The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial

Ginger for Pain Management in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Background: Primary dysmenorrhea is a common gynecological disorder that affects many women of reproductive age. Ginger, a widely used spice with anti-inflammatory properties, has been suggested as a potential treatment for the painful cramps associated with this condition. Objective: The aim of this systematic review and meta-analysis was to evaluate the efficacy of ginger for pain management in primary dysmenorrhea. Methods: Our systematic review was registered in Prospero (CRD42023418001). Six English (PubMed, Scopus, Web of Science, PsycINFO, CINAHL complete, and Cochrane) and one Persian electric database (SID) was searched up to May 2023 for English or Persian studies that measure the effect of ginger on pain in dysmenorrhea. The Cochrane tool was used to assess the risk of bias of the included studies. Random effects meta-analyses were performed to obtain standardized mean differences (SMD) and 95% confidence intervals (CI). Results: Out of the 804 articles initially identified from the search, 24 were included for qualitative analysis and 12 for quantitative analysis after a full-text evaluation. The combined results of the studies indicate that ginger is notably more effective than placebo in reducing both the intensity (SMD = -1.13; 95% CI = -1.59 to -0.68, I2 = 81.05%) and duration of pain (SMD = -0.29; 95% CI = -0.46 to -0.12). There were no differences between ginger and nonsteroidal anti-inflammatory drugs (NSAIDs) (SMD = 0.01; 95% CI = -0.24 to 0.25), or exercise (SMD = 0.06; 95% CI = -0.66 to 0.78) for pain intensity. Safety-related data were infrequently reported. Conclusions: The results of this meta-analysis suggest that ginger can effectively reduce pain associated with dysmenorrhea. The findings are limited due to risk of bias in the included studies and the unclear risk-benefit ratio.

Carboranyl Analogues of Mefenamic Acid and Their Biological Evaluation

Mefenamic acid represents a widely used nonsteroidal anti-inflammatory drug (NSAID) to treat the pain of postoperative surgery and heavy menstrual bleeding. Like other NSAIDs, mefenamic acid inhibits the synthesis of prostaglandins by nonselectively blocking cyclooxygenase (COX) isoforms COX-1 and COX-2. For the improved selectivity of the drug and, therefore, reduced related side effects, the carborane analogues of mefenamic acid were evaluated. The ortho-, meta-, and para-carborane derivatives were synthesized in three steps: halogenation of the respective cluster, followed by a Pd-catalyzed B-N coupling and hydrolysis of the nitrile derivatives under acidic conditions. The COX inhibitory activity and cytotoxicity for different cancer cell lines revealed that the carborane analogues have stronger antitumor potential compared to their parent organic compound.

The effect of a probiotic on gastrointestinal symptoms due to menstruation in healthy adult women on oral contraceptives: randomized, double-blind, placebo-controlled trial protocol

Introduction

For many women, uncomfortable and stressful symptoms accompany the menstrual cycle each month, sometimes in a debilitating manner. Previous studies have reported that gastrointestinal symptoms in healthy women significantly differ by the day of the menstrual cycle, but few studies have assessed interventions intended to minimize these symptoms. Probiotics supplements have been shown to attenuate gastrointestinal symptom severity as well as self-reported feelings of stress in various populations. This study evaluates the effect of a probiotic on abdominal pain and gastrointestinal symptoms in healthy women who take an oral contraceptive, have regular menses, and typically experience these symptoms during menstruation with the primary aim being change in abdominal pain intensity related to the menstrual cycle with probiotic versus placebo supplementation.

Methods and analysis

In this randomized, double-blind, placebo-controlled parallel study, participants will receive either a probiotic or placebo supplement. Participants will begin answering questionnaires approximately 7 days before the start of menstruation (i.e., active bleeding), and 3 days later, they will begin consuming the study supplement for 8 weeks. The questionnaires administered will collect data about abdominal pain severity (primary outcome) and duration related to the menstrual cycle, digestive health, dietary intake, stress, and digestion-associated quality-of-life. A subgroup of women will provide weekly vaginal swabs and stool samples to examine the effect of the probiotic supplement on microbiota composition and diversity for exploratory purposes. Two-sided tests using a linear model and a type I error rate of α = 0.05 will be employed to test all hypotheses. Continuous variables will be presented as means with standard errors and categorical variables, as counts or proportions.

Ethics and dissemination

This study was reviewed and approved by the University of Florida Institutional Review Board 01. Written informed consent will be obtained from all participants prior to any study activities. Study findings will be disseminated at scientific conferences and publication in the trial registry or in a peer-reviewed journal. Any protocol amendments will be reported in the final manuscript of this study.

Trial registration

ClinicalTrials.gov NCT04457401. Registered prospectively on 07 July 2020. The trial was completed in December of 2021.

Protocol version

V4.0 (11-04-2020)

Trial status

Currently recruiting. Recruitment began in November 2020 and extend until December 2021.

Effect of varash oil to decrease menstrual pain in primary dysmenorrhea of senior high school student at Palu City

OBJECTIVE

menstrual pain is a common gynecological symptom at women on or near their menstrual period. Two third of them experienced moderate to severe pain. However, just several seek for medical help. This research aims to know the effect of ginger oil used on decreasing menstrual pain scale.

MATERIALS AND METHODS

this cross over experimental study was held from February until May 2020 on 64 grade XI high school students at Palu city. Participants were grouping cluster randomly into group A which applied 5ml ginger oil five days before until the second day of the first menstrual period, and group B that given the same treatment in the next period. A visual pain scale measured the pain scale on the second day of the menstrual period.

RESULT

most participants were in the age of 17 years old. The study found a lowering of pain scale significantly at both groups after treatment. The main menstrual pain scale were 6.87 ± 1.817 and 6.46±1.362 decreased to 3.48±1.928 and 4.24±2.010 after treatment (p=0.0001). Differences between the two groups were significant in the first period (p=0.0001) but not significant in the second period (p=0.410).

CONCLUSION

the use of ginger oil several days before menstruation can reduce menstrual pain scale on students with primary dysmenorrhea; therefore, its use can be recommended to prevent the pain.

Metabolomics Study of Guizhi Fuling Capsules in Rats With Cold Coagulation Dysmenorrhea

Dysmenorrhea refers to a kind of uterine cramping pain that occurs in women during the period of menstrual. Guizhi Fuling Capsules are mainly used for the treatment of various pain syndromes and especially effective in treating primary dysmenorrhea. However, the research on its modern pharmacology and mechanism of action have not been thoroughly carried out. It is not clear about the main active ingredients, potential targets and metabolic pathways involved in its efficacy. Therefore, this research project employed estradiol benzoate sensitization combined with oxytocin pain to construct the cold coagulation syndrome dysmenorrhea model, observed the anti-dysmenorrhea effect of Guizhi Fuling Capsules, and used the metabolomics to explore its mechanism. The results showed that Guizhi Fuling Capsules could considerably reduce the number of writhing times in dysmenorrhea rats, increasing the level of PGE2 and β-EP and reducing the contents of PGF2α in rat serum. Pathological sections of uterus and ovaries also showed that Guizhi Fuling Capsules could significantly relieve endometrial hyperplasia and improve ovarian function. The LC/MS-based metabolomics of rat uterine indicated that the model group has a great deviation from the control group. Compared with the model group, the Guizhi Fuling Capsules group had a tendency to shift to the control group, and the main metabolic changes was mainly concentrated on saturated and unsaturated fatty acids. Among them, arachidonic acid is in a pivotal position, and the expression of its rate-limiting enzyme (COX-2) involved in its cyclooxygenase metabolic pathway was significantly up-regulated in the model group, but significantly decreased after the intervention of Guizhi Fuling Capsules. In conclusion, Guizhi Fuling Capsules can effectively relieve primary dysmenorrhea, and this effect may be attributed to the regulation effects of Guizhi Fuling Capsules on endogenous metabolism, such as inhibiting arachidonic acid converted to prostaglandins through downregulate the expression of COX-2, which plays an anti-inflammatory effect.

Synthesis of Novel Esters of Mefenamic Acid with Pronounced Anti-nociceptive Effects and a Proposed Activity on GABA, Opioid and Glutamate Receptors

BACKGROUND

Mefenamic acid (MFA), a commonly prescribed non-steroidal anti-inflammatory drug (NSAID), possesses a greater risk of dose-related central nervous system (CNS) toxicity than other NSAIDs. In this study, α-tocopherol and α-tocopherol acetate were selected as prodrug moieties for MFA in an attempt to reduce the CNS toxicity and enhance the therapeutic efficacy.

METHOD

α-tocopherol monoester of MFA (TMMA) and α-tocopherol di-ester of MFA (TDMA) were synthesized by esterification reaction and were subjected to various in vivo characterizations.

RESULTS

Masking of the carboxylate group of MFA with the proposed pro-moieties significantly (p<0.05) delayed the onset of tonic-clonic seizure in mice. Besides, the intraperitoneal administration of TMMA and TDMA in mice produced significantly (p<0.05) stronger anti-inflammatory effects in the carrageenan-induced paw edema test and greater anti-nociceptive effect in the acetic acid-induced writhing test than MFA at an equimolar dose of 20 mg/kg. Treatment with TMMA and TDMA caused a significant (p<0.05) inhibition of pain at 1st and 2nd phases of formalin-induced licking test in mice, whereas treatment with MFA inhibited the 2nd phase only. Pretreatment with naloxone and flumazenil significantly (p<0.05) reversed the anti-nociceptive effect of MFA, TMMA and TDMA in the acetic acid-induced writhing test. In addition, treatment with TMMA and TDMA caused significantly (p<0.05) a higher inhibition of pain in the glutamate-induced licking response in mice than MFA.

CONCLUSION

Masking the carboxylate moiety of MFA by α-tocopherol and α-tocopherol acetate has a great potential for reducing CNS toxicity, enhancing the therapeutic efficacy and altering the mode of anti-nociceptive action.

Integrating Lifestyle Focused Approaches into the Management of Primary Dysmenorrhea: Impact on Quality of Life

OBJECTIVE

This narrative review aims to identify alternative ways to improve the symptoms of primary dysmenorrhea (PD).

BACKGROUND

PD refers to endometrial painful cramps during the premenstrual period. This condition affects a lot of women worldwide and is accompanied with absenteeism and high economic costs, thus, risk-free, and effective therapeutic approaches are needed. Pharmacological agents such as non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which are widely prescribed for these women, demonstrate adequate efficacy in alleviating pain and discomfort. The long natural course of the disease dictates remedies that focus on lifestyle changes and on improvement of Quality-of-Life (QoL) for women suffering with PD.

MATERIALS AND METHODS

Five major search engines, namely MEDLINE, PubMed, EMBASE, and Cochrane Library were searched for articles published prior to October 2020 focused in PD. A total of 74 paper were included.

DISCUSSION

Physical activity, for instance yoga, aromatherapy massage, and other forms of relaxation, vitamins and dietary changes, acupressure and acupuncture,a and some psychological interventions are just few of the proposed health behavior targeted approaches in cases of PD. This review focuses on lifestyle changes and alternative methods that could potentially result in minimizing symptoms of PD and in improving overall QoL for these patients, by providing current scientific evidence on their efficacy.

CONCLUSION

Complementary and alternative medicine practices (CAM) are widely accepted by women. International literature provides controversial scientific evidence, thus further studies need to be conducted in order to prove or disregard their efficacy in cases of PD.

Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis

It has been evidenced that very few systematic reviews have examined the effectiveness of ginger for pain duration and its severity among women with primary dysmenorrhea. This meta-analysis was therefore performed to methodically incorporate and significantly evaluate randomized controlled ginger studies for the treatment of primary dysmenorrhea. The literature was searched using PubMed, Embase, Ovid, ClinicalKey, Medline, and electronic database. We have analyzed clinical trials by comparing ginger with placebo and non-steroidal anti-inflammatory drugs in women with primary dysmenorrhea. The primary outcomes assessed in our meta-analysis were pain severity and pain duration. Secondary outcomes were change in bleeding, side effects of the drug, and rate of satisfaction. We have screened a total of 638 studies, out of which narrative synthesis was formulated for eight studies. We have performed a meta-analysis of five trials examining ginger with placebo and other two randomized controlled trials comparing ginger with a non-steroidal anti-inflammatory drug (NSAID); it seems to be more helpful for relieving menstrual pain than a placebo (mean difference [MD] = 2.67, 95% CI = 3.51-1.84, P = 0.0001, I2 = 86%), although it was found that ginger and NSAIDs were equally effective in pain severity (risk ratios [RR] = 1.15, 95% CI = 0.53-2.52, P = 0.72, I2 =77%). We have not observed any significant difference between ginger and placebo on pain duration among primary dysmenorrheic women (MD = -2.22, 95% CI = -7.62-3.18, P = 0.42, I2 = 56%). Accessible information proposes that oral ginger can be a compelling treatment for primary dysmenorrhea. This meta-analysis strongly supports the requirement for high methodological quality consistency for upcoming trials.

Effects of Mefenamic Acid in Pain Control during Loop Electrical Excision Procedure:A Prospective Double-Blind Randomized Control Trial

OBJECTIVE

To investigate the effectiveness of pre-procedural oral mefenamic acid compared with placebo in women undergoing Loop Electrosurgical Excision Procedure (LEEP) with intracervical lidocaine injection.

STUDY DESIGNS

A prospective double-blinded randomized control trial. Materials, Setting, Methods: Women undergoing LEEP for any indications were asked to participate in the study. The participants were randomly allocated into two groups. In group 1 (oral mefenamic acid), the participants were offered oral mefenamic acid (500 mg) for 30 minutes before procedures. In group 2 (placebo), the patients were given oral placebo (identical tablet) for 30 minutes before operation. All participants received immediate 10 mL of 2% lidocaine with 1:100,000 of epinephrine intracervical injection before undergoing the LEEP. All participants were excised in one piece of LEEP. No top-hat excision in this study.  The patients graded their pain on a 10-cm visual analog scale (VAS) at different points during the procedure, including speculum insertion, at starting excision, and 30 minutes post excision. Primary outcomes revealed the difference of VAS during all steps of LEEP by generalized estimating equations procedure.

RESULTS

Sixty participants (30 in mefenamic group and 30 in placebo group) participated in this study. The study did not find differences of VAS during all steps of LEEP and analgesic drug requirement at 30 minutes after LEEP procedure. All patients reported no immediate complications and no intervention-related adverse events were observed.

CONCLUSION

Using pre-procedural oral mefenamic acid before LEEP procedure was not associated with pain reduction during all steps of excision.
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Use of complementary and alternative therapies for the treatment of dysmenorrhea among undergraduate pharmacy students in Malaysia: a cross sectional study

Background

Dysmenorrhea is a common problem that affects female students’ quality of life and academic activities. Complementary and alternative therapies (CATs) are used for the treatment of dysmenorrhea. This study investigated the practices and perceptions of female undergraduate students with dysmenorrhea towards CATs.

Methods

This was a cross-sectional study conducted among undergraduate pharmacy students in a public university in Malaysia using a validated and pre-tested self-administered questionnaire. The study was conducted in November and December 2019. The data was analysed using descriptive and inferential statistical tests.

Results

Of the 318 female undergraduate students invited, 219 completed the questionnaire (response rate: 68.9%) with 52% aged between 21 and 23 years. The prevalence of dysmenorrhea was 72.1%, and the prevalence of ever-use and current use of CATs was 70.3 and 54.4%, respectively. Bed rest (71.5%), hot compress/heating pad (47.5%) and massage (43.0%) were the most common CATs used by the respondents. The most common reasons for using CAT were to reduce the need for analgesics (61.4%), efficacy (37.3%) and recommendation by others (32.9%). About 23 and 9% of the respondents believed that CATs were equally “effective” and “more effective” than analgesics, respectively. Reducing the need for analgesics (AOR: 4.066, 95% CI: 2.136–7.739) and those who agreed that CATs are effective (AOR: 2.701, 95% CI: 1.337–5.457) were independently associated with the current use CATs for the treatment of menstrual pain.

Conclusion

The prevalence of ever-use and current use of CATs is high among female undergraduate pharmacy students. Bed rest and heat applications are the most common CATs used. Reducing the need for analgesics and efficacy are the factors associated with the current use of CATs. Students should be educated about the safe and effective use of CATs to reduce adverse effects and improve their quality of life.

Randomized, double-blind, placebo-controlled clinical trial studying the effects of Turmeric in combination with mefenamic acid in patients with primary dysmenorrhoea

Primary dysmenorrhea (PDM) is one of the common complaints in women. This study aimed to assess the effects of turmeric and mefenamic acid and a combination compared with placebo on PDM. This clinical trial was conducted on dormitory students with PDM. Subjects completed the visual analog scale (VAS) before randomization. One hundred twenty-eight patients, randomly assigned to one of following groups: Turmeric group (n=32), mefenamic acid group (n=32), turmeric and mefenamic acid group (n=32), and placebo group (n=32). Turmeric and mefenamic acid were administrated in 500mg and 250mg, respectively. Pain severity was assessed in the baseline and the end line by VAS. Statistical analysis was performed using SPSS software. The combination of turmeric and mefenamic acid, dramatically, alleviated pain in comparison to other groups. Our results illustrated that combination of turmeric and mefenamic acid would be better in pain alleviation in PDM.

The Use of a New Food-Grade Lecithin Formulation of Highly Standardized Ginger (Zingiber officinale) and Acmella oleracea Extracts for the Treatment of Pain and Inflammation in a Group of Subjects with Moderate Knee Osteoarthritis

PURPOSE

To evaluate the efficacy of a new food-grade lecithin formulation of standardized extracts of Zingiber officinale and Acmella oleracea on pain and inflammation.

PATIENTS AND METHODS

Pilot study with one-group pretest-posttest quasi-experimental design in which 50 subjects with moderate knee osteoarthritis (OA) (mean age: 62.46±8.45) were supplied for four weeks with two tablets/day.

RESULTS

Primary outcomes were 1) the evaluation of pain intensity, by a 30-day visual analogue scale (VAS) and 2) the assessment of knee function by WOMAC (Western Ontario and McMaster Universities Arthritis) Index and by Tegner Lysholm Knee Scoring collected at baseline, at 15 and 30 days after treatment. Secondary outcomes were 3) health-related quality of life, by the ShortForm36 (SF-36); 4) inflammation grade by C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR); and 5) body composition by dual-energy X-ray absorptiometry (DXA) measured at baseline and 30 days after treatment. Data showed significant effects of supplement intake for WOMAC (β=-3.27, p<0.0001), Lysholm (β=1.06, p=0.0003), CRP (β=-0.13, p=0.006), ESR (β=-3.09, p=0.004), physical activity (β=4.3, p=0.009) and fat-free mass (β=376.7, p=0.046). A significant VAS's decrease over time was observed in both knees (left: β=-0.08, p<0.0001; right: β=-0.07, p<0.0001).

CONCLUSION

The tested formulation seems to be effective and also free of side effects.

Chronic pelvic pain syndrome: Highlighting medicinal plants toward biomolecules discovery for upcoming drugs formulation

Chronic pelvic pain syndrome (CPPS) can be triggered by a various types of gynecological, gastrointestinal, urological, and musculoskeletal disorders. Recently, the role of the central nervous system has proven to be an integral part on the development of any chronic pain syndrome, including CPPS. However, owing to the complex and heterogeneous etiology and pathophysiology of CPPS, the establishment of effective therapeutic interventions remains challenging for both physicians and patients. Nonetheless, recent studies have pointed that medicinal plants and their secondary metabolites can be effectively used in CPPS therapy, besides contributing to restore the patients' quality of life and potentiate the conventional CPPS management. In this sense, this review aims to provide a careful overview on the biomedical data for the use of medicinal plants use and their secondary metabolites on CPPS management.

Supportive therapy for dysmenorrhea: Time to look beyond mefenamic acid in primary care

Dysmenorrhea is a recurrent and chronic primary health care issue. Mefenamic acid and NSAID based therapy regimens have unwanted side effects on its long-term usage. NSAIDs reduce pain, albeit they do not address the enhanced pain sensitivity and other neuronal symptoms of dysmenorrhea. Hence, there is a need for supportive therapy which can target both pelvic pain and the neuronal symptoms. Historically, European medicinal plants and their extracts such as, valeriana officinalis, humulus lupulus, and passiflora incarnata have been used in menstrual disorders for centuries. The current review is focused on the available evidence for its use as monotherapy or as supportive therapy in combination with other conventional medications.

Comparison of the effect of vitamin E, vitamin D and ginger on the severity of primary dysmenorrhea: a single-blind clinical trial

Objective

Dysmenorrhea is one of the most common problems for women, especially during their reproductive age. Various studies have examined the effects of vitamins D and E and ginger supplements. This study aimed to investigate the individual effects of each of these supplements on dysmenorrhea.

Methods

This single-blind clinical trial was conducted in 2016 on students aged 18 to 25 years who complained of mild to severe dysmenorrhea. The participants were randomly assigned into 4 groups: vitamin D, vitamin E, ginger, and placebo. The effects of the supplements on the severity of dysmenorrhea were evaluated in 2 successive cycles using the visual analog scale (VAS) and a questionnaire.

Results

Initially, 240 female students were enrolled in the study; thereafter, 40 students were excluded from the study owing to follow-up loss. The average VAS score for dysmenorrhea in the entire study population was 7.13±0.80 before the intervention; the mean VAS score after the first and second months of supplement use was 5.37±1.51 and 4.93±1.48, respectively. The highest reduction in pain severity was observed in the ginger group (F=74.54, P<0.001).

Conclusion

Vitamin D, vitamin E, and ginger significantly reduced the severity of dysmenorrhea, with ginger having the most significant effect followed by vitamin D and vitamin E. Given the low risk of these supplements, more studies must be conducted on their use as opposed to analgesics.

Comparison of Rosemary and Mefenamic Acid Capsules on Menstrual Bleeding and Primary Dysmenorrhea: A Clinical Trial

Background:

Primary dysmenorrhea is the most common complaint of women. Imbalance secretion of prostaglandin from the endometrium during menstruation cycle is effective in primary dysmenorrhea and menstrual bleeding. The aim of this study was to compare rosemary capsule and mefenamic acid on menstrual bleeding and primary dysmenorrhea.

Materials and Methods:

This randomized double-blinded study was conducted on 82 students with primary dysmenorrhea in the Islamic Azad University of Mashhad in 2016. Participants had moderate dysmenorrhea and normal menstrual bleeding. No intervention was carried out at the two cycles. During the next two cycles, participants were randomly divided into two groups (rosemary and mefenamic acid(. Participants in the intervention group received 250 mg rosemary capsules and the control group received 250 mg mefenamic acid capsules in the first 3 days of menstruation. The visual analogue scale (VAS) was used to determine the severity of pain and Hingham chart to determine the amount of bleeding in menstruation. Independent t-tests, Mann--Whitney were used for statistical analysis. p < 0.05 was considered statistically significant.

Results:

Pain intensity score standard deviation (SD) before and after intervention for rosemary group were 40.39 (11.41) and 23.57 (12.78) (t₄₁ = 9.90, p < 0.001). For the control group, they were 46.75 (13.32) and 28.29 (17.21) (t₃₉ = 9.10, p < 0.001). Menstrual bleeding score (SD) before and after intervention for rosemary group were 55.21 (21.32) and 46.30 (24.16) (t₄₁ = 2.60, p = 0.01). For the control group, they were 51.05 (23.87) and 43.43 (29.47) (t₃₉ = 2.10, p = 0.01). There was no statistically significant difference between the pain severity and menstrual bleeding score SD in these two groups.

Conclusions:

Rosemary capsules reduce the menstrual bleeding and primary dysmenorrhea the same as mefenamic acid capsules.

No. 345-Primary Dysmenorrhea Consensus Guideline

OBJECTIVE

This guideline reviews the investigation and treatment of primary dysmenorrhea.

INTENDED USERS

Health care providers.

TARGET POPULATION

Women and adolescents experiencing menstrual pain for which no underlying cause has been identified.

EVIDENCE

Published clinical trials, population studies, and review articles cited in PubMed or the Cochrane database from January 2005 to March 2016.

VALIDATION METHODS

Seven clinical questions were generated by the authors and reviewed by the SOGC Clinical Practice-Gynaecology Committee. The available literature was searched. Guideline No. 169 was reviewed and rewritten in order to incorporate current evidence. Recommendations addressing the identified clinical questions were formulated and evaluated using the ranking of the Canadian Task Force on Preventive Health Care.

BENEFITS, HARMS, AND COSTS

Primary dysmenorrhea is common and frequently undertreated. Effective therapy is widely available at minimal cost. Treatment has the potential to improve quality of life and to decrease time lost from school or work.

GUIDELINE UPDATE

This guideline is a revision and update of No. 169, December 2005.

SPONSORS

SOGC.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Microbiota and Chemical Compounds in Fermented Pinelliae Rhizoma (Banxiaqu) from Different Areas in the Sichuan Province, China

This study focused on the microbiota and chemical compounds of the fermented Pinelliae Rhizoma produced in Longchang (LC), Zizhong (ZZ) and Xindu (XD), in Sichuan Province (China). High-throughput sequencing was used to analyze the microbiota. GC-MS and LC-MS were used to detect the compounds produced during the three different Pinelliae Rhizoma fermentation processes. The bacteria and fungi of the three fermented Pinelliae Rhizoma differed substantially, with the bacterial content mainly composed of the Bacillus genus, while the common fungi were only included in four OTUs, which belong to three species of Eurotiomycetes and Aspergillus cibarius. 51 volatile compounds were detected; they varied between LC, XD, and ZZ fermented Pinelliae Rhizoma. C10 and C15 terpenes were most frequently detected, and only curcumene and β-bisabolene were detected in the three fermented Pinelliae Rhizoma. 65 non-volatile compounds were detected by LC-MS, most were of C16, C18, C20, C21 and C22 structures. Cluster analysis showed more similarity between LC and XD fermented Pinelliae Rhizoma with regards to volatile compound content, but more similarity between the XD and ZZ fermented Pinelliae Rhizoma for non-volatiles. Moreover, no correlation between geographical distance and microflora or compounds of fermented Pinelliae Rhizoma was observed. These results showed that hundreds of compounds are produced by the natural mixed fermentation of Pinelliae Rhizoma, and may mostly relate to the microorganisms of five species.

Ginger: Panacea or Consumer’s Hype?

Ginger in its many forms, from juices of the fresh rhizome, to ginger powder and ginger essential oil, is growing in popularity for claimed universal health benefits. Nevertheless, and contrarily to the common notion of the public, ginger is not devoid of side effects, especially interactions with other drugs, and many of the claimed benefits remain to be substantiated. This work presents a comprehensive revision of the current state of the art on ginger pharmacokinetics and bioavailability, interaction with active pharmaceutical ingredients, raising awareness of the risks of uncontrolled ginger consumption. A second section of the work described the verified actions of various extracts of ginger, or of their main active ingredients, gingerols, based mainly on data obtained from controlled clinical trials. Finally, the last section is devoted to innovative technological solutions to improve the bioavailability of gingerols and ginger extracts that are expected to ultimately lead to the development of more consumer-compliant products.

Effect of Ginger and Novafen on menstrual pain: A cross-over trial

OBJECTIVE

Menstrual pain is a periodic pain which happens during the days of menses. The menstrual disturbances as a health problem among young girls affect not only reproductive, but also psychical health and quality of life. This study was done with the goal of comparing the effect of Ginger and Novafen on the menstrual pain.

MATERIALS AND METHODS

This crossover clinical trial study was done in Iran on 168 single girl students 18-26 years old in Babol University of Medical Sciences with primary menstrual pain. The participants were randomly allocated to two groups receiving the drugs Novafen and Ginger. At the beginning of pain, in the two groups 200 mg capsule was given every 6 h for two serial cycles. Pain severity was measured by the visual scale before treatment, 1 h after consuming the drug (for 24 h) and 48 h after the onset of drug.

RESULTS

The mean age of participants was 21.83 ± 2.07 years. It has been reported that the intensity of pain from dysmenorrhea decreased in the Novafen and Ginger groups. Before treatment, the average pain intensity in Novafen and Ginger users were 7.12 ± 2.32 and 7.60 ± 1.84, respectively and after treatment pain intensity decreased to 3.10 ± 2.69 and 2.97 ± 2.69, respectively. Differences between two groups each time showed no statistical significance (p > 0.05).

CONCLUSION

Both drugs reduced menstrual pain. Ginger as well as Novafen is effective in relieving pain in girls with primary dysmenorrhea . Therefore, treatment with natural herbal medicine, non-synthetic drug, to reduce primary dysmenorrhea is recommended.

Plants of the Genus Zingiber as a Source of Bioactive Phytochemicals: From Tradition to Pharmacy

Plants of the genus Zingiber (Family Zingiberaceae) are widely used throughout the world as food and medicinal plants. They represent very popular herbal remedies in various traditional healing systems; in particular, rhizome of Zingiber spp. plants has a long history of ethnobotanical uses because of a plethora of curative properties. Antimicrobial activity of rhizome essential oil has been extensively confirmed in vitro and attributed to its chemical components, mainly consisting of monoterpene and sesquiterpene hydrocarbons such as α-zingiberene, ar-curcumene, β-bisabolene and β-sesquiphellandrene. In addition, gingerols have been identified as the major active components in the fresh rhizome, whereas shogaols, dehydrated gingerol derivatives, are the predominant pungent constituents in dried rhizome. Zingiber spp. may thus represent a promising and innovative source of natural alternatives to chemical food preservatives. This approach would meet the increasing concern of consumers aware of the potential health risks associated with the conventional antimicrobial agents in food. This narrative review aims at providing a literature overview on Zingiber spp. plants, their cultivation, traditional uses, phytochemical constituents and biological activities.

Is Ginger Effective in Reducing Post-tonsillectomy Morbidity? A Prospective Randomised Clinical Trial

Objectives

An assessment of the effects of ginger on pain, nausea, vomiting, bleeding, and wound site healing that occur after tonsillectomy.

Methods

This prospective clinical study was participated by 49 patients aged 18–45 years out of 56 patients that underwent tonsillectomy and regularly attended follow-up visits. The patients were randomly divided into two groups. Group 1 consisted of 23 patients that used ginger capsules and group 2 consisted of 26 patients that did not use ginger capsules in addition to the routine antibiotic and paracetamol treatment following tonsillectomy. The pain, nausea, vomiting, and bleeding scores of patients were assessed on days 1, 4, 7, and 10 by using the visual analogue scale. Similarly, the epithelialization degrees of tonsillar bed were assessed on postoperative days 1, 4, 7, and 10 and regular oral intake times of patients were recorded.

Results

There were no differences between groups in terms of age and sex. On the postoperative days 1, 4, 7, and 10, the pain scores were lower in the group 1 (all P<0.001) and there were no differences between the two groups in terms of postoperative nausea, vomiting, and bleeding scores (P=0.35 and P=0.53). On the postoperative days 7 and 10, epithelialization in the tonsil bed was quicker in the group 1 (P=0.041 and P=0.026) and the regular oral intake time was earlier in group 1 (P<0.001).

Conclusion

In this study, ginger relieved pain, accelerated wound site epithelialization, and decreased duration of oral intake following tonsillectomy. It did not result in postoperative bleeding or any other complications. Ginger can be recommended as an adjunct to routine medical treatment for decreasing morbidity following tonsillectomy.

Investigating Chemical Composition and Indications of Hydrosol Soft Drinks (Aromatic Waters) Used in Persian Folk Medicine for Women's Hormonal and Reproductive Health Conditions

Hydrosol soft drinks in Persian nutrition culture are produced as side products of the essential oil industry to be used as safe remedies for treatment of some ailments. This study investigated hydrosols for women's hormonal health conditions. Detailed information was gathered by questionnaires. Chemical constituents of these mono- or poly-herbal hydrosols were identified after liquid/liquid extraction and gas chromatography-mass spectrometry. Hierarchical cluster and K-means analysis (SPSS software) were used to find their relevance. A literature survey was also performed. In most cases, thymol, carvacrol, and carvone were the major constituents except for dill, white horehound, willow, Moderr, and yarrow hydrosols, whose their major components were dill ether, menthol, phenethyl alcohol, linalool, or camphor. Based on clustering methods, some similarities could be found in their constituents with some exceptions. None of them have been studied scientifically before. These investigations may lead to the development of some functional drinks or even new lead components.

Comparison of the effect of honey and mefenamic acid on the severity of pain in women with primary dysmenorrhea

BACKGROUND AND OBJECTIVE

Primary dysmenorrhea starts simultaneously with menstruation or before it and usually continues for 48-72 h. As a prevalence disorder, it affects about 80-97% of women in the reproductive age. The conventional treatment modalities of primary dysmenorrhea are associated with complications and side effects. In addition, there is a lack of knowledge of the effect of honey on the treatment of primary dysmenorrhea. The objective of this study is to investigate the effect of honey on the severity of pain in women with dysmenorrhea.

METHODS

A randomized crossover clinical trial was conducted on 56 female students. Subjects were randomly assigned to two groups. Groups I and II received honey and mefenamic acid in the 'first treatment period', respectively. In the 'second treatment period', the intervention methods were reversed between the groups. Samples recorded the severity of pain during the first 3 days of menstruation.

RESULTS

There were no significant differences in the most severe level of pain in the first and second months of the first treatment period, and the first and second months of the second treatment period between the groups.

CONCLUSIONS

Honey and the mefenamic acid capsules led to the same amount of pain relief in women with primary dysmenorrhea. Honey is suggested to be used for pain relief due to its lower side effects and pharmacological complications.

Serum heme oxygenase-1 levels in patients with primary dysmenorrhea

PURPOSE

Primary dysmenorrhea effects the life-quality of women negatively. The aim of this study was to evaluate heme oxygenase-1 (HO1) activity together with malondialdehyde (MDA) and nitric oxide (NO) levels in patients with primary dysmenorrhea.

METHODS

A total of 28 nulliparous women with the diagnosis of primary dysmenorrhea and 26 healthy controls were included in this study. On the first day of menstruation, all patients underwent ultrasound examination to exclude pelvic pathology and the visual analogue scale was applied to patients. Patient's visual analogue scale (VAS) scores, age, body mass index (BMI), menstrual cycle length (day), length of bleeding (day) were recorded. In the same day, fasting blood samples were taken from each patient for biochemical analysis.

RESULTS

Serum MDA, NO and HO1 levels were found to be higher in women with primary dysmenorrhea compared to healthy controls (p = 0.012, p = 0.009, p < 0.001, respectively). There were no correlation among serum levels of HO1, NO and MDA, age, BMI, cycle length, pain score and menses duration in both groups. In Pearson's correlation analysis, positive correlation was found between HO1 levels with the NO levels (r = 0.316, p < 0.05) and VAS scores (r = 0.520, p < 0.01). Also, positive correlation was found between MDA levels and VAS scores (r = 0.327, p < 0.05).

CONCLUSIONS

Serum HO1, NO and MDA levels increase in patients with primary dysmenorrhea. Antioxidant support might be helpful to reduce pain severity in primary dysmenorrhea.

Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis

This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI −0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.

Efficacy of Ginger for Alleviating the Symptoms of Primary Dysmenorrhea: A Systematic Review and Meta-analysis of Randomized Clinical Trials

OBJECTIVE

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.