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Abstract

Conventional treatment for primary dysmenorrhoea (PD) has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine (CHM) may be a suitable alternative. To determine the efficacy and safety of CHM for PD when compared with placebo, no treatment, and other treatment. The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to Dec 2006), and the Chinese BioMedicine Database (CBM, 1990 to Dec 2006) were searched. Citation lists of included trials were also reviewed. Any randomised controlled trials (RCTs) involving CHM versus placebo, no treatment, conventional therapy, heat compression, another type of CHM, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra-uterine contraceptive device (IUD). Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta-analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed-effect statistical model was used, where suitable. If data were not suitable for meta-analysis, any available data from the trial were extracted and presented as descriptive data. Thirty-nine RCTs involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for CHM compared to placebo were unclear as data could not be combined (3 RCTs). CHM resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed CHM resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months follow up when compared to commonly used Chinese herbal health products. CHM also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18). The review found promising evidence supporting the use of CHM for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

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... However, continuous use of NSAIDs or oral contraceptives is associated with side effects such as gastrointestinal discomfort or injures to the gastroduodenal mucosa (Sostres et al. 2010;Hee et al. 2013). The conventional treatment for PD has a failure rate of 20% to 25% and may not tolerated by some women (Zhu et al. 2008). Chinese herbal medicines have been considered a feasible alternative therapy in the treatment of PD, especially in Asian countries, such as China, Korea, and Japan (Oya et al. 2008;Chen et al. 2013;Chen et al. 2014). ...
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Danggui Sini Decoction (DSD), a traditional herbal prescription, has been commonly used in the treatment of primary dysmenorrhoea (PD). We investigated the current evidence of randomised controlled trials (RCTs) and performed a systematic review to evaluate the efficacy of DSD in the treatment of PD. We registered the protocol for this systemic review in PROSPERO with the registration number CRD 42017074062 on August 10, 2017. Nine databases were searched from inception to August 2019. Eleven RCTs with 1005 patients were included. DSD was shown to have more favourable effects on the clinical effective rate than western medicine, which support the clinical use of DSD in the treatment of PD. However, considering the high risk of bias in the included studies, more well-designed RCTs are needed to further evaluate the efficacy of DSD in the treatment of PD.
... [9] Zhu et al included 3475 women in a systematic review to assess the efficacy and safety of traditional Chinese medicines in the treatment of primary dysmenorrhea, and results showed a significant advantage compared with other treatments. [10] Similar conclusions were also obtained in the metaanalysis of Shaofu Zhuyu decoction (SZD), [11] Wenjing decoction, [12] and Xuefu Zhuyu decoction. [13] Many researchers have conducted experiments on the mechanisms of CHM in the treatment of primary dysmenorrhea. ...
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Introduction: Chinese herbal medicines (CHM) have been commonly used in the treatment of primary dysmenorrhea in East Asia. Several systematic reviews have been conducted to assess the clinical efficacy of CHM in the treatment of primary dysmenorrhea. However, their comparative efficacy is still unclear. Therefore, the purpose of this study is to conduct a network meta-analysis (NMA) to systematically compare the advantages of different CHM in the treatment of primary dysmenorrhea. Methods and analysis: The following electronic databases will be searched in this study: Web of Science, PubMed, Cochrane Library, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Database. Search terms include (Chinese herbal medicine or Chinese patent medicine or medicinal plants or phytotherapy or traditional medicine or Chinese herbal drugs or plant extracts or herbal medicine or herbal extract or herb or traditional Chinese medicine) and (primary dysmenorrhea or dysmenorrhea or painful menstruation) and (randomized controlled trial). The language will be limited to Chinese and English, and the search date will be up to May 2019. The included studies must be randomized controlled trials (RCTs) with patients diagnosed with primary dysmenorrhea. CHM must be used as interventions in the experimental group. While in the control group, studies that used a different herbal medicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or placebo will be included. The primary outcomes include clinical efficacy and visual analog scale (VAS), and the secondary outcomes include adverse events and quality of life. Four reviewers will independently extract the data and assess the qualities of the studies. Statistical analysis will be conducted with R package for each outcome. Ethics and dissemination: Ethical approval is not required as this NMA is based on published studies. The completed NMA will be published in a peer-reviewed scientific journal. Trial registration number: PROSPERO CRD42018095254.
... (22) Uterus has been grouped among the Aza-e-Ratbah, which contains more fluid in comparison to other organs and Aza-e-Harrah, in which the rate of metabolic activity is very high. 23 Uterus has also been endowed with Quwate Ghazia (nutritive faculty) and remarkably the Quwate Tanasuliya (reproductive faculty) 17 With the help of these powers, uterus serves two functions i.e. elimination of waste products in the form of menstrual blood and development, protection and delivery of fetus. 24 When Sue Mizaj afflicts the uterus to throw the Quwate Ghazia (nutritive faculty) of the uterus out of the aitdal. ...
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Usre Tams (Dysmenorrhea) is the most common of gynecologic complaints. It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population. Since ancient times, Hijamah bila Shart (Dry cupping) is a method of treatment for this disease. Therefore, objective of this preliminary study was to evaluate the efficacy of Hijamah bila Shart on intensity of pain in Usre Tams by using verbal multi-dimensional scoring system. It was conducted on 40 patients. Patients suffering from primary dysmenorrhoea with regular cycles, age group 15-40years were selected. For dry cupping, two glass cup of medium size were applied below the umbilicus for 20 minutes on day land/or day 2 of the menstrual phase for one cycle and pain intensity was assessed by verbal multi-dimensional scoring system for pain before and after the treatment. Keywords: Dysmenorrhoea, Hijamah bila Shart, Dry cupping, Usre Tams
... There are two types of treatment for managing dysmenorrhea pharmacological and nonpharmacological. Despite the wide range of pharmacological treatment and its effect on pain relief, pain relief may be inadequate forsome females, or side effects may not be well tolerated so many females seek to traditional practices to relief menstrual pain (Zhu et al., 2015). So, this study was conducted to assess traditional practices self-reported by nursing students to relieve dysmenorrhea. ...
... Lee et al. [17] conducted a systematic review to evaluate the efficacy of Danggui Shaoyao San for the treatment of primary dysmenorrhea and concluded on the superiority of Danggui Shaoyao San over analgesics or placebo. Zhu et al. [18] conducted a review to determine the efficacy and safety of TCM for the treatment of primary dysmenorrhea. This review included a total of 3475 women and TCM showed an obvious advantage for the treatment of primary dysmenorrhea compared with placebo, no treatment, and other treatment. ...
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Purpose: Wenjing decoction is a well-accepted traditional Chinese medicine for the treatment of primary dysmenorrhea in East Asia, but its clinical effectiveness and risk have not been adequately assessed. In this paper, we conducted a systematic review and meta-analysis to evaluate the efficacy of Wenjing decoction for the treatment of primary dysmenorrhea. Methods: Eight databases were used in our research: the Cochrane Library, the Web of Science, PubMed, EMBASE, the Chinese Biomedical Literature Database (CBM), the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database, and the Wan-fang Database. The following search terms were used: (Wenjing decoction OR Wenjing formula OR Wenjing tang) AND (primary dysmenorrhea OR dysmenorrhea OR painful menstruation) AND (randomized controlled trial). No language limitation was used. Results: A total of 18 studies, including 1736 patients, were included in the meta-analysis. Wenjing decoction was shown to be significantly better than nonsteroidal anti-inflammatory drugs for the improvement of primary dysmenorrhea according to the clinical effective rate (RR 1.41, 95% CI 1.24-1.61), the visual analogue scale (MD -1.77, 95% CI -2.69 to -0.84), and the pain scale for dysmenorrhea (MD -1.81, 95% CI -2.41 to -1.22). Conclusions: The results supported the clinical use of Wenjing decoction for the treatment of primary dysmenorrhea. However, the quality of the evidence for this finding was low due to a high risk of bias in the included studies. Therefore, well-designed randomized controlled trials are still needed to further evaluate the efficacy of Wenjing decoction for the treatment of primary dysmenorrhea.
... Menopausal symptoms can be successfully alleviated by healthy lifestyle and yoga rather than going for hormone replacement therapy. Many cases of infertility (up to 30%) can be [14] [3] [15, 16] [17] [18] [19] [20] [21] [22] resolved by proper couple counseling rather than directly resorting to medicine or surgery. Many chronic non communicable diseases like diabetes, hypertension are mainly due to ignorance on both, the physical level (diet, lifestyle) as well as on the mental level (stress, wrong understanding of purpose of life).So interventions like diet, yoga, physical exercise, behavior therapy etc. which are simple, cheap can be easily adopted are quite effective. ...
... A study conducted by Daly et al. proved that Chinese herbs was the most frequently utilized therapy (42.6%), followed by acupuncture (37.2%) and massage (33.0%) [11]. This was because there were positive evidences regarding the effectiveness of Chinese herbal medicines in treating several diseases like primary dysmenorrhea, irritable bowel syndrome and type 2 diabetes [12][13][14]. Some studies had also shown that acupuncture was beneficial in patients with chronic low back pain and allergic rhinitis [15, 16]. ...
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The objectives of this study were to determine the knowledge and attitude of adult Malaysians about Traditional Chinese Medicine (TCM), to understand the variation in the knowledge and attitude toward TCM among different demographic groups of adult Malaysian population and to determine the pattern of TCM use among adult Malaysians. This study was a descriptive, cross-sectional survey using the convenience sampling method. A total of 400 adult Malaysians were recruited for this study. An interview-administered questionnaire was used. Descriptive statistics Mann-Whitney U Test and Kruskal-Wallis H test were used to analyze the data. The reliability of survey data in this study may affect since closed-ended questions are used. The more commonly utilized therapy was herbal medicine (n=192, 82.1%), acupuncture (n=79, 33.8%) and oriental massage (n=58, 24.8%). The mean knowledge score and mean attitude score for the respondents were 5.00±1.71 and 7.17±2.10 respectively. There was a significant difference in the mean knowledge score between genders, among TCM users and non-TCM users, people of different education levels and ethnicity. There were more TCM users than non-TCM users and the use of TCM was higher in females than males. The most popularly used TCM modalities were herbal medicines and acupuncture. Gender, education, ethnicity and use of TCM had a significant effect on adults' knowledge toward TCM.
... However, frequent use of these medications have been reported to have a failure rate of 20-25% [8], and have adverse effects ranging from minor symptoms such as diarrhea, stomachache, and nausea to serious illness such as chronic kidney disease [9,10]. Although the majority of patients experience no ill effects from NSAIDS, many would benefit by having an alternative treatment for reducing pain treatment for primary dysmenorrhea with minimal adverse effects [11]. As some herbs have anti-inflammatory and analgesic activities, they might be useful as alternatives to NSAIDS or for decreasing the effective dose of NSAIDS for treating primary dysmenorrhea [12]. ...
Article
There has been no attempt to date to synthesize the available evidence for the efficacy of ginger for treating primary dysmenorrhea. This systematic review evaluates the current evidence for the effectiveness of ginger for treating primary dysmenorrhea. Literature searches were conducted using 12 electronic databases including PubMed, EMBASE, Cochrane Library, Korean databases, Chinese medical databases, and Indian scientific database. Search terms used were: "ginger" or "Zingiber officinale" and "dysmenorrhea" and "pain." Studies using ginger as a treatment of primary dysmenorrhea were considered for inclusion. The major outcome of primary dysmenorrhea was assessed using a pain visual analogue score (PVAS). Initial searches yielded 29 articles. Of these original results, seven met specific selection criteria. Four of the RCTs compared the therapeutic efficacy of ginger with a placebo during the first 3-4 days of the menstrual cycle and were included in the meta analysis. The meta-analysis of these data showed a significant effect of ginger in reducing PVAS in subjects having primary dysmenorrhea (risk ratio, -1.85; 95% CI of -2.87, -0.84, P = 0.0003). Six RCTs out of 7 exhibited low to moderate of risk of bias. Collectively these RCTs provide suggestive evidence for the effectiveness of 750-2000 mg ginger powder during the first 3-4 days of menstrual cycle for primary dysmenorrhea. Wiley Periodicals, Inc.
... There is insufficient evidence to determine whether NSAIDs are the safest and the most effective treatment of dysmenorrhea [12]. Moreover, studies have indicated that the conventional treatment for primary dysmenorrhea has a failure rate of 20-25 % [18]. These treatments may be contradictory or not tolerated by some women with primary dysmenorrhea [19]. ...
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Purpose: The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea. Methods: One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement. Results: The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups during the study. The menstrual days were more in the ginger group in the first (p = 0.01) and second cycle (p = 0.04). Repeated measurement showed a significant difference in pain intensity within the groups by time, but not between groups. Conclusion: Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea. Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea.
... Those with severe effects require effective pharmacologic and non-pharmacologic interventions[5]. Few Cochrane reviews confirm effective dysmenorrhoea management approaches such as use of non-steroidal anti-inflammatory drugs (NSAIDs)[20]; acupuncture[21]; and Chinese herbal medicine[22]. Thus, follow-up findings by the authors indicated students employed orthodox analgesics, herbal medicine, and non-pharmacologic approaches to manage pain. ...
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Background: Dysmenorrhoea is a common problem of women at the reproductive age and may have negative effect on the education of females at various stages on the educational ladder. Context and purpose: This study sought to gain an in-depth understanding of the experience of dysmenorrhoea and its effect on female students in a secondary and a tertiary institution in Accra, Ghana. Methods: The study employed a descriptive phenomenology design and was conducted at a University and a Senior High School (SHS) in Accra. Purposive and snowball sampling techniques were used to recruit participants and data was saturated with 16 participants. Concurrent analysis was done by applying the processes of content analysis and the NVivo software was used to manage the data. Results: It was realized that dysmenorrhoea is associated with symptoms such as diarrhoea, headache and vomiting. Pain may start one week to the day of menstruation and the severity differed across the days of menstruation. The effect of dysmenorrhoea included activity intolerance, altered emotion and interaction, altered sleep pattern, absenteeism and inattentiveness, wishes and regrets, and misconceptions. Conclusions: It was concluded that severe dysmenorrhoea has a debilitating effect on female students and is associated with misconceptions that could result in drastic action with fatal consequences. Thus, there is the need to enhance education on dysmenorrhoea, and an aggressive step should be taken to effectively manage dysmenorrhoea.
... Highfrequency transcutaneous electrical nerve stimulation (TENS) has some effectiveness for short-term pain management (Proctor et al., 2002). There is limited evidence in favour of Chinese herbal medicine that may be difficult to apply outside of the Traditional Chinese Medicine setting (Zhu et al., 2008; Flower et al., 2012). While a voluminous literature exists in almost exclusively Chinese medical journals, various problems in study design, execution, statistical analysis and reporting among papers published in Chinese journals make it extremely difficult to judge the efficacy of the evaluated herbal medicine (Guo et al., 2010). ...
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Study question: Is there a global consensus on the management of endometriosis that considers the views of women with endometriosis? Summary answer: It was possible to produce an international consensus statement on the current management of endometriosis through engagement of representatives of national and international, medical and non-medical societies with an interest in endometriosis. What is known already: Management of endometriosis anywhere in the world has been based partially on evidence-based practices and partially on unsubstantiated therapies and approaches. Several guidelines have been developed by a number of national and international bodies, yet areas of controversy and uncertainty remain, not least due to a paucity of firm evidence. Study design, size, duration: A consensus meeting, in conjunction with a pre- and post-meeting process, was undertaken. Participants/materials, setting, methods: A consensus meeting was held on 8 September 2011, in conjunction with the 11th World Congress on Endometriosis in Montpellier, France. A rigorous pre- and post-meeting process, involving 56 representatives of 34 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. Main results and the role of chance: A total of 69 consensus statements were developed. Seven statements had unanimous consensus; however, none of the statements were made without expression of a caveat about the strength of the statement or the statement itself. Only two statements failed to achieve majority consensus. The statements covered global considerations, the role of endometriosis organizations, support groups, centres or networks of expertise, the impact of endometriosis throughout a woman's life course, and a full range of treatment options for pain, infertility and other symptoms related to endometriosis. Limitations, reasons for caution: This consensus process differed from that of formal guideline development. A different group of international experts from those participating in this process would likely have yielded subtly different consensus statements. Wider implications of the findings: This is the first time that a large, global, consortium, representing 34 major stake-holding organizations from five continents, has convened to systematically evaluate the best available current evidence on the management of endometriosis, and to reach consensus. In addition to 18 international medical organizations, representatives from 16 national endometriosis organizations were involved, including lay support groups, thus generating input from women who suffer from endometriosis.
... These drugs have useful effects such as anti-inflammatory, antipyretic and analgesic [5, 6] . Moreover studies have indicated that the conventional treatment for primary dysmenorrhea has a failure rate of 20% to 25% [7]. These procedures may be contradictory or not tolerated by some women with primary dysmenorrhea [8]. ...
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Zingiber officinale R. rhizome (ginger) is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases. The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea. This was a randomized, controlled trial. The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea. The students were all residents of the dormitories of Shahed University. They were randomly assigned into two equal groups, one for ginger and the other for placebo in two different treatment protocols with monthly intervals. The ginger and placebo groups in both protocols received 500 mg capsules of ginger root powder or placebo three times a day. In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period. In the second protocol ginger and placebo were given only for the first three days of the menstrual period. Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale. There was no difference in the baseline characteristics of the two groups (placebo n = 46, ginger n = 56). The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one (P = 0.015) and protocol two (P = 0.029). There was also significant difference in duration of pain between the two groups for protocol one (P = 0.017) but not for protocol two (P = 0.210). Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically significant effect on relieving intensity and duration of pain. Trial registration
... These drugs, however, have failed to show effect in 20% to 25% of women, and moreover some women complain about digestive disorders while taking the drug. In this case, Korean herbal medicine can be a plausible alternative [5]. Gyejibongnyeong-hwan (GJBNH) is one of the most popular Korean medicine formulas for periodical pain due to dysmenorrhea. ...
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Gyejibongnyeong-hwan (GJBNH) is one of the most popular Korean medicine formulas for menstrual pain of dysmenorrhea. The concept of blood stagnation in Korean medicine is considered the main factor of causing abdominal pain, or cramps, during menstrual periods. To treat the symptoms, GJBNH is used to fluidify the stagnated blood and induce the blood flow to be smooth, reducing pain as the result. The purpose of this trial is to identify the efficacy of GJBNH in dysmenorrhea caused by blood stagnation. This study is a multi-centre, randomised, double-blind, controlled trial with two parallel arms: the group taking GJBNH and the group taking placebo. 100 patients (women from age 18 to 35) will be enrolled to the trial. Through randomization 50 patients will be in experiment arm, and the other 50 patients will be in control arm. At the second visit (baseline), all participants who were already screened that they fulfil both the inclusion and the exclusion criteria will be randomised into two groups. Each group will take the intervention three times per day during two menstrual cycles. After the treatment for two cycles, each patient will be followed up during their 3rd, 4th and 5th menstrual cycles. From the screening (Visit 1) through the second follow-up (Visit 6) the entire process will take 25 weeks. This trial will provide evidence for the effectiveness of GJBNH in treating periodical pain due to dysmenorrhea that is caused by blood stagnation. The primary outcome between the two groups will be measured by changes in the Visual Analogue Score (VAS) of pain. The secondary outcome will be measured by the Blood Stagnation Scale, the Short-form McGill questionnaire and the COX menstrual symptom scale. Analysis of covariance (ANCOVA) and repeated measured ANOVA will be used to analyze the data analysis. Current Controlled Trials: ISRCTN30426947.
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Background Unpleasant experiences of dysmenorrhea can lead to increased anxiety. The anxiety associated with dysmenorrhea is a pain-related anxiety which might reduce the efficacy of medication as well as enhance the perception of pain. The present study evaluated the efficacy of eye movement desensitization and reprocessing (EMDR) in reducing anxiety among female university students with primary dysmenorrhea. Methods In this randomized controlled trial, 88 female university students were recruited from April 2019 to February 2020. Eligible participants were selected by convenience sampling and were allocated into study groups (44 individuals in the intervention group and comparison group) using balanced block randomization. The final sample comprised 78 participants who completed the study (39 individuals in each group). Data were collected using the Spielberger State-Trait Anxiety Inventory, Subjective Units of Distress Scale, and Validity of Cognition Scale before the intervention and at the time of the first menstrual period after completion of the intervention. The intervention group received EMDR in two individual interventional sessions which lasted approximately one hour. Data analysis was performed using analysis of variance with control of covariance method at a significance level of 0.05. Results The results of the study showed that EMDR did not have a statistically significant effect on State-Trait Anxiety of patients with dysmenorrhea ( p > 0.05). Based on the Cohen’s d effect size of 0.06 for state-anxiety, -0.01 for trait-anxiety, and partial eta square less than 0.059 for both uncorrected and corrected models, the intervention was within a trivial effect. Conclusion EMDR intervention did not have a statistically and clinically significant effect on State-Trait Anxiety of patients with dysmenorrhea. Therefore, the efficacy of EMDR in treating dysmenorrhea-related anxiety remains inconclusive. Trial registration IRCT20180823040851N2 on 2019-02-09.
Article
Traditional Chinese Medicine is the most comprehensive and widely practiced system of traditional medicine in the world.Originally TCM appeared to the West as an unfathomable mythological doctrine. Once the linguistic barriers had been overcome, it became possible to understand and apply the terminological and physiological concepts, the method of diagnosis and the clinical findings in our Western context.Since the NIH consensus conference 1998 [54], our understanding of TCM has been the subject of methodologically robust studies. We now have evidence of the efficacy and effectiveness of acupuncture beyond its use in pain therapy and allergy treatment. And, thanks to fMRI studies i.a., we also have better understanding of the mechanisms underlying acupuncture.Meta-analyses and studies also confirm the efficacy of Chinese medicinal drugs and remedies in some fields, yet there is still extensive need for further research. But opportunities are also emerging for new medicines and prescriptions for (accompanying) treatments of infections, autoimmune diseases, cancer, metabolic illnesses, dermatological disorders and gastro-intestinal diseases.To enable further evaluation of TCM, but also to ensure an integrative, critical application in the practice of TCM, it is vital for doctors to have thorough training. Further institutionalisation is necessary to provide orientation and patient safety.The days of regarding TCM as some kind of mysticism are, indeed, long over and it can offer real opportunities for a better service for patients. In many fields there is increasing evidence of TCM’s effectiveness yet further comprehensive research is essential. This should be encouraged unconditionally.
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Guizhi Fuling capsule (GZFLc) is a modern preparation from traditional Chinese Medicine. Guizhi Fuling was first prescribed by Zhang Zhongjing almost two thousand years ago for the treatment of primary dysmenorrhea. It has also been used to treat uterine fibroids, dysfunctional uterine bleeding, and endometriosis. Although effective against dysmenorrhea clinically, there are limited information on the mechanism of its action. The major components responsible for the activity are not well defined. The aim of this study has been to elucidate a mechanism that may facilitate the development of a bioactivity-based assay for quality control during drug formulation and manufacturing. Using an oxytocin-induced mouse dysmenorrhea model, we showed that oral administration of GZFLc at 150 and 300 mg/kg, dosages relevant to clinic usages, significantly suppressed oxytocin-induced writhing response. The antidysmenorrhea effect was also demonstrated by a rotarod assay. We showed that GZFLc treatment significantly prolonged the hanging time of mice on the rotating rod. Histological studies showed that GZFLc treatment reduced lamina propria edema, while no effect on COX2 expression was detected. GZFLc instead exhibited direct inhibitory effect against COX2, a critical enzyme that catalyzes arachidonic acid conversion to prostaglandins. By HPLC profiling, we showed that paeoniflorin, paeonol, and cinnamaldehyde are the major components from the corresponding plants. At 5 and 10 mg/kg, both paeoniflorin and paeonol were active against induced dysmenorrhea. The study not only links GZFLc antidysmenorrhea activity to COX2 inhibition but also uncovers a mechanism of action by which an assay can be developed for bioefficacy evaluation of GZFLc.
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Background: Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea (PD). So far, several systematic reviews (SRs) and meta-analyses (MAs) have reported on the efficacy and safety of acupuncture and moxibustion in treating PD. Objectives: The aim of this study was to critically summarize the evidence from relevant SRs and MAs reporting on the efficacy and safety of acupuncture and moxibustion in treatment of PD. Materials and methods: Seven electronic databases, including Cochrane Database of Systematic Reviews, EMBASE, PubMed, SinoMed, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database, were systematically searched. SRs or MAs about acupuncture for PD published up to May 2019 were included in the analysis. More than two authors independently assessed the quality of the evidence by AMSTAR2, PRISMA, PRISMA-A, and GRADE approach. Results: A total of 28 SRs and MAs, 281 original studies, reporting on 26,459 female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality. Moderate-quality evidence suggested that acupuncture and moxibustion were more effective compared to indomethacin or Fenbid in treating PD. Low-quality evidence suggested that, compared to NSAIDs, acupuncture and moxibustion could relieve pain with less adverse effects. Conclusion: Acupuncture and moxibustion seem to be effective and safe approaches in treatment of PD; yet, the methodological quality of most of the studies and the quality of evidence were low. Thus, additional studies are required to further confirm these results.
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Background: Primary dysmenorrhea (PD), the most common gynecological diseases, seriously affects women's life and work; however, without more effective treatment. Chinese herbal medicine (CHM) has been widely used for relieving dysmenorrheic pain in patients with PD. To assess the effectiveness and safety of CHM in patients with PD, a systematic review and meta-analysis of current published evidence regarding CHM as treatment for PD would be conducted in this study. Methods: Literatures related to CHM for PD from the establishment of the database to June 2019 will be retrieved from the following databases: MEDLINE, EMBACE, Wed of Science and Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, and Wanfang Database. There are no language restrictions for retrieving literature. Eligible randomized clinical trials (RCTs) evaluating the effectiveness and safety of CHM in PD patients will be put in the study including outcomes of pain intensity, clinical effectiveness rate, quality of life, and adverse events. By scanning the titles, abstracts and full texts, 2 reviewers will independently select studies, extract data, and assess the quality of study. Meta-analysis of RCTs will be conducted using Review Manager 5.1 software. The results will be presented as risk ratio for dichotomous data, and standardized or weighted mean difference for continuous data. Result: This study will provide high-quality available evidence for the treatment of PD with CHM based on pain, clinical efficacy, quality of life, and adverse events. Conclusion: The systematic review willto evaluate the efficacy of CHM in treating PD and provide evidence for clinicians. Prospero registration number: CRD42019121185.
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The article summarizes the results of numerous randomized studies and structured the approach to the tactics of managing patients with primary dysmenorrhea. The starting therapy is the administration of non-steroidal anti-inflammatory drugs and/or estrogen-progestational drugs. In the absence of the effect of therapy for 3 months, it is advisable to switch to a drug of another group or a combination of drugs. Failure to achieve the desired therapeutic result within 6 months is the basis for clarifying the diagnosis. The article is illustrated by the clinical case of a patient with primary dysmenorrhea.
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Background: Primary dysmenorrhea is cramping abdominal pain associated with menses. It is prevalent, affects quality of life, and can cause absenteeism. Although evidence based medical treatment options exist, women may not tolerate these or may prefer to use non-medical treatments. Physical activity has been recommended by clinicians for primary dysmenorrhea since the 1930s, but there is still no high quality evidence on which to recommend its use. Objective: We sought to determine the effectiveness of physical activity for the treatment of primary dysmenorrhea. Data sources: Systematic literature searches of Medline, Embase, Cochrane, Web of Science, CINAHL, PsycINFO, SPORTDiscus, PEDro, AMED, WHO ICTRP, Clinicaltrials.gov and OpenGrey were performed, from database inception to 24thMay 2017. Google searches and citation searching of previous reviews were also conducted. Study eligibility criteria: Studies were selected using the following PICOS criteria: Participants: non-athlete females experiencing primary dysmenorrhea; Intervention: Physical activity delivered for at least two menstrual cycles; Comparator: Any comparator; Outcomes: Pain intensity or pain duration; Study type: Randomized controlled trials. Study appraisal and synthesis methods: Study quality was assessed using the Cochrane Risk of Bias Tool. Random effects meta-analyses for pain intensity and pain duration were conducted, with pre-specified subgroup analysis by type of physical activity intervention. Strength of the evidence was assessed using GRADE. Results: Searches identified 15 eligible randomized controlled trials totalling 1681 participants. Data from 11 studies was included in the meta-analyses. Pooled results demonstrated effect estimates for physical activity versus comparators for pain intensity (-1.89cm on Visual Analogue Scale, 95% CI -2.96 to -1.09) and pain duration (-3.92 hours, 95% CI -4.86 to -2.97). Heterogeneity for both of these results was high and only partly mitigated by subgroup analysis. Primary studies were of low or moderate methodological quality but results for pain intensity remained stable during sensitivity analysis by study quality. GRADE assessment found moderate quality evidence for pain intensity and low quality evidence for pain duration. Conclusion: Clinicians can inform women that physical activity may be an effective treatment for primary dysmenorrhea but there is a need for high quality trials before this can be confirmed.
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Background The aims of this study were to investigate the relationships between tongue features and the existence of menstrual pain and to provide basic information regarding the changes in tongue features during a menstrual cycle. Methods This study was conducted at the Kyung Hee University Medical Center. Forty-eight eligible participants aged 20 to 29 years were enrolled and assigned to two groups according to their visual analogue scale (VAS) scores. Group A included 24 females suffering from primary dysmenorrhea (PD) caused by qi stagnation and blood stasis syndrome with VAS ≥ 4. In contrast, Group B included 24 females with few premenstrual symptoms and VAS < 4. All participants completed four visits (menses-follicular-luteal-menses phases), and the tongue images were taken by using a computerized tongue image analysis system (CTIS). Results The results revealed that the tongue coating color value and the tongue coating thickness in the PD group during the menstrual phase were significantly lower than those of the control group (P = 0.031 and P = 0.029, resp.). Conclusions These results suggest that the tongue features obtained from the CTIS may serve as a supplementary means for the differentiation of syndromes and the evaluation of therapeutic effect and prognosis in PD. Trial Registration This trial was registered with Clinical Research Information Service, registration number KCT0001604, registered on 27 August 2015.
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Background: Dysmenorrhea has a high prevalence among women, especially in young women. Zinc has been proved to have a beneficial effect in treating pain. The aim of this study is to determine the effectiveness of zinc supplementation in treating dysmenorrhoeal pain. Method: This is an experimental study, using pre and post-test design. The study participants were medical staffs of H. Adam Malik Hospital and other satellite hospitals. This study was conducted on March 2016 to June 2016. Thirty seven patients with moderate to severe primary menstrual pain were given 30 mg of zinc per day (divided into two doses), 2 days prior to menstruation until its cessation, for two to three months. The pain was assessed with the visual analog scale (VAS). Results: The mean age of participants was 22.95±1.33 years old and the mean body weight, height, and body mass index were 55.54 ± 9.36 kg, 160.16 ± 5.46 cm, 22.02 ± 3.44 kg/m2, respectively. The mean pain score is higher prior to zinc supplementation (4.92 ± 1.80; moderate pain) and the score decreased over three months of zinc supplementation, resulting in a mean score of 2.7 ± 2.03 (moderate pain). The differences were found to be statistically significant (p = 0.000). Conclusion: Dysmenorrhea is frequently found in young women. Two to three months of zinc supplementation during menstruation is proved to be useful in reducing the intensity of dysmenorrheal pain.
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Introduction Gyejibongneyong-hwan (GBH), also known as Guizhi Fuling formula, and is widely used for uterine fibroids in East Asian countries. Many clinical trials assessing the efficacy and safety of GBH formula for the treatment of dysmenorrhoea have been reported. This review will assess the clinical evidence for and against the use of GBH formula as a treatment for dysmenorrhoea. It will also discuss the proposed mechanism(s) that could link herbal medicine to improvements in dysmenorrhoea. Methods and analysis Fourteen databases will be searched until September 2016. We will include randomised controlled trials (RCTs) examining GBH decoctions for any type of dysmenorrhoea. All RCTs of decoctions or modified decoctions will be included. The methodological qualities of the RCTs will be assessed using the Cochrane Collaboration tool for assessing risk of bias. Ethics and dissemination This systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. It will be updated to inform and guide healthcare practices. Trial registration number CRD42015023419.
Article
Objectives: This paper was aim to report the effects of Sobokchukeo-tang-gagambang and warm needle therapy on the dysmenorrhea patients.Methods: The patients having treated with Sobokchukeo-tang-gagambang and warm needle therapy, from January 1st in 2014 until May 31st in 2016, was enrolled in this study. We collected and analyzed their age, accessory complaint except dysmenorrhea, treatment period, dosage of herbal medicine, diagnosed gynecological disease, remedies? effectiveness, etc.Results: All of the patients treated with Sobokchukeo-tang-gagambang and warm needle therapy in this study were recovered. Also, correlation between the characteristic and recovery status of patients was not confirmed.Conclusions: Sobokchukeo-tang-gagambang and warm needle therapy is effective on patients having variable gynecological diseases. But the cases are very deficient, so we need to study about availability of Sobokchukeo-tang and warm needle therapy on dysmenorrhea more systematically.
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Background: Large-scale surveys of complementary traditional Chinese medicine (TCM) use in pediatric cancer patients are lacking. The aim of our study was to investigate the use of TCM in pediatric cancer patients. Methods: We analyzed cancer patients younger than 18 years (n = 12 965) who were registered in the National Health Insurance Research Database in Taiwan between 2001 and 2011. Patients were categorized into TCM or non-TCM users based on their use of TCM. Results: In Taiwan, 8086 (62.4%) children with cancer sought TCM treatment at some point. Children in older age groups, including school-aged children and adolescents, were more likely to use TCM. There was no significant difference in the distributions of gender and urbanization. The 3 most common diseases for which TCM users visited the clinic were neoplasm (33.2%), respiratory system disease (32.9%), and infectious disease (8.86%). The most commonly utilized TCM therapy was Chinese herbal remedies. Patients who had comorbid conditions such as allergic rhinitis, dyspepsia, disorders of menstruation, and disease of the musculoskeletal system and connective tissue tended to visit TCM clinics. Conclusions: Adjunctive TCM use is not low in Taiwanese children with cancer. Further studies to investigate the efficacy and safety of TCM in children with cancer are warranted.
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Pain is among the foremost complaints of women seeking gynecological consultation, yet the diagnosis is often limited to endometriosis. Chronic Pelvic Pain discusses how to diagnose a broad scope of underlying conditions presenting in relation to pelvic pain in women and their treatment. Starting with an anatomical review from a pain point of view, several chapters continue to explore specific conditions such as vulvodynia, the often overlooked painful bladder syndrome and pelvic inflammatory disease. Also covered are topics such as sexual dysfunction, psychological aspects of chronic pelvic pain and alternative treatment methods. Practical treatment tips for specific conditions which are readily applicable in everyday practice are provided throughout. Special attention is given to the use of sonography and MRI in diagnostics. With its comprehensive approach, addressing both body and mind, this is essential reading for medical specialists and consultants and specialist medical trainees in gynecology, pain medicine, and family practice.
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Traditionally, endometriosis had been thought to occur only rarely in adolescence, but with an increasing awareness of the disease among the medical community, it is being more frequently diagnosed. Although the natural history of endometriosis is largely unknown, a young patient in chronic pain seeking help is typically what confronts physicians. The diagnostic and therapeutic management issues in young patients with endometriosis are discussed in this chapter and encompass medical, surgical, and complementary therapies.
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Traditional Chinese Medicine (TCM) was reimbursed by the statutory health insurance in Switzerland ("Obligatorische Krankenpflegeversicherung" (OKP)) between 2000 and 2005. A project was set up specifically to evaluate TCM, as well as other 4 systems and methods of complementary medical care from a scientifically sound perspective. The decision to stop granting these 5 systems of complementary medical care OKP reimbursement at the end of the evaluation period after 2005 was not based on scientific facts but was at least in parts politically motivated. After the referendum decision in favour of anchoring "the duty to consider complementary medical care approaches" in the constitution, a new application for automatic reimbursement is being submitted based on new data. TCM is to be applied exclusively by specially trained and certified doctors ("certificate of special ability in acupuncture and TCM") if warranted by the indication, the resulting costs are to be reimbursed by the OKP. Any indication covering the whole spectrum of medicine may warrant TCM treatment if treatment by conventional medical practice is not absolutely necessary. This explicitly excludes diseases which have been proven to respond most efficiently to conventional treatment or where conventional medical treatment is needed to prevent damage for the patient. For many diseases, Western medicine is not able to either supply any treatment which is able to deal with the causes of the disease, or to supply any treatment which leads to a satisfactory measure of healing or improvement in the patient's suffering. The symptomatic pharmacological treatment used by western medicine in this context is often not well tolerated by the patient or leads to side effects with complications. Many acute or chronically relapsing infections do not necessarily require an antibiotic treatment. Considering the global threat of resistance, this is even to be avoided wherever possible. Due to the different paradigm employed, TCM is often able to offer successful treatment from its perspective for many diseases.
Article
Objectives: The purpose of this study is to identify the clinical effects of korean medicine treatment of dysmenorrhea patients. Methods: We studied twenty-six patients who visited Oriental Hospital of University from September 2011 to December 2011. Women with organic disease such as endometriosis, uterine myoma and pelvic inflammatory disease were excluded from this study. We treated them with herb, acupuncture and moxibustion for one menstrual cycle. The severity of dysmenorrhea was measured by VAS(Visual analog scale) and MVRS(Multidimensional Verbal Rating scale). Results: The meanStandard Error of mean(S.E) of VAS on after treatment was decreased significantly compared with that of before(p=0.00). The meanS.E of MVRS on after treatment was decreased significantly compared with that of before(p=0.00). Conclusions: This study shows that korean medicine treatment such as herb, acupuncture and moxibustion has remarkable effects on dysmenorrhea patients. Further study will be needed.
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Objectives: Oriental Medicine has thousands years of history. But this era, every medical decision should be based on scientific evidence, that is evidence-based medicine (EBM). This study is to suggest quantitative case report form for dysmenorrhea that can be easily used in clinics. Methods: First, to search published papers in Korea and overseas, OASIS, KISS and NCBI(pubmed) database. Second, to search clinical trials in clinical trial register website, ISRCTN and clinicaltrials.gov. Result: Visual Analogue Scale(VAS) is the most commonly used scale. Conclusion: The main scales for dysmenorrhea are Visual Analogue Scale(VAS), Multidimensional verbal Rating scale(MVRS), pain-killer intake amount and restriction of daily life activities. To measure the effect of herbal medicine, more than 2 menstrual cycle is recommended.
Article
Objectives To characterize the application of traditional Chinese medicine (TCM) among pediatric patients. Design and setting This study examined data sets from the National Health Insurance Research Database in Taiwan. Two cohorts, each with one million patients who were randomly sampled from the beneficiaries of the National Health Insurance Program from January 1 to December 31 in 2005 or 2010, were chosen for analysis. Children had at least one TCM outpatient clinical record were defined as TCM users, whereas children who had no TCM outpatient records were defined as non-TCM users. Main Outcome Measures The demographic data, treatment modalities and the disease distributions of the pediatric TCM users were analyzed from two randomly sampled cohorts. Results Overall, 22% and 22.5% of the children used TCM in 2005 and 2010, respectively. The utilization rate of TCM increased with age. Herbal remedies were the most commonly used therapeutic approach, followed by manipulative therapy and acupuncture. There was an increasing trend of using herbal remedies (increased from 65.6% to 74.4%) and acupuncture (increase from 7.5% to 11.4%), but there was a markedly decreased use of manipulative therapies from 25.6% to 12.3% from 2005 to 2010. There is an obvious increasing use of TCM due to diseases of the digestive system, skin/subcutaneous tissue and genitourinary system from 2005 to 2010. A further comparison of the prevalence rates between TCM and non-TCM visits indicated that allergic rhinitis, dyspepsia, injury and musculoskeletal diseases, as well as menstrual disorders, were the main diseases that children tended to visit TCM clinics in Taiwan. Conclusions Our nationwide population-based study revealed the high prevalence and specific usage patterns of TCM in the pediatric population in Taiwan. The results of this study should provide valuable information for physicians, parents and the government concerning pediatric healthcare.
Article
This study aims to evaluate the immediate effect of a global pelvic manipulation (GPM) technique, bilaterally applied, on low back pelvic pain in women with primary dysmenorrhea (PD). A prospective, randomized, double-blind, controlled trial. Faculty of Nursing, Physiotherapy and Podiatry. University of Sevilla, Spain. The sample group included 40 women (30 ± 6.10 years) that were divided into an experimental group (EG) (N = 20) who underwent a bilateral GPM technique and a control group (CG) (N = 20) who underwent a sham (placebo) intervention. Evaluations were made of self-reported low back pelvic pain (visual analog scale), pressure pain threshold (PPT) in sacroiliac joints (SIJs), and the endogenous response of the organism to pain following catecholamines and serotonin release in blood levels. The intragroup comparison showed a significant improvement in the EG in the self-perceived low back pelvic pain (P = 0.003) and in the mechanosensitivity in both SIJs (P = 0.001). In the between-group comparison, there was a decrease in pain perception (P = 0.004; F(1,38) = 9.62; R(2) = 0.20) and an increase in the PPT of both SIJs, in the right side (P = 0.001; F(1,38) = 21.29; R(2) = 0.35) and in the left side (P = 0.001; F(1,38) = 20.63; R(2) = 0.35). There were no intergroup differences for catecholamines plasma levels (adrenaline P = 0.123; noradrenaline P = 0.281; dopamine P = 0.173), but there were for serotonin levels (P = 0.045; F(1,38) = 4.296; R(2) = 0.10). The bilateral GPM technique improves in a short term the self-perceived low back pelvic pain, the PPT in both SIJs, and the serotonin levels in women with PD. It shows no significant differences with a sham intervention in catecholamines plasma levels.
Article
Primary dysmenorrhea is a common gynecological condition, for which Chinese herbal medicine (CHM) has been widely used in addition to western medicine. The aim of this study is to explore CHM commonly used to treat dysmenorrhea in young Chinese women. Observational retrospective study. The National Health Insurance Research Database in Taiwan. Women aged from 13 to 25 years with single diagnosis of primary dysmenorrhea. CHM prescriptions made for primary dysmenorrhea women during 1998-2008 were extracted to build up CHM prescription database. Association rule mining was used to explore the prevalent CHM combination patterns in treating primary dysmenorrhea. Prevalence and mechanisms of CHM combinations. Totally 57,315 prescriptions were analyzed and, on average, 5.3 CHM was used in one prescription. Dang-Gui-Shao-Yao-San (DGSYS) was the most commonly used herbal formula (27.2%), followed by Jia-Wei-Xiao-Yao-San (JWXYS) (20.7%) and Wen-Jing-Tang (WJT) (20.5%). Corydalis yanhusuo and Cyperus rotundus were the most commonly used single herb, found in 33.1% and 29.2% of all prescriptions. Additionally, C. yanhusuo with C. rotundus is the most commonly used two CHM in combination, accounting for 14.24% of all prescriptions, followed by DGSYS with C. yanhusuo (10.47%). Multi-target effects on primary dysmenorrhea, such as analgesia, mood modifying and hormone adjustment, were found among commonly prescribed CHM in this study. This study discovered the potential importance of C. yanhusuo, C. rotundus and DGSYS in treating primary dysmenorrhea. Further clinical trials or bench studies are warranted based on the results.
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Primary dysmenorrhea is common among young women and results in their incapacitation; it can be accompanied by various symptoms that can disrupt their lives. The aim of this randomized trial was to compare the effect of ginger, zinc sulfate, and placebo on the severity of primary dysmenorrhea 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 four days, from the day before the commencement of menstruation to the third day of their menstrual bleeding. The severity of dysmenorrhea 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 ginger and the zinc sulfate groups (p < .001). Compared with the placebo receiving group, participants receiving ginger and zinc sulfate reported more alleviation of pain during the intervention (p < .05). Ginger and zinc sulfate had similar positive effects on the improvement of primary dysmenorrheal pain in young women.
Article
Key content•Dysmenorrhoea is a common condition of women in their reproductive years.•Local factors and the centralised response to pain are thought to be involved in the pathophysiology.•The majority of women will respond to medical treatments.•The role of surgical treatments is small.•More evidence is now available on the use of complementary therapies to treat dysmenorrhoea.Learning objectives•To understand the theories regarding the aetiology of dysmenorrhoea.•To update knowledge of evidenced-based treatments for dysmenorrhoea.Ethical issues•Is there a role for surgical treatments to interrupt nerve pathways in the treatment of dysmenorrhoea?•Would women who fail to respond to medical treatments for dysmenorrhoea be best treated by chronic pain teams?Please cite this article as: Wallace S, Keightley A, Gie C. Dysmenorrhoea. The Obstetrician & Gynaecologist 2010;12:149–154.
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This study investigated the efficacies of electroacupuncture and electroacupuncture combined with Tao Hong Si Wu Wan in treating primary dysmenorrhea and compared the results with those obtained using conventional medical treatment. One treatment group, group 1, was administered Tao Hong Si Wu Wan (2625 mg) while the other, group 2, was administered a placebo (2625 mg) twice daily for 3 months. Electroacupuncture was used in both treatment groups: two sessions per menstrual cycle for three menstrual cycles. The reference group, group 3, was administered ibuprofen, 600 mg, twice daily, for five menstrual cycles. Uses of the herb, placebo and ibuprofen were blinded. A ridit analysis was used for testing and interpreting the effects of treatment. Pain intensity was determined using a qualitative grading method in a blinded manner. The ridit scores in groups 1 and 2 were significantly higher than those in reference group immediately after treatment and three months later. Twelve months after the treatment, group 1 had a higher ridit score than group 2. In comparison to the reference group, groups 1 and 2 achieved better menstrual pain relief both immediately and 3 months after treatment. In addition, group 1 had better long-term pain relief than group 2.
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Objective . This study was a multicenter, randomized, double-blind, and controlled trial with two parallel arms: the GJBNH group and the placebo group. This trial recruited 100 women aging 18 to 35 years with primary dysmenorrhea caused by blood stagnation. The investigational drugs, GJBNH or placebo, were administered for two menstrual periods (8 weeks) to the participants three times per day. The participants were followed up for two menstrual cycles after the administration. Results . The results were analyzed by the intention-to-treat (ITT) dataset and the per-protocol (PP) dataset. In the ITT dataset, the change of the average menstrual pain VAS score in the GJBNH group was statistically significantly lower than that in the control group. Significant difference was not observed in the SF-MPQ score change between the GJBNH group and the placebo group. No significant difference was observed in the PP analyses. In the follow-up phase, the VAS scores of the average menstrual pain and the maximum menstrual pain continually decreased in the placebo group, but they increased in the GJBNH group. Conclusion . GJBNH treatment for eight weeks improved the pain of the dysmenorrhea caused by blood stagnation, but it should be successively administered for more than two menstrual cycles. Trial Registration . This trial is registered with Current Controlled Trials no. ISRCTN30426947 .
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In recent years, the popularity increased for nutritional supplements and herbal products. Prescription drugs, but not herbal therapies are paid by health insurances. They are sold over-the-counter (OTC) on the patients’ own expense. However, there are potential risks of self-medication, e.g. incorrect self-diagnosis, severe adverse reactions, dangerous drug interactions, risk of addiction etc. They are often used by patients at their own discretion without knowledge of and control by their physicians. Certain users are at risk of intoxication. Multiple medications taken by older patients increase the risk for adverse drug reactions, drug-drug interactions, and compliance problems for this age group (polypharmacy). Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants. Herbal preparations may also be carcinogenic or interfere with cancer treatments. Pregnant women use various OTC preparations. However, in many cases, it is unclear whether their use is safe for mother or baby. Self-medication with herbals is also largely distributed among anxious and depressive patients, and patients with other conditions and symptoms. The popularity of herbal products has also brought concerns on quality, efficacy and safety. Cases of botanical misidentification, contaminations with heavy metals, pesticides, radioactivity, organic solvents, microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards. Hepatotoxic effects have been reported for more than 300 plant species, and some commonly used herbs have been demonstrated to interact with Western medication. Health care professionals have a critical responsibility assessing the self-care ability of their patients. Databases are available for pharmacists with information on action, side effects and toxicities as well as herb-drug interactions. There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations (phytovigilance). Physicians, pharmacists, and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs. Information centers for consumers and general practitioners are needed, and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled, double blind and randomized clinical trials.
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The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group represents an international collaboration of guideline developers, clinicians, health services researchers and methodologists. Many leading organizations, including the World Health Organization (WHO), use the GRADE approach because it has led to progress in the assessment of evidence and in the development of healthcare recommendations. The GRADE system distinguishes the quality of evidence from the strength of a recommendation. The quality of evidence reflects the extent of confidence that an estimate of effect is correct if it is used in the context of single endpoints. In the context of giving guidance, it reflects the extent to which confidence in an estimate of the effect is adequate to support recommendations. The strength of a recommendation, separated into strong and weak or conditional recommendations for or against an intervention, is defined as the extent to which one can be confident that the desirable effects of an intervention outweigh the undesirable effects. A recommendation for action requires consideration for the magnitude of the expected benefit and downsides of an intervention for all patient-important endpoints, the associate values and preferences and resource use. The GRADE system includes a systematic approach to evaluate the generalizability of study results to healthcare practice. Judgments about generalizability, better termed directness, are separated into judgments about the availability of direct comparisons between two alternative management strategies and judgments about differences between the population, intervention, comparator to the intervention, and outcomes (PICO) of interest for a given question, and those included in the relevant studies. In addition to providing an overview of the GRADE system, this article focuses on the approach to assessing directness or generalizability. (As supplied by publisher)
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Cochrane reviews are considered by many to be the "gold standard" or the final word in medical conversation on a topic. We explored the eleven most relevant Cochrane reviews on herbal medicine and identified that frequently herbal medicines in the included studies had not been sufficiently well characterised. If data on the effects of the plant parts are unavailable, effects of co-active ingredients need to be considered and the plausibility of the study medications for the specific indications discussed. Effect sizes calculated from exploratory studies would be best used to determine the sample sizes required for future confirmatory studies, rather than as definitive reports of intervention effects. Reviews should be comprehensive, including discussion of putative adverse events and possible drug interactions. We suggest that the guidelines for preparing Cochrane reviews be revised and offer assistance in this task.
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. The aim of the study was to explore the association between women's use of herbal dietary supplement Si-Wu-Tang during the postpartum period and their health-related quality of life. . This is a population-based correlational study. We used multistage, stratified, systematic sampling to recruit 24,200 pairs of postpartum women and newborns from the Taiwan National Birth Registry in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population. Trained interviewers performed home interviews 6 months after the women's deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women along with the frequency of Si-Wu-Tang use. . Si-Wu-Tang use after delivery improved women's score for bodily pain and also improved their score for mental health when used more than 10 times. In addition, there were increases in general health and vitality scores in the group who continuously used Si-Wu-Tang more than 10 times after using Sheng-Hua-Tang. . Use of Si-Wu-Tang after delivery may be associated with women's health-related quality of life especially for those who previously used Sheng-Hua-Tang. These results are exploratory and need to be replicated.
Article
Background: Sixty percent (60%) to 80% of patients who visit chiropractic, osteopathic, or Chinese medicine practitioners are seeking pain relief. Objectives: This article aimed to identify the amount, quality, and type of complementary and alternative medicine (CAM) pain research in Australia by systematically and critically reviewing the literature. Methods: PubMed, Scopus, Australasian Medical Index, and Cochrane library were searched from their inception to July 2009. Australian and New Zealand Clinical Trial Registration and National Health and Medical Research Council databases were searched for human studies yet to be completed. Predefined search terms and selection criteria were used for data identification. Results: Of 204 studies selected, 54% were on chiropractic, 27% on Chinese medicine, 15% about multitherapy, and 4% on osteopathy. Chronic spinal pain was the most studied condition, with visceral pain being the least studied. Half of the articles in Chinese medicine or multitherapy were systematic reviews or randomized control trials. In comparison, only 5% of chiropractic and none of osteopathy studies were in these categories. Government funding was rare, and most studies were self-funded or internally funded. All chiropractic, osteopathic, and Chinese herbal medicine studies were conducted by the researchers of the professions. In contrast, half of the acupuncture studies and all t'ai chi studies were conducted by medical doctors or physiotherapists. Multidisciplinary collaboration was uncommon. Conclusions: The quantity and the quality of CAM pain research in Australia are inconsistent with the high utilization of the relevant CAM therapies by Australians. A substantial increase in government funding is required. Collaborative research examining the multimodality or multidisciplinary approach is needed.
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our study had two objectives: a) to systematically identify all existing systematic reviews of Chinese herbal medicines (CHM) published in Cochrane Library; b) to assess the methodological quality of included reviews. We performed a systematic search of the Cochrane Database of Systematic Reviews (CDSR, Issue 5, 2010) to identify all reviews of CHM. A total of fifty-eight reviews were eligible for our study. Twenty-one of the included reviews had at least one Traditional Chinese Medicine (TCM) practitioner as its co-author. 7 reviews didn't include any primary study, the remaining reviews (n = 51) included a median of 9 studies and 936 participants. 50% of reviews were last assessed as up-to-date prior to 2008. The questions addressed by 39 reviews were broad in scope, in which 9 reviews combined studies with different herbal medicines. For OQAQ, the mean of overall quality score (item 10) was 5.05 (95% CI; 4.58-5.52). All reviews assessed the methodological quality of primary studies, 16% of included primary studies used adequate sequence generation and 7% used adequate allocation concealment. Of the 51 nonempty reviews, 23 reviews were reported as being inconclusive, while 27 concluded that there might be benefit of CHM, which was limited by the poor quality or inadequate quantity of included studies. 58 reviews reported searching a median of seven electronic databases, while 10 reviews did not search any Chinese database. Now CDSR has included large numbers of CHM reviews, our study identified some areas which could be improved, such as almost half of included reviews did not have the participation of TCM practitioners and were not up-to-date according to Cochrane criteria, some reviews pooled the results of different herbal medicines and ignored the searching of Chinese databases.
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To evaluate the risk of gastrointestinal and operative site bleeding associated with the use of parenteral ketorolac tromethamine. Postmarketing surveillance inception cohort study. A total of 35 hospitals throughout the Philadelphia, Pa, region, 1991 to 1993. Patients administered 10,272 courses of parenteral ketorolac therapy were compared with patients administered 10,247 courses of a parenteral opiate who were matched to the ketorolac patients by hospital, admitting service, and date of initiation of study drug. Medical records were reviewed for demographics, medical history, doses and duration of study drug, various aspects of the hospital course including surgery and concomitant medications, and adverse events. The multivariate adjusted odds ratio (OR) comparing ketorolac with opiates for gastrointestinal bleeding was 1.30 (95% confidence interval [CI], 1.11 to 1.52); for operative site bleeding, the OR was 1.02 (95% CI, 0.95 to 1.10). The OR was elevated further in subjects 75 years of age or older for both gastrointestinal bleeding (OR = 1.66; 95% CI, 1.23 to 2.25) and operative site bleeding (OR = 1.12; 95% CI, 0.94 to 1.35). A dose-response relationship was evident between average daily ketorolac dose and both gastrointestinal bleeding and operative site bleeding (trend test P < .001 for both). When analgesic therapy lasted 5 or fewer days, ketorolac was associated with only a small increased risk of gastrointestinal bleeding (OR = 1.17; 95% CI, 0.99 to 1.30); when therapy was prolonged beyond 5 days, the OR was 2.20 (95% CI, 1.36 to 3.57). The association of ketorolac with operative site bleeding was not affected by duration of therapy. The overall associations between ketorolac use and both gastrointestinal bleeding and operative site bleeding are small. However, the risk associated with the drug is larger and clinically important when ketorolac is used in higher doses, in older subjects, and for more than 5 days. Improving physicians' prescribing practices by limiting the dose and duration of ketorolac use, especially in the elderly, should enhance its overall risk-benefit balance.
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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.
Conference Paper
Gastrointestinal (GI) complications related to nonsteroidal antiinflammatory drug (NSAID) therapy are the most prevalent category of adverse drug reactions. Patients with arthritis are among the most frequent users of NSAID and are therefore particularly at risk for these side effects. To evaluate the nature of NSAID related GI complications and to determine how their frequency can be reduced, a series of studies of such complications in patients with rheumatic disease has been carried out based on data from the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS). We review the literature and present findings from the ARAMIS studies. This report addresses whether GI side effects such as dyspepsia can serve as warning symptoms for serious GI complications and describes the risk factors for these life threatening complications. It also describes differences among NSAID with regard to their GI toxicity and describes a study that investigated whether H-2-receptor antagonists and antacids affect the development of serious GI complications. In addition, ongoing research and topics to be addressed in future studies are described.
Article
Dysmenorrhoea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhoea include nulliparity, heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination. Non-steroidal anti-inflammatory drugs are the initial therapy of choice in patients with presumptive primary dysmenorrhoea. Oral contraceptives and depo- medroxyprogesterone acetate also may be considered. If pain relief is insufficient, prolonged-cycle oral contraceptives or intravaginal use of oral contraceptive pills can be considered. In women who do not desire hormonal contraception, there is some evidence of benefit with the use of topical heat; the Japanese herbal remedy toki-shakuyaku-san; thiamine, vitamin E, and fish oil supplements; a low-fat vegetarian diet; and acupressure. If dysmenorrhoea remains uncontrolled with any of these approaches, pelvic ultrasonography should be performed and referral for laparoscopy should be considered to rule out secondary causes of dysmenorrhea. In patients with severe refractory primary dysmenorrhoea, additional safe alternatives for women who want to conceive include transcutaneous electric nerve stimulation, acupuncture, nifedipine, and terbutaline. Otherwise, the use of danazol or leuprolide may be considered and, rarely, hysterectomy. The effectiveness of surgical interruption of the pelvic nerve pathways has not been established.
Article
Primary dysmenorrhoea can be readily relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs inhibit prostaglandin synthetase, reducing the level of prostanoids in the uterus and the uterine contractions that cause the painful cramps. Piroxicam-β-cyclodextrin is rapidly absorbed and quickly reaches peak blood concentrations. Four published clinical studies have evaluated piroxicam-β-cyclodextrin for relief of primary dysmenorrhoea. Piroxicam-β-cyclodextrin 20mg once daily was significantly more effective than placebo in relief of dysmenorrhoea, was better than ketoprofen in relieving the abdominal pain of dysmenorrhoea, and had a quicker onset and longer duration of relief than naproxen. Both investigators and patients rated a greater preference for piroxicam-β-cyclodextrin over the comparator medications. The tolerability of piroxicam-β-cyclodextrin in the treatment of dysmenorrhoea was good, with a very low incidence of adverse effects.
Article
Objective To describe how menstrual cramps vary from cycle to cycle within a woman over time. To examine the influence of weight and lifestyle factors on occurrence, duration, and severity of menstrual pain. Design A one-year prospective menstrual diary study. Participants One hundred and sixty-five women aged 17 to 19 years entering a local university in 1985. Main outcome measures The occurrence, length, and maximum severity of pain during a menstrual period. Results Menstrual pain occurred during 71.6% of observed menstrual bleeds, most commonly beginning the first day of menses. The median duration was two days. Sixty percent of women reported at least one episode of severe pain, while 13% reported severe pain more than half the time. Earlier age at menarche and long menstrual periods increased the occurrence, duration and severity of pain. In smokers, cramps tended to last longer. Being overweight was an important risk factor for menstrual cramps and doubled the odds of having a long pain episode. Frequent alcohol consumption decreased the probability of having menstrual cramps, but in women who had pain it increased duration and severity. Physical activity was not associated with any pain parameter. Conclusions Women who have pain lasting three days are an important target group for prophylactic therapy. The occurrence and severity of menstrual cramps is influenced by potentially modifiable characteristics including weight, smoking, and alcohol consumption. Doctors may wish to counsel women presenting with dysmenorrhoea about the importance of healthy lifestyles and about the inefficacy of alcohol consumption as a treatment for dysmenorrhoea.
Article
To study aspects of the aetiology of primary dysmenorrhoea and mechanisms underlying the therapeutic effect in this condition of an oral contraceptive. Intrauterine pressure was recorded before and during infusion of hypertonic saline (5% NaCl, 0.06 ml/kg/min) over 75 min on the first day of bleeding in women with dysmenorrhoea and after 3 weeks of oral contraceptive treatment. Plasma sampling every 15 min of ongoing infusion for the estimation of osmolality, arginine vasopressin, oxytocin and the prostaglandin (PG) F-metabolite, 15-keto-13,14-dihydro-PGF2 alpha. Ten healthy nulliparous women with moderate to severe primary dysmenorrhoea. Plasma levels of posterior pituitary hormones and the PGF-metabolite. Total pressure area (TPA) of the recording curve. In dysmenorrhoea before infusion the plasma concentration of vasopressin was in mean 2.18, oxytocin 5.05 and the PGF-metabolite 321.5 pmol/l, and the TPA 3.8 kPa x 10 min. After oral contraceptive treatment the vasopressin level and the TPA were significantly reduced. At both sessions apart from intensifying the pain, the saline infusion increased vasopressin and oxytocin levels as well as the TPA, whereas the concentration of the PGF-metabolite at both sessions decreased. Confirmation is provided of the elevated secretion of arginine vasopressin and PGF2 alpha, as well as increased uterine activity in primary dysmenorrhoea. The observations are in agreement with the concept that a lowered level of vasopressin and a decreased uterine activity contributes to the beneficial effect of OCs in the condition. Stimulation of the secretion of vasopressin increases the uterine activity and symptoms of primary dysmenorrhoea, but results suggest that this effect does not involve a mechanism of increased PGF-synthesis. The role of oxytocin in dysmenorrhoea can not yet be defined.
Article
Ten adolescents with primary dysmenorrhea (PD) were treated with the oral contraceptive (OC) Lyndiol 2.5 mg (R) for one cycle. The levels of PGF2 alpha, PGE2 and the metabolites of PGI2 and TXA2: 6-keto-PGF1 alpha and TXB2 were tested by a radioimmunoassay method during the 1st and 23rd day of the pre-treatment cycle (PrTC), the 23rd day of treatment (TC) and the 1st day of the post-treatment cycle (PoTC). The ratios PGF2 alpha/PGE2 and TXB2/6-keto-PGF1 alpha were also tested and compared during the above-mentioned days. Analytical comparison was made, for each Prostaglandin (PG) separately, between the 1st day of the PrTC and PoTC as well as the 23rd day of the PrTC and TC, respectively. All PG levels during TC and PoTC were found significantly lower, compared to those of the PrTC respectively. With regard to the ratios mentioned above, no statistically significant differences were found on the same days and cycles as previously stated. The reduction of the PG levels in PD patients after treatment with oral contraceptives, together with an improvement of the clinical findings of the disease, support the theory that oral contraceptives can be used for the treatment of PD cases, especially for those adolescents who also desire a contraceptive method.
Article
With approximately 25% of dysmenorrheic patients reporting no improvement with nonsteroidal anti-inflammatory drugs, a study was devised to evaluate the effectiveness of a laparoscopic technique for the interruption of the uterosacral nerves. In a double-blind study of 21 patients with primary dysmenorrhea, 81% (9 of 11) reported significant relief from menstrual pain after the surgery. Performed as an outpatient procedure, laparoscopic uterine nerve ablation may alleviate dysmenorrheic complaints when other modalities have failed. Half the treated women reported continued relief of menstrual pain at 12 months. These results suggest that uterosacral nerve interruption may prove an effective alternative treatment for this menstrual disorder.
Article
Oral contraceptives reduce menstrual pain but the interaction with vasopressin and prostaglandin F2 alpha, two uterine stimulants related to the condition, is unknown. Ten women with a history of moderate to severe dysmenorrhoea were studied. Repeated blood samples were taken during a first menstrual cycle without treatment, during the first 21 days of a second cycle when they received an oral contraceptive (150 micrograms levonorgestrel and 30 micrograms ethynyloestradiol) and on the first or second day of the bleeding following hormonal withdrawal. Measurements were made of plasma concentrations of arginine vasopressin, 15-keto-13,14-dihydroprostaglandin F2 alpha, oestradiol-17 beta, progesterone, ethynyloestradiol, levonorgestrel, FSH, LH and prolactin, and serum osmolality was measured. Seven of the women rated their discomfort as moderate to severe on the first two menstruations, but as none or light at the withdrawal bleeding; with the rating scale for degree of pain that was used, this decrease in pain was significant (P less than 0.001). The plasma concentration of vasopressin in these seven women showed significant variation, with the highest concentrations being obtained at the beginning of the two painful menstruations (3.76 +/- 0.76 and 1.75 +/- 0.30 (S.E.M.) pmol/l) and at ovulation in the control cycle (1.91 +/- 0.58 pmol/l). During treatment the concentrations were consistently low, except on the first day of withdrawal bleeding (2.33 +/- 0.35 pmol/l). The concentrations of the prostaglandin F2 alpha metabolite showed less variation, but again the values at withdrawal bleeding (271 +/- 39 pmol/l) were not different from those obtained over the painful menstruations (255 +/- 24 and 217 +/- 25 pmol/l).(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Primary dysmenorrhea and secondary dysmenorrhea induced by an intrauterine device are associated with increased production and release of endometrial prostaglandins. The condition may be treated by oral contraceptives, which reduce overall menstrual fluid volume, or by a prostaglandin synthetase inhibitor, such as ibuprofen. Unless the patient wishes to use oral contraceptives for birth control, ibuprofen (Motrin) is the drug of choice because it need only be given for two to three days each cycle, does not suppress the pituitary ovarian axis, and does not cause metabolic alterations. Clinical trials have shown ibuprofen to be highly efficacious, and more effective than indomethacin, aspirin, or propoxyphene, with no or few side effects.
Article
In normally menstruating women plasma vasopressin concentrations vary with the stage of the cycle and are highest at the time of ovulation and lowest at the onset of menstruation. To determine whether this is the result of changes in the circulating concentrations of ovarian steroids, vasopressin concentrations were determined in six postmenopausal women given oestrogen and progestogen. An increase in plasma oestradiol concentrations to 299 +/- 97.8 pmol/l augmented vasopressin release. Administration of medroxyprogesterone did not influence vasopressin concentrations but when given in combination with oestrogen a fall was observed. Thus it appears that ovarian steroids can modulate vasopressin release.
Article
To determine the average menarcheal age and menstrual cycle pattern, prevalence of dysmenorrhea, frequency of smoking, alcohol and drug use, sexual education level, and the gynecologic problems in female adolescents in Turkey. A questionnaire consisting of 43 questions were given to 13,665 high school girls between the ages 13-18 years. The results showed that average menarcheal age was 13.28 +/- 1.09 years and 77.8% of the girls had menstrual cycles between 20-35 days; 10,688 (78.1%) of the girls complained about pain during their menstruation and 25.6% frequently missed school for this reason. That notwithstanding, only 0.4% of the adolescents with dysmenorrhea had sought medical consultation. Out of 13,665 girls, 19.7% smoked cigarettes, 14.9% used alcohol, and 0.63% used other drugs. Although 50.8% of the students believed that their knowledge about sexuality was adequate, on evaluating the results, this was not confirmed. Girlfriends were found to be the most important source of sexual knowledge. The study indicated that 88.8% of the girls wanted to have sexual education at schools and 60.5% of those preferred to take such a lecture together with boys. The study also revealed that 10.5% of the girls previously consulted a gynecologist and menstrual disorders (26.1%) and dysmenorrhea (23.4%) were the most common complaints. The results showed that 68.7% of the girls preferred a woman gynecologist and 66.3% wanted to be alone with the doctor during examination. We provided data about demographic and epidemiologic features of Turkish female adolescents.
Article
We evaluated the analgesic effect of Toki-shakuyaku-san (TSS) in women who had a combination of "deficiency," of "Yin," "cold," and "stagnated blood" syndromes, and were suffering from dysmenorrhea. A diagnostic scoring system was used for determination of these conditions. We treated patients with either TSS or placebo during 2 menstrual cycles with a double-blind technique, and we followed them for 2 additional cycles. A significant alleviation of dysmenorrhea was observed in patients treated with TSS as compared to those treated with placebo. Our results suggest that TSS is effective for treatment of dysmenorrhea in patients with the above-mentioned conditions.
Article
To explore the prevalence of dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students' management strategies, and their knowledge of available treatment. A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The following definition of dysmenorrhoea was used: any type of pain or discomfort associated with menstrual periods including cramps, nausea, and headaches. The reported prevalence of dysmenorrhea among these girls was 80%; 53% of those girls with dysmenorrhea reported that it limited their activities. In particular, 37% said that dysmenorrhea affected their school activities. The most common medication used by those reporting dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for dysmenorrhea. The prevalence and impact of dysmenorrhea on Grade 11 and 12 girls is high, and they lack knowledge of and experience with effective treatment. Health education measures are needed in this area to prevent unnecessary suffering and interruption to school routine.
Article
Dysmenorrhoea is the occurrence of painful menstrual cramps of uterine origin and is a very common gynaecological complaint. Medical therapy for dysmenorrhoea includes oral contraceptive pills (OCP) and nonsteroidal anti-inflammatory drugs (NSAIDS) which both act by suppressing prostaglandin levels. While these treatments are very successful there is still a 20-25% failure rate and surgery has been an option for cases of dysmenorrhoea that fail to respond to medical therapy. Uterine nerve ablation (UNA) and presacral neurectomy (PSN) are two surgical treatments that have become increasingly utilised in recent years. These procedures both interrupt the majority of the cervical sensory nerve fibres, thus diminishing uterine pain. Uncontrolled studies have supported the use of these procedures for primary dysmenorrhoea however both operations only partially interrupt some of the cervical sensory nerve fibres in the pelvic area; therefore dysmenorrhoea associated with additional pelvic pathology may not always benefit from this type of surgery. To assess the effectiveness of surgical interruption of pelvic nerve pathways as treatment for primary and secondary dysmenorrhoea, and to determine the most effective surgical treatment. Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials, MEDLINE, and EMBASE were performed to identify relevant randomised controlled trials (RCTs). Attempts were also made to identify trials from citation lists of review articles and handsearching. In most cases, the first or corresponding author of each included trial was contacted for additional information. The inclusion criteria were randomised comparisons of surgical techniques of interruption of the pelvic nerve pathways (both open and laparoscopic procedures) for the treatment of primary and secondary dysmenorrhoea. The main outcome measures were pain relief and adverse effects. Seven RCTs were identified that fulfilled the inclusion criteria for this review. One trial (Sutton 1994) was excluded because another treatment was given in combination with destruction of pelvic nerve pathways and the effects of these two treatments could not be separated. Of the remaining six trials, three were included in the meta-analysis (Chen 1996, Candiani 1992, Lichten 1987). The results of the other three trials (Dover 1999, Tjaden 1990, Vercellini 1997) were included in the text of the review for discussion because the data were not available in a form that allowed them to be combined in a meta-analysis. For the treatment of primary dysmenorrhoea there is some evidence of the effectiveness of uterine nerve ablation (UNA) when compared to a control of no treatment. The comparison between UNA with presacral neurectomy (PSN) for primary dysmenorrhoea showed no significant difference in pain relief in the short term, however long term PSN was shown to be significantly more effective. For the treatment of secondary dysmenorrhoea the identified RCTs addressed only endometriosis. The treatment of UNA combined with surgical treatment of endometrial implants versus surgical treatment of endometriosis alone showed that the addition of UNA did not aid pain relief. For PSN combined with endometriosis treatment versus endometriosis treatment alone there was also no overall difference in pain relief, although the data suggests a significant difference in relief of midline abdominal pain. Adverse events were significantly more common for presacral neurectomy, however the majority were complications such as constipation, which may spontaneously improve. There is insufficient evidence to recommend the use of nerve interruption in the management of dysmenorrhoea, regardless of cause. Future RCTs should be undertaken.
Dysmenorrhea is the leading cause of short-term school absenteeism. It is associated with a negative impact on social, academic, and sports activities of many female adolescents. Dysmenorrhea has not previously been described among Hispanic adolescents, the fastest growing minority group in the United States. To determine the prevalence of dysmenorrhea among Hispanic female adolescents; its impact on academic performance, school attendance, and sports and social activities; and its management. A total of 706 Hispanic female adolescents, in grades 9 through 12, completed a 31-item questionnaire about the presence, duration, severity, treatment, and limitations of dysmenorrhea at a local urban high school. Among participants who had had a period in the previous 3 months, 85% reported dysmenorrhea. Of these, 38% reported missing school due to dysmenorrhea during the 3 months prior to the survey and 33% reported missing individual classes. Activities affected by dysmenorrhea included class concentration (59%), sports (51%), class participation (50%), socialization (46%), homework (35%), test-taking skills (36%), and grades (29%). Treatments taken for dysmenorrhea included rest (58%), medications (52%), heating pad (26%), tea (20%), exercise (15%), and herbs (7%). Fourteen percent consulted a physician and 49% saw a school nurse for help with their symptoms. Menstrual pain was significantly associated with school absenteeism and decreased academic performance, sports participation, and socialization with peers (P<.01). Dysmenorrhea is highly prevalent among Hispanic adolescents and is related to school absenteeism and limitations on social, academic, and sports activities. Given that most adolescents do not seek medical advice for dysmenorrhea, health care providers should screen routinely for dysmenorrhea and offer treatment. As dysmenorrhea reportedly affects school performance and attendance, school administrators may have a vested interest in providing health education on this topic to their students. Arch Pediatr Adolesc Med. 2000;154:1226-1229.
Article
Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological complaint. Common treatment for dysmenorrhoea is medical therapy such as nonsteroidal anti-inflammatories (NSAIDs) or oral contraceptive pills (OCPs) which both work by reducing myometrial activity (contractions of the uterus). The efficacy of conventional treatments such as nonsteroidals is considerable, however the failure rate is still often 20-25%. Many consumers are now seeking alternatives to conventional medicine and research into the menstrual cycle suggests that nutritional intake and metabolism may play an important role in the cause and treatment of menstrual disorders. Herbal and dietary therapies number among the more popular complementary medicines yet there is a lack of taxonomy to assist in classifying them. In the US, herbs and other phytomedicinal products (medicine from plants) have been legally classified as dietary supplements since 1994. Included in this category are vitamins, minerals, herbs or other botanicals, amino acids and other dietary substances. For the purpose of this review we use the wider term herbal and dietary therapies to include the assorted herbal or dietary treatments that are classified in the US as supplements and also the phytomedicines that may be classified as drugs in the European Union. To determine the efficacy and safety of herbal and dietary therapies for the treatment of primary and secondary dysmenorrhoea when compared to each other, placebo, no treatment or other conventional treatments (e.g. NSAIDS). Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials, CCTR, MEDLINE, EMBASE, CINAHL, Bio extracts, and PsycLIT were performed to identify relevant randomised controlled trials (RCTs). The Cochrane Complementary Medicine Field's Register of controlled trials (CISCOM) was also searched. Attempts were also made to identify trials from the National Research Register, the Clinical Trial Register and the citation lists of review articles and included trials. In most cases, the first or corresponding author of each included trial was contacted for additional information. The inclusion criteria were RCTs of herbal or dietary therapies as treatment for primary or secondary dysmenorrhoea vs each other, placebo, no treatment or conventional treatment. Interventions could include, but were not limited to, the following; vitamins, essential minerals, proteins, herbs, and fatty acids. Exclusion criteria were: mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD. Seven trials were included in the review. Quality assessment and data extraction were performed independently by two reviewers. The main outcomes were pain intensity or pain relief and the number of adverse effects. Data on absence from work and the use of additional medication was also collected if available. Data was combined for meta-analysis using Peto odds ratios for dichotomous data or weighted mean difference for continuous data. A fixed effects statistical model was used. If data suitable for meta-analysis could not be extracted, any available data from the trial was extracted and presented as descriptive data. MAGNESIUM: Three small trials were included that compared magnesium and placebo. Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less. There was no significant difference in the number of adverse effects experienced. VITAMIN B6: One small trial of vitamin B6 showed it was more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6. MAGNESIUM AND VITAMIN B6: Magnesium was shown to be no different in pain outcomes from both vitamin B6 and a combination of vitamin B6 and magnesium by one small trial. The same trial also showed that a combination of magnesium and vitamin B6 was no different from placebo in reducing pain. VITAMIN B1: One large trial showed vitamin B1 to be more effective than placebo in reducing pain. VITAMIN E: One small trial comparing a combination of vitamin E (taken daily) and ibuprofen (taken during menses) versus ibuprofen (taken during menses) alone showed no difference in pain relief between the two treatments. OMEGA-3 FATTY ACIDS: One small trial showed fish oil (omega-3 fatty acids) to be more effective than placebo for pain relief. JAPANESE HERBAL COMBINATION: One small trial showed the herbal combination to be more effective for pain relief than placebo, and less additional pain medication was taken by the treatment group. Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily, although this conclusion is tempered slightly by its basis on only one large RCT. Results suggest that magnesium is a promising treatment for dysmenorrhoea. It is unclear what dose or regime of treatment should be used for magnesium therapy, due to variations in the included trials, therefore no strong recommendation can be made until further evaluation is carried out. Overall there is insufficient evidence to recommend the use of any of the other herbal and dietary therapies considered in this review for the treatment of primary or secondary dysmenorrhoea.
Article
To compare the efficacy of the cyclooxygenase (COX)-2-specific inhibitor valdecoxib with naproxen sodium in treating menstrual pain associated with primary dysmenorrhea. This single-center, double-blind, placebo-controlled, randomized, crossover study compared the efficacy and safety of single oral doses of valdecoxib 20 mg and 40 mg with naproxen sodium 550 mg, or placebo, with an option of treatment for up to 3 days, twice daily. Efficacy was assessed by time-weighted sum of total pain relief, sum of pain intensity difference, time-specific pain relief, and pain intensity difference over 12 hours, time to rescue medication or first re-medication, the percentage of patients taking rescue medication, and patient's global evaluation of study medication. Mean time-weighted sum of total pain relief and sum of pain intensity difference were significantly superior to placebo for the first 8 and 12 hours after the initial dose of valdecoxib 20 mg (P <.01) and 40 mg (P <.001). Valdecoxib 20 mg and 40 mg were comparable to naproxen sodium 550 mg for all efficacy measures. Other differences in efficacy measures favoring the higher dose of valdecoxib did not achieve statistical significance, with the exception of sum of pain intensity difference-12. Both doses of valdecoxib were well tolerated. Both valdecoxib 20- and 40-mg doses were effective and well tolerated for the treatment of primary dysmenorrhea. Valdecoxib 20 mg and 40 mg demonstrate analgesic efficacy, based on onset, magnitude, and duration of analgesia that is similar to naproxen sodium, making it a potential choice for treating women with primary dysmenorrhea.
Article
To develop and test the safety and effectiveness of an acupressure garment (the Relief Brief) in decreasing the pain and symptom distress associated with dysmenorrhea. A randomized clinical trial applied a 2 (Relief Brief use or control group) x 3 (baseline and two treatment measurement occasions) mixed factorial design. Sixty-one (61) women with moderately severe primary dysmenorrhea were randomly assigned to the standard treatment control group or the Relief Brief acupressure device group after one pretreatment menses, with 58 women reporting the effect on their pain during two post-treatment menstrual cycles. The acupressure garment: The Relief Brief is a cotton Lycra panty brief with a fixed number of lower abdominal and lower back latex foam acupads that provide pressure to dysmenorrhea-relieving Chinese acupressure points. Menstrual pain severity (worst pain and symptom intensity), pain medication use, and adverse effects were analyzed using between-groups and repeated measures analyses of treatment effects. Statistical and clinical significance criteria were applied a priori. For pain measures and pain medication use, the group main effect, time main effect and group x time interaction were statistically significant. Median pain medication use, the same for both groups at baseline (6 pills per day), dropped to 2 pills per day for the Relief Brief group but remained at 6 pills for the control group at the second treatment cycle. Predicted clinical significance criteria were surpassed: almost all (90%) women wearing the Relief Brief obtained at least a 25% reduction in menstrual pain severity (a 2-3 point drop) compared to only 8% of the control group (z = 6.07; p < 0.05). Relief Brief use was associated with at least a 50% decline in menstrual pain symptom intensity in more than two thirds of the women. An acupressure device is an effective and safe nonpharmacologic strategy for the treatment of primary dysmenorrhea. With design modifications, it could serve as a main treatment modality for women who suffer from primary dysmenorrhea and do not wish to or cannot use the conventional pharmacologic agents. In addition, this acupressure device may serve as an adjuvant therapy to medication in more severe cases of dysmenorrhea.
Article
Doppler findings in women with severe symptoms of primary dysmenorrhea include high impedance to blood flow in uterine arteries with a preserved cyclic pattern throughout the whole cycle. Doppler findings in women who present with mild symptoms of primary dysmenorrhea are not yet documented. The aim of this study was to investigate possible differences in Doppler findings among women with mild and severe primary dysmenorrhea. One hundred and fifty four women were examined with color Doppler ultrasound: 50 in the control group, 60 in the mild and 44 in the severe primary dysmenorrhea subgroup. We calculated resistance index in uterine arteries in these women on the first day of the cycle, in the follicular (days 9-12) and the luteal (days 20-23) phase of the cycle and used analysis of variance for comparing results. The rate of visualization was 100% for uterine and arcuate arteries, 44-76% for the radial and 32-62% for spiral arteries, respectively. A significant difference in Doppler index values among the mild and severe dysmenorrheic group was observed in the luteal phase for the arcuate artery and in all the three measurement periods for the radial and spiral arteries. There is a difference in Doppler findings between women with mild and severe symptoms of primary dysmenorrhea.
Article
Primary dysmenorrhea occurs in as many as 50% of female adolescents and is associated with significant decreases in academic performance, sports participation, and socialization with peers. Complementary and alternative medicine treatment options are of interest to patients and health care providers. The use of rose tea to alleviate menstrual pain has long been a part of folk knowledge around the world but has not been studied scientifically. To determine the effectiveness of drinking rose tea as an intervention for reducing pain and psychophysiologic distress in adolescents with primary dysmenorrhea, 130 female adolescents were randomly assigned to an experimental (n = 70) and a control (n = 60) group. Preintervention and postintervention data at 1 month, 3 months, and 6 months were gathered on the biopsychosocial outcomes of dysmenorrhea. The results showed that compared with the control group, the experimental group perceived less menstrual pain, distress, and anxiety and showed greater psychophysiologic well-being through time, at 1, 3, and 6 months after the interventions. Findings suggest that drinking rose tea is a safe, readily available, and simple treatment for dysmenorrhea, which female adolescents may take to suit their individual needs.
Article
The aim of this study was to describe the prevalence, clinical effect, characteristics, and underlying risk factors of primary dysmenorrhea (PD) in Canada. A stratified, random sample of 2721 women 18 years and older was identified, and the women were interviewed by telephone. Data about menstrual symptoms and patterns and socio-demographic factors were obtained. The frequency, severity, and effect of menstrual pain were quantified. Logistic regression analysis was performed in order to identify independent risk factors for PD. In the sample, 1546 women were having menstrual periods; of these, 934 (60%) met the criteria for PD. Sixty percent of the women with PD described their pain as moderate or severe. Fifty-one percent reported that their activities had been limited, and 17% reported missing school or work because of PD. The prevalence of PD decreased with increasing age (P < 0.001) and increased with smoking (P = 0.002). Users of oral contraceptives (OCs) tended to have less pain than non-users (P = 0.005). Socio-economic status, nulliparity, and earlier age at menarche were not independently associated with PD. However, nulliparous women, smokers, and women not using OCs were more likely to report disabling symptoms. The majority of Canadian women will suffer from dysmenorrhea at some time during their reproductive years. Available prescription treatments are underused. Young age, smoking, and non-use of OCs are independent risk factors for PD.
Article
A proof-of-concept study to assess the safety and efficacy of a traditional Chinese medicine formula as treatment for primary dysmenorrhea showed no statistically significant benefit over placebo. However, some efficacy parameters suggested possible superiority of the active treatment and so a larger study needs to be performed to determine whether this remedy has a role in the treatment of dysmenorrhea.
Radix Rehmanntae Glutinosae Conquitae) 15g, Bai Shao (Radix Paeoniae Latiflorae) 20g, Dang Gui (Radix Angelicae Sinensis) 12g, Hong Hua (Flos Carthami Tinctorii) 12g
  • Yu Bu Shen Hua
  • Tang
Bu Shen Hua Yu Tang: Ba Jie Tian (Radix Morindae Officinalis) 15g, Gou Qi Zi (Fructus Lycii) 15g, Xian Ling Pi (Herba Epimedii) 15g, Shu Di (Radix Rehmanntae Glutinosae Conquitae) 15g, Bai Shao (Radix Paeoniae Latiflorae) 20g, Dang Gui (Radix Angelicae Sinensis) 12g, Hong Hua (Flos Carthami Tinctorii) 12g, Pu Huang (Pollen Typhae) 12g, Wu Ling Zhi (Excrementum Trogopteri Seu Pteromi) 12g, Chuan Xiong (Radix Ligustici Chuanxiong) 6g, Xiang Fu (Rhizoma Cypri Rotundi) 9g, Zhi Qiao (Fructus Aurantii) 9g, Gan Cao (Radix Glycyrrhizae Uralensis)6g. Modification of formulation might be required. Herbal decoction, one dose daily, starting from 5 days prior to bleeding for a period of 7 days
Bing Pian (Borneol), dosage of herbal ingredients unstated. 4 pills, bid Jiu Qi Jian Tong Wan: no detail of dosage of herbal ingredient stated. 9g, bid Both groups started herbs 7 days prior to period for a period of 5 days Outcomes 1. Pain: Experimental: Cases of cure: 14/60 Cases of improvement
  • Wen Jing Jian Tong Jiao Nang
Wen Jing Jian Tong Jiao Nang: Rou Gui (Cortex Cinnamomi Cassiae), Jiu Xiang Chong (Aspongopus), Xiao Hui Xiang (Fructus Foeniculi Vulgaris), Dang Gui (Radix Angelicae Sinensis), Wu Ling Zhi (Excrementum Trogopteri Seu Pteromi), Xiang Fu (Rhizoma Cypri Rotundi), Yan Hu Suo (Rhizoma Corydalis Yanhusuo), Bing Pian (Borneol), dosage of herbal ingredients unstated. 4 pills, bid Jiu Qi Jian Tong Wan: no detail of dosage of herbal ingredient stated. 9g, bid Both groups started herbs 7 days prior to period for a period of 5 days Outcomes 1. Pain: Experimental: Cases of cure: 14/60 Cases of improvement: 27/60 Cases of response: 16/60 Cases of no response: 3/60 Total effectiveness: 57 (95.00%)
Nang: no details of formulation provided, 4 pills, tid. Both groups started from 3 days prior to bleeding for a period of 5 days Outcomes 1. Pain: Experimental: Rate and Cases of cure
  • Tian Qi Tong Jing Jiao
Tian Qi Tong Jing Jiao Nang: no details of formulation provided, 4 pills, tid. Both groups started from 3 days prior to bleeding for a period of 5 days Outcomes 1. Pain: Experimental: Rate and Cases of cure: 51.4%, 18/35
no details of formula stated. 10g, bid, started from 7 days prior to bleeding for a period of 10 days Outcomes 1. Pain: Experimental: Rate and Cases of cure
  • Shu Yue Yue
Yue Yue Shu: no details of formula stated. 10g, bid, started from 7 days prior to bleeding for a period of 10 days Outcomes 1. Pain: Experimental: Rate and Cases of cure: 38%, 19/50
Unclear Chinese herbal medicine for primary dysmenorrhoea (Review) Copyright © 2007 The Cochrane Collaboration Ltd Table 04 Quality features of included studies (Continued ) Study Allocation concealme Randomisation Blinding ITT Follow-up Huang
Adverse effect: unstated 4. Lab tests: unstated 5. Use of additional medication: unstated 6. Satisfaction from patients: unstated 7. Quality of life: unstated Notes Allocation concealment B – Unclear Chinese herbal medicine for primary dysmenorrhoea (Review) Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd Table 04. Quality features of included studies (Continued ) Study Allocation concealme Randomisation Blinding ITT Follow-up Huang 2000 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 2 cycles Jiang 2000 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Kotani 1997 Unclear/Not stated Unclear/Not stated Double blinded Unclear/Not stated 2 cycles Li 1999 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Li 2001 Unclear/Not stated Unclear/Not stated Single blinded Unclear/Not stated 3 cycles Li 2004 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Liu 2000 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Liu 2002 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Liu 2003 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Liu 2004 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Liu 2005 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Lu 2002 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Luo 2001 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Miao 2001 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Niu 1996 Unclear/Not stated Unclear/Not stated Single blinded Unclear/Not stated 3 cycles Qin 2003 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Shen 2001 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Song 2003 Unclear/Not stated Unclear/Not stated Single blinded Unclear/Not stated 3 cycles Sun 2006 Unclear/Not stated Unclear/Not stated Unclear/Not stated Unclear/Not stated 3 cycles Sun 2004 Unclear/Not stated Random number table Double blinded Unclear/Not stated 3 cycles Sun 2004-2
95% CI) 17 19 100.0 12
  • Subtotal
Subtotal (95% CI) 17 19 100.0 12.00 [-54.76, 78.76 ]
Radix Aucklandiae Lappae) 6g. Modification of formulation might be required. Herbal decoction, 1 dose daily, 3 days prior to bleeding for a period of 6 days Indomethacin: 50mg, bid, as soon as pain started for a period of 6 days Outcomes 1
  • Xiao Hui Xiang
Xiao Hui Xiang (Fructus Foeniculi Vulgaris) 9g, Guang Mu Xiang (Radix Aucklandiae Lappae) 6g. Modification of formulation might be required. Herbal decoction, 1 dose daily, 3 days prior to bleeding for a period of 6 days Indomethacin: 50mg, bid, as soon as pain started for a period of 6 days Outcomes 1. Pain: Experimental: Rate and Cases of cure: 62.50%, 20/32
Rhizoma Cypri Rotundi) 15g. Herbal decoction, one dose daily, 7 days prior to period till postal menstruation Self-designed formula
  • Xiang Fu
Xiang Fu (Rhizoma Cypri Rotundi) 15g. Herbal decoction, one dose daily, 7 days prior to period till postal menstruation Self-designed formula (external administration): Bai Zhi (Radix Angelicae) 6g, Dang Gui (Radix Angelicae Sinensis) 6g, Chi Shao (Radix Paeoniae Rubrae) 6g, Da Huang (Radix et Rhizoma Rhei) 6g,
Minium) mixed with sesame oil, in a form of paste, applied on 'Guan Yuan' outpoint during menstruation
  • Huang Dan
Huang Dan (Minium) mixed with sesame oil, in a form of paste, applied on 'Guan Yuan' outpoint during menstruation
Pain: Experimental: Cases of cure: 48/70 Cases of improvement: 14/70 Cases of response: 6/70 Cases of no response: 2/70 Total effectiveness: 97.14% Control: Cases of cure: 18/62 Cases of improvement: 18/62 Cases of response: 2/62 Cases
  • Yuan Hu Zhi Tong Pian
Yuan Hu Zhi Tong Pian: 4 tablets, bid, 1st OCT herbs started from 7 days prior to period for 7 days Outcomes 1. Pain: Experimental: Cases of cure: 48/70 Cases of improvement: 14/70 Cases of response: 6/70 Cases of no response: 2/70 Total effectiveness: 97.14% Control: Cases of cure: 18/62 Cases of improvement: 18/62 Cases of response: 2/62 Cases of no response: 2/62 Total effectiveness: 93.55
3 pills, tid Both groups started from 4 days prior to bleeding for a period of 7 days Outcomes 1. Pain: Experimental: Cases and rate of cure: 12/42, 28.6% Casess and rate of improvement: 23/42, 54.8% Cases and rate of response: 4/42, 9
  • Yuan Hu Zhi Tong Jiao Nang
Yuan Hu Zhi Tong Jiao Nang: 3 pills, tid Both groups started from 4 days prior to bleeding for a period of 7 days Outcomes 1. Pain: Experimental: Cases and rate of cure: 12/42, 28.6% Casess and rate of improvement: 23/42, 54.8% Cases and rate of response: 4/42, 9.5% Cases and rate of no response: 3/42, 7.1% Total effectiveness: 92.9%
Clinical observation on the use of Li Qi Huo Xue Tang in the treatment of severe cases of primary dysmenorrhoea
  • Jiang
The use of Nuan Gong Zhi Tong Tang in the treatment of 40 cases of primary dysmenorrhoea
  • Li
Analysis on the use of Wen Jing Zhi Tong Yin in the treatment of 60 cases of primary dysmenorrhoea of a patter of 'retention of coldness and stagnation of blood'
  • Liu
Clinical observation on the use of Du Yi Wei Jiao Nang in the treatment of 60 cases of dysmenorrhoea
  • Qin
The use of Tong Jing Jiao Nang in the treatment of 50 cases of primary dysmenorrhoea
  • Song
Laboratory research on the use of Tong Jing Ling suppository in the treatment of primary dysmenorrhoea of the pattern of retention of cold and stagnation of Qi
  • Wang
Modified Dang Gui Shao Yao San in the treatment of 45 cases of primary dysmenorrhoea
  • Wu
The use of Nv Jin Jiao Nang in the treatment of 30 cases of primary dysmenorrhoea
  • Ye
The use of Tong Jing Yao Fang in the treatment of 78 cases of primary dysmenorrhoea
  • Chen
Clinical anaylsis on the use of Dan Shen Tong/Tanshinone in the treatment of 203 cases of primary dysmenorrhoea
  • Ji
A clinical report on use of Yang Xue Tiao Jing He Ji for 200 cases of dysmenorrhoea
  • Li
Clinical observation on the use of Tong Jing Lin Ke Li in the treatment of primary dysmenorrhoea
  • Song
Clinical research on the use of series capsule Tiao Jing Mie Tong in the treatment of primary dysmenorrhoea
  • Wang
Clinical observation on the use of Jia Wei Muo Jie Pian in the treatment of primary dysmenorrhoea
  • Deng