), fatigue (70.88%), and vomiting/diarrhea
(6.32%). In 107 participants, 60.74% were presented with
PMS, symptoms consisted of: breast heaviness (17.75%),
abdominal bloating (12.14%), backache (25.23%), headache
(13.08%), uneasiness (22.42%), and anxiety (8.41%).50
All of the above findings are consistent with El-Gilany
et al’s study which says that the most frequent symptoms
associated with dysmenorrhea were fatigue, headache, back-
ache, dizziness, and anorexia/vomiting.51
Distribution of Associated Symptoms
The participants had experienced several symptoms associ-
ated with menstruation other than dysmenorrhea. Fatigue
was seen in majority of the participants 35 (70%), 19 (38%)
had headache which was the next common symptom. Nausea
and vomiting was seen in 16 (32%) participants, followed
by diarrhea occurrence in 14 (28%) of the nursing students.
Wilcoxon signed-rank test showed that there was a significant
difference in pain measurements before and after the admin-
istration of ginger tea (p < 0.05). These findings indicate that
ginger tea was effective in reducing menstrual pain.
The findings stated above were supported by another
study conducted among adolescent girls in Erode to assess
the effectiveness of ginger powder on dysmenorrhea. The
results showed that the pretest mean score was 65.12
(SD = 8.74) and the posttest mean score was 43.24 (SD = 6.72)
with paired t value of 23.02, which was significant at 0.01
level. This showed that ginger was effective.37
A similar study conducted in Apollo College of Nursing
proved that before administration of ginger tea the pain
level was high (mean = 6.60, SD = 1.59) in comparison with
the pain scores after administering ginger tea (mean = 2.47,
SD = 1.11). The difference was found to be statistically signif-
icant at p < 0.001 level of confidence. The study indicates that
nonpharmacological intervention was needed for dysmenor-
rhea which is a major health problem.36
At the international level, a systematic review done in
the United States examined the efficacy of oral ginger for
dysmenorrhea. RCTs comparing oral ginger against pla-
cebo or active treatment in women with dysmenorrhea
were included. The results proved that ginger appeared
to be more effective for reducing pain severity than pla-
cebo. Available data suggest that oral ginger could be an
effective treatment for menstrual pain in dysmenorrhea.
The present study findings along with literature review
indicate that ginger has got a positive effect in reducing
dysmenorrhea.40
Association between Baselines Pain with Selected
Demographic Variables
The findings suggested that demographic as well as clinical
variables have no association with baseline pain (dysmenor-
rhea before treatment).The p-value was > 0.05 (at 5% level of
significance) for all the variables which clearly explains that
there is no association between baseline dysmenorrhea and
demographic variables.
This finding was supported by another similar study con-
ducted by Kavuluru to assess the effect of ginger preparation
in dysmenorrhea which revealed that there was no significant
association between preinterventional and postinterven-
tional dysmenorrhea with selected demographic variables at
p (0.05) level of significance.48
Similar findings were seen in a study by Rahnama et al
who conducted a RCT of ginger capsules in the treatment of
PD. This study results showed that there was no association
of pretest and posttest dysmenorrhea with baseline charac-
teristics at p < 0.05 level of significance.52
Conclusion
Pain is a natural mechanism of the body. It is unavoidable
in most of the conditions. But the severity of pain can be
reduced with appropriate interventions. The world is moving
more toward natural therapies to cope up with pain. Dys-
menorrhea is one such type of pain, which is inevitable, but
with appropriate interventions can be reduced to an extent.
74
Journal of Health and Allied Sciences NU Vol. 9 No. 2/2019
Ginger Tea on Dysmenorrhoea among Nursing Students Crasta et al.
The awareness about alternative therapies such as ginger
which can reduce the pain without much adverse effects on
body systems must be elucidated.
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