Intervention Review

Herbal and dietary therapies for primary and secondary dysmenorrhoea

  1. Michelle Proctor1,*,
  2. Patricia A Murphy2

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 23 APR 2001

Assessed as up-to-date: 12 FEB 2001

DOI: 10.1002/14651858.CD002124


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.

Author Information

  1. 1

    Department of Corrections , Psychological Service , Auckland, New Zealand

  2. 2

    University of Utah College of Nursing, Annette Poulson Cumming Endowed Chair in Women's and Reproductive Health, Salt Lake City, Utah, USA

*Michelle Proctor, Psychological Service , Department of Corrections , PO Box 302457 , North Harbour , Auckland, 1310, New Zealand. michelleproctor@clear.net.nz. michelle.proctor@corrections.govt.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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).

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以中草藥和飲食療法治療原發性及次發性痛經

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。

目標

為確定中草藥和飲食療法治療原發性及次發性痛經的療效和安全性,比較中草藥和飲食療法,並比較安慰劑,不治療或其他常規治療(如非固醇類抗炎藥)的效果。

搜尋策略

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。

選擇標準

納入標準為中草藥或飲食療法治療原發性及次發性痛經的隨機對照試驗,比較中草藥與飲食療法、安慰劑、不治療或常規治療的效果。干預措施可以包括但不僅限於下列各項:維生素,必需礦物質,蛋白質,中草藥以及脂肪酸。排除標準為:輕度或不常見的痛經,或是因子宮內避孕器造成的痛經。

資料收集與分析

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 (metaanalysis) 。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。

主要結論

鎂:共收錄三個小型試驗,比較鎂和安慰劑的療效。整體而言,鎂止痛效果比安慰劑更有效,需要額外的藥物也較少。不良反應的次數則無顯著差異。維生素B6:一個小型試驗顯示,維生素B6比安慰劑或結合鎂和維生素B6治療,更有效地減少疼痛。鎂和維生素B6:一個小型試驗顯示,在止痛的效果上,鎂與維生素B6之間以及與結合維生素B6和鎂之間沒有差異,此試驗同時表明,結合鎂和維生素B6與安慰劑之間止痛的效果沒有差異。維生素B1:一個大型試驗顯示,維生素B1比安慰劑更能有效地減少疼痛。維生素E :一個小型試驗比較每日使用維生素E結合經期使用ibuprofen與單純經期使用ibuprofen,止痛的效果沒有差異。omega3脂肪酸:一個小型試驗顯示,魚油(ω3脂肪酸)比安慰劑更能有效地止痛。日本漢方:一個小型試驗顯示,中草藥複方比安慰劑更能有效地止痛,所需額外的藥物也較少。

作者結論

每日100毫克維生素B1被證明治療痛經有效,但這個結論只建立於一個大型的隨機對照試驗基礎上。鎂治療痛經的結果相當有希望,但目前還不清楚應使用什麼劑量或什麼治療處方。由於收錄的隨機對照試驗差異頗大,因此需要進一步的評估而無強烈的建議。整體而言,目前並無足夠的證據建議使用本綜論收錄的任何中草藥或飲食療法,治療原發性或次發性痛經。

翻譯人

本摘要由高雄醫學大學附設醫院張榮參翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

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