Herbal and dietary therapies for primary and secondary dysmenorrhoea
Department of Obstetrics and
Gynecology, National Women's
Hospital, Claude Road, Epsom,
Auckland, New Zealand, 1003.
ml.wilson@auckland.ac.nz
BACKGROUND: Dysmenorrhoea refers
to the occurrence of painful
menstrual cramps of uterine
origin and is a common gynecological
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 STRATEGY:
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
randomized 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.
REVIEWER'S 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.
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