Introduction: Primary dysmenorrhea is a painful experience, highly prevalent among women, and it is defined as painful menstruation. This is often sufficiently severe that it prevents a woman from performing normal activities and it is a source of recurrent disability for a significant number of women in their early reproductive years. Primary dysmenorrhea is caused by excess prostaglandin F2α (PGF2α) produced in the endometrium. It can be accompanied by various symptoms such as nausea, diarrhea, vomiting, headache, and dizziness. Patients with primary dysmenorrhea generally experience exceptional pain relief through the use of nonsteroidal anti-inflammatory drugs (NSAIDs), which are prostaglandin synthetase inhibitors. However, these drugs are now rarely used because of their potential association with life-threatening cardiovascular and gastrointestinal (GI) effects. Studies suggest that some herbal treatments can provide pain relief comparable to that offered by NSAID therapy without the systemic side effects that may occur with these drugs. In this paper, a systematic review was conducted to evaluate the efficacy of herbal medications in the treatment of primary dysmenorrhea.
Methods: Five databases were used in this study: Google Scholar, Scientific information database (SID), ResearchGate, PubMed, and ScienceDirect. The following search terms were used: (Primary dysmenorrhea OR Dysmenorrhea OR Painful menstruation) AND (Herbal medicine treatment OR Herbal medicine OR Medicinal plants). NO language limitations were used.
Results: This review includes 11 papers, 4 of which on comparison of the efficacy of herbal medications with nonsteroidal anti-inflammatory drugs such as mefenamic acid, 4 on the effects of herbal treatment without applying any NSADs, one on the effect of rose essential oil on dysmenorrhea, one on the comparison of the effect of ginger and zinc sulfate on primary dysmenorrhea, and one on assessing medicinal plants as complementary medicine in primary dysmenorrhea. These studies looked into the use of plants such as Cinnamomum verum (cinnamon), Zingiber officinale (ginger), Salvia officinalis (common sage), Menta piperita (peppermint), Foeniculum vulgare (fennel), Teucrium polium (felty germander), Matricaria chamomilla (chamomile), Vitex angus-castus (vitex), Darcocephalum (dragon head), Anethum graveolens (dill) seeds, Thymus vulgaris (thyme), Cuminum cyminum (cumin), Amomum subulatum (black cardamom). Sample sizes in the studies ranged from 44 to 150 patients. The controls were given placebo capsules (containing starch (, placebo drops, diclofenac sodium, and mefenamic acid capsules, while individuals in the case groups were given fennelin oral drops, agnugol tablets, chamomile capsules, cinnamon capsules, Darcocephalum and salvia officinalis decoctions, peppermint capsules, diclofenac sodium with rose essential oil aromatherapy, and ginger capsules. The length of treatments in the studies ranged from one to seven months and the measures most commonly used in the studies were the visual analogue scale and clinical efficacy. No specific complications were reported.
Conclusion: From 11 papers in this review 4 found that the efficacy of herbal treatments is comparable or better than to that offered by NSAID treatments, and 7 papers confirm that medicinal plants are highly effective on primary dysmenorrhea. In many cases herbal medications appear to have far less complications than NSAIDs. Herbal treatments seem to suppress pain and reduce the clinical symptoms of dysmenorrhea by decreasing the level of prostaglandins, enhancing circulatory flow through the uterine pathway, mediating nitric oxide, and blocking the calcium channel. Further trails are required to confirm the benefits of mentioned medicinal plants and ensure the absence of complications.