Herbal and dietary therapies for primary and secondary dysmenorrhoea
Editorial Group: Cochrane Menstrual Disorders and Subfertility Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 12 FEB 2001
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Proctor M, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD002124. DOI: 10.1002/14651858.CD002124.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
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.
Data collection and analysis
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.
Plain language summary
Vitamin B1 and magnesium may both help reduce the pain of dysmenorrhoea
Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in the uterus. When the pain is associated with a recognised condition such as endometriosis, it is called secondary dysmenorrhoea. Primary dysmenorrhoea refers to pain of an unknown cause. Nonsteroidal anti-inflammatory drugs or the contraceptive pill have been used but more women are looking for non-drug therapies, including herbal and dietary treatments. The review of trials found some evidence that Vitamin B1 and magnesium help reduce pain but more research is needed.
痛經 (Dysmenorrhoea) 是指經期中子宮內絞痛，是一種常見的婦科不適。常以非固醇類消炎藥 (NSAID) 或口服避孕藥 (OCPs) 等內科方法治療，以減少子宮肌層活動(子宮收縮)達成效果。使用非固醇類消炎藥的常規治療效果相當好，但失敗率仍常達20 – 25 ％ 。許多消費者正尋求常規治療的替代療法。經由對月經週期的研究，顯示營養攝取和代謝，可能對月經疾病的發生及治療具有重要影響。中草藥和飲食療法是較受歡迎的輔助醫學，但缺乏一個分類法進行分類。在美國，草藥和其他植物性醫藥產品，自1994年以來，已在法律上被列為膳食補充劑。這類膳食補充劑中包括維生素，礦物質，草藥或其他植物性藥物，氨基酸及其他膳食物質。本綜論使用較廣泛的名詞定義中草藥和飲食療法，來收錄在美國被歸類為補充劑的各類草藥或飲食療法，以及在歐盟被歸類為藥品的植物性藥物。
使用電子文獻搜尋Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials、CCTR、MEDLINE、EMBASE、CINAHL、Bio extracts、 PsycLIT以及The Cochrane Complementary Medicine Field's Register of controlled trials (CISCOM) 等資料庫，以確認相關的隨機對照試驗 (RCTs) 。也嘗試由National Research Register、the Clinical Trial Register、綜論文獻及收錄的隨機對照試驗參考文獻清單中,搜尋相關的隨機對照試驗。大多數情況下，會接觸所收錄隨機對照試驗的第一作者或通訊作者，以獲得更多的資料。
本綜論共收錄7篇隨機對照試驗。研究品質評估和數據擷取分別由兩位獨立評論作者完成。主要結果為疼痛強度或疼痛緩解和不良反應的次數。也盡量收集無法工作的數據和所使用的額外藥物。結合數據後，其中二分類的數據使用Peto勝算比 (odds ratios) ，連續數據使用加權平均差 (weighted mean difference) ，以固定效應模型 (fixed effects model) 進行統合分析 (metaanalysis) 。如果無法提取適合統合分析的數據，任何有用的數據將從試驗中提取進行數據描述。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。
維生素B1 及鎂，可以減少痛經的疼痛。痛經 (經期中子宮內絞痛) 是一個很常見的身體不適。當經痛伴存著可確認的疾病，如子宮內膜異位症，則稱為次發性痛經。原發性痛經則指原因不明的疼痛。非固醇類消炎藥或避孕藥已使用於治療痛經，但更多的婦女仍找尋非藥物療法，包括草藥和飲食治療。評論隨機對照試驗後發現維生素B1和鎂，可幫助減輕疼痛，但仍需要更多的研究