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

Geographical Origin Authentication-A Mandatory Step in the Efficient Involvement of Honey in Medical Treatment

Nowadays, in people's perceptions, the return to roots in all aspects of life is an increasing temptation. This tendency has also been observed in the medical field, despite the availability of high-level medical services with many years of research, expertise, and trials. Equilibrium is found in the combination of the two tendencies through the inclusion of the scientific experience with the advantages and benefits provided by nature. It is well accepted that the nutritional and medicinal properties of honey are closely related to the botanical origin of the plants at the base of honey production. Despite this, people perceive honey as a natural and subsequently a simple product from a chemical point of view. In reality, honey is a very complex matrix containing more than 200 compounds having a high degree of compositional variability as function of its origin. Therefore, when discussing the nutritional and medicinal properties of honey, the importance of the geographical origin and its link to the honey's composition, due to potential emerging contaminants such as Rare Earth Elements (REEs), should also be considered. This work offers a critical view on the use of honey as a natural superfood, in a direct relationship with its botanical and geographical origin.

Comparison of the effect of vaginal misoprostol and evening primrose oil capsule with misoprostol alone on the consequences of abortion in women with intrauterine fetal death: a randomized clinical trial

BACKGROUND

Misoprostol is the choice drug for inducing an abortion with intrauterine fetal death, but it has several side effects that increase with accumulating the dose received. Induction abortion with cheap and non-invasive methods with minimal complications is essential. This study aimed to compare the effect vaginal misoprostol plus vaginal evening primrose oil capsule with vaginal misoprostol alone on the consequences of abortion in pregnant women with intrauterine fetal death at 12-20 weeks of pregnancy.

METHODS

This study is a randomized, triple-blind clinical trial with two parallel groups at a ratio of 1:1. We randomized 82 women with indications of termination of pregnancy due to intrauterine fetal death into two groups. The experimental group (n = 42) received 200 mcg of misoprostol tablet with 1000 mg evening primrose oil capsule intravaginal. The control group (n = 40) received 200 mcg of misoprostol tablet with 1000 mg evening primrose oil placebo capsule intravaginal. Both groups received the drugs every 4 h for up to five doses. The primary outcome was the mean induction-to-fetal expulsion interval. Secondary outcomes were the mean dose of misoprostol, the highest pain intensity in the induction-to-fetal expulsion interval, the frequency of participants requiring blood transfusion, curettage, and the frequency of side effects of misoprostol or evening primrose oil. Pain intensity was measured through the Visual Analog Scale.

RESULTS

The mean age of the experimental group was 32.30 ± 6.19 years, and the control group was 30.27 ± 7.68 years. The mean gestational age of the experimental group was 15.29 ± 2.26 weeks, and the control group was 15.10 ± 1.89 weeks. The mean induction-to-fetal expulsion interval in the experimental group (3.12 ± 2.17 h) was significantly lower than that in the control group (8.40 ± 4.1 h) (p < 0.001). The mean dose of misoprostol received in the experimental group (271.42 ± 115.39 mcg) was significantly lower than that in the control group (520 ± 201.53 mcg) (p < 0.001). Also, the mean pain intensity in the experimental group (5.02 ± 0.60) was significantly lower than that in the control group (8.65 ± 1.001) (p < 0.001). The two groups were not significantly different in the frequency of blood transfusion requirements, analgesia and drug side effects. The need for curettage in the experimental group (4.8%) was significantly lower than that in the control group (47.5%) (p < 0.001).

CONCLUSIONS

Vaginal administration of evening primrose oil with misoprostol reduced duration of time of fetal expulsion, pain intensity, mean dose of misoprostol received, and the need for curettage in participants. Therefore, we suggest this method for induced abortion in women with intrauterine fetal death.

TRIAL REGISTRATION

IRCT20181207041873N3. Dated 16/2/2021 prospectively registered https://en.irct.ir/user/trial/53681/view .

A Comprehensive Review of the Effect of Honey on Human Health

Honey is a nutritious, healthy, and natural food, to which antioxidant, anti-inflammatory, and antimicrobial properties have been attributed, mainly due to its content of phenolic compounds. The aim of this review is to analyze the available evidence of the effect of honey on humans. Forty-eight clinical trials published between 1985 and 2022 were analyzed, with a total of 3655 subjects. More beneficial effects of honey intake than no or negative effects on different cardiovascular and metabolic risk factors, glucose tolerance, mucositis caused by chemo-radiotherapy, cough in children and wound healing, among others have been observed. Although the number of studies conducted to date is limited and the different investigations are not standardized, beneficial effects of honey intake have been observed, especially when its intake replaces the intake of other sweeteners. In addition, honey could be a safe adjuvant to be administered alongside drugs used for certain diseases.

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.

Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women

OBJECTIVE

The study was conducted to determine the prevalence of dysmenorrhea and investigate factors associated with dysmenorrhic pain among university students in Lahore, Pakistan.

DESIGN AND SETTING

A cross-sectional study was conducted across various public and private sector universities in Lahore.

METHODS

A self-administered structured questionnaire was used to collect data from 600 randomly selected female university students.

RESULTS

The prevalence of dysmenorrhea was 91.5%. Age at menarche (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.10-3.50) was the only significant factor associated with dysmenorrhea. The mean pain severity score among dysmenorrhic students was 5.62 ± 2.28. Most of the participants (65.8%) were experiencing moderate/severe pain. Univariate analysis showed that irregular cycle (OR [95% CI] = 1.62 [1.13-2.33]), age at menarche of ≤14 years (OR [95% CI] = 1.46 [1.05-2.04]), duration of menses of more than 5 days (OR [95% CI] = 1.42 [1.02-1.99]), stress (OR [95% CI] = 2.16 [1.54-3.03]), moderate meat/protein consumption (OR [95% CI] = 1.55 [1.08-2.21]), and medical specialization (OR [95% CI] = 1.72 [1.17-2.52]) were significantly associated with pain severity among dysmenorrhic female students. Multivariate binary logistic regression analysis revealed that medical specialization (OR [95% CI] = 1.83 [1.22-2.73]), age at menarche (OR [95% CI] = 0.603 [0.42-0.86]), regularity of menses (OR [95% CI] = 1.52 [1.04-2.22]), moderate meat/protein consumption (OR [95% CI] = 1.69 [1.16-2.45]), and stress (OR [95% CI] = 1.87 [1.32-2.66]) were independent predictors of moderate/severe dysmenorrhic pain.

CONCLUSION

The study revealed an alarmingly high prevalence of dysmenorrhea among university students. High levels of stress and early menarche were the potent determinants of moderate/severe dysmenorrhea that disturbs quality of life.

Comparison of effect of auriculotherapy and mefenamic acid on the severity and systemic symptoms of primary dysmenorrhea: a randomized clinical trial

BACKGROUND

Primary dysmenorrhea (PD) is the most common complaint in young women and adolescents. Side effects of non-steroidal anti-inflammatory drugs can limit their use. Therefore, non-pharmacological pain relief methods such as auriculotherapy may play an important role in PD management. This study was conducted to compare the effect of auriculotherapy and mefenamic acid on the severity and systemic symptoms of PD.

METHODS

In a randomized clinical trial, 83 students were randomized into two groups. In the auriculotherapy group, electrical stimulation of the ear was conducted once a week for two menstrual cycles. In each cycle close to menstruation, ear seeds were inserted on pressure points to be pressed in times of pain. In the mefenamic acid group, subjects took mefenamic acid capsules upon seeing the initial symptoms of menstruation until the pain reduces. The primary outcomes were mean pain intensity and systemic symptoms associated with it. Pain intensity was measured through the visual analog scale (VAS) and the verbal multidimensional scoring system (VMS). Systemic symptoms were assessed using VMS, as well as the yes/no question form.

RESULTS

Mean pain intensity with the VAS was significantly lower in the auriculotherapy group than the mefenamic acid group in the first and second cycles of intervention. There was a significant difference in VMS grade between both groups during the second cycle of intervention. In terms of the systemic symptoms in the second cycle of intervention, no subjects had dysmenorrhea grade 3 (common systemic symptoms) in the auriculotherapy group. Whereas in the mefenamic acid group, 16.7% of the subjects still had dysmenorrhea grade 3. There was no significant difference between the two groups in the frequency of systemic symptoms of PD. There was a significant decrease in the frequency of fatigue and diarrhea in both groups. However, there was a significant reduction in the frequency of nausea, headache, and anger in the auriculotherapy group.

CONCLUSION

Mean pain intensity with the VAS was lower with the auriculotherapy. Also, 65.9% of auriculotherapy group subjects were in the dysmenorrhea grades 0 and 1. Therefore, auriculotherapy is recommended because of its fewer complications and more effect on PD.

TRIAL REGISTRATION

ClinicalTrials.gov IRCT20181207041873N1. Registered on February 24, 2019. https://en.irct.ir/user/trial/35967/view.

Effectiveness of Olea Herbal Ointment on Episiotomy Wound Healing Among Primiparous Women: A Randomized Clinical Trial

Background: Episiotomy is a surgical incision in the perineal region to increase the vaginal diameter during delivery. Since the perineal region is not well visible to the mothers and there is a possibility of infection for the episiotomy wound by vaginal and rectal bacteria, such a cut is associated with infection and delay in wound healing. Objectives: This study aimed to detect the effect of Olea ointment on episiotomy wound healing among primiparous women. Methods: This randomized controlled clinical trial included 73 women referring to the Al-Zahra Education, Research, and Remedial Center in Rasht, Iran, during 2017 - 18. Women were randomly assigned into two groups: Intervention group (n = 39) and control group (n = 34). Episiotomy wound healing was assessed using the REEDA scale prior to the intervention, 2 and 24 hours following the first intervention, and 5 and 10 days after delivery. Statistical analysis was performed using Fisher’s exact test, Mann-Whitney U test, independent t-test, repeated-measure test, Friedman test, and chi-square. Results: The mean baseline scores of REEDA was 2.72 ± 0.46 in the Olea ointment group and 2.71 ± 0.46 in the control group; however, there was no statistically significant difference between the two groups. On the other hand, the episiotomy healing scores in the Olea ointment group were significantly lower than those of the control group at four intervals in the follow-up assessments: -0.34 (95% CI: -0.56 to -0.12) two hours after intervention, -0.63(95% CI: -0.89 to -0.37) 24 hours after intervention, -0.30 (95% CI: -0.48 to -0.12) on Day 5 postpartum, and -0.29 (95% CI: -0.46 to -0.13) on Day 10 postpartum. Conclusions: The present findings suggested that the Olea ointment facilitated wound healing of episiotomy; however, further studies are suggested to support these data.

Anti-Inflammatory and Restorative Effects of Olives in Topical Application

METHODS

A literature search was conducted (1990-2021) in Medline, Embase, CINAHL, Google Scholar, Science Direct, SID, IranDoc, and Magiran databases. From the 102 reviewed articles, 17 articles were selected to be included in the current article.

RESULTS

Various forms of olive have long been used to accelerate the healing of various wounds and skin damage such as diabetic foot ulcers, atopic dermatitis, diaper dermatitis, episiotomy wound, and nipple ulcer but there are still no credible documents or articles that provide reliable evidence of topical use.

CONCLUSION

According to the information obtained from the articles reviewed, olive oil appears to be an effective, safe, and available treatment. This study suggests that olive oil is an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of olive oil in similar or different injuries in different populations.

Augmentation of the Female Reproductive System Using Honey: A Mini Systematic Review

Phytochemical contents of honey are presumed to be beneficial to the female reproductive system (FRS). However, the biological effects of honey supplementation (HS) in vivo on the FRS remain unclear. This review aims to investigate the current literature on the effects of HS on the FRS, particularly on the sex hormone profile and reproductive organs (uterus and vagina). A systematic literature search using Scopus, MEDLINE via Ovid and Cochrane Library databases was conducted. Records were screened and identified for preclinical and clinical studies addressing the effects of HS on the FRS. Data on populations, interventions, outcomes and methodological quality were extracted. Studies were synthesised using tables and written summaries. Of the 198 identified records, six fulfilled the inclusion criteria. All six records were used for data extraction: two experimental studies using rats as the model organism and four human clinical studies of honey on female reproductive health. HS elevated the progesterone levels, restrained body weight increase, prevented uterine and vaginal atrophies in ovariectomised rats, attenuated symptoms of candidiasis and improved oxidative status in patients. Current evidence shows that short-term HS following surgical or physiological menopause exerts an oestrogenic, antioxidant and anti-inflammatory effect on the FRS. However, insufficient long-term studies preclude any definitive conclusions.

Apitherapy for menopausal problems

PURPOSE

Apitherapy, a method from the field of complementary and alternative medicine, claims that all health problems including menopausal problems can be cured using bee products, especially honey, bee-collected pollen, propolis, and royal jelly. This study was to investigate the recommendations of protagonists of holistic apitherapy and compare these to the current evidence.

METHODS

Since holistic apitherapy is only promoted in books and apitherapeutical congresses, we identified books on the topic in English, French, and German language via bookseller platforms and the JUSTfind system of the Justus-Liebig-University Gießen, Germany, which comprises 337 databases from the EBSCO Discovery Service.

RESULTS

Only 29.5% (n = 38) of the apitherapy books mentioned the topic of menopausal problems. Among these, there were 24 different recommendations. Royal jelly is the number one recommended therapy, followed by pollen, the combination of pollen and royal jelly, and propolis. All other recommendations are mentioned just once. The recommendation regarding royal jelly must be regarded as correct. Strictly speaking, evidence regarding bee-collected pollen is poor, since all studies on pollen did not investigate pollen directly, but pollen extracts and these pollens came from pollen that was anemophilous but not entomophilous.

CONCLUSION

Royal jelly and pollen could be interesting treatment options in cases of menopausal symptoms. In order to promote bee products for menopausal symptoms with a good conscience trials, comparing bee products against other options, such as selective serotonin reuptake inhibitors, C. racemosa extracts, and/or yoga should be initiated, since these methods have already proven their value.

The effect of bee prepolis on primary dysmenorrhea: a randomized clinical trial

Objective

Primary dysmenorrhea typically occurs with no associated pelvic pathology and is common in adolescents and young women. This study evaluated the effect of bee propolis on relief of primary dysmenorrhea.

Methods

The study was performed in 2018 in Hamadan, in western Iran, among female students with primary dysmenorrhea. Participants were randomly divided into two groups, using balanced block randomization, and were administered a placebo or bee propolis capsules for 5 days during two menstruation cycles. The number of participants required was estimated to be 86 in total, with 43 students in each group according to the inclusion criteria. We used the visual analog scale to assess pain severity. The independent t-test was conducted for comparing between two groups, using SPSS 16.0.

Results

A significant change was found in the mean pain scores during the first (P<0.001) and second (P<0.001) months after using bee propolis in comparison with placebo. The means of the pain scores in the bee propolis group were 5.32±2.28 and 4.74±2.40 in first and second months after the intervention, respectively, whereas the means of the pain scores in the placebo group were 7.40±1.21 and 7.17±1.24 in first and second months after the intervention, respectively.

Conclusion

Our study showed that the use of bee propolis for two months compared with placebo reduced primary dysmenorrhea during the first and second months after use, with no adverse effects. Therefore, it could be used as an alternative to nonsteroidal anti-inflammatory drugs for relief of primary dysmenorrhea.

The Effect of Olea Ointment on Post-Episiotomy Pain Severity in Primiparous Women: A Paralleled Randomized Controlled Clinical Trial

Background:

Episiotomy is the most commonly performed surgical procedure during delivery, and its associated pain is a major problem in obstetrics. This study aimed to determine the effect of Olea ointment on the severity of post-episiotomy pain in primiparous women.

Materials and Methods:

This paralleled randomized controlled clinical trial was performed on 73 primiparous women in Al-Zahra hospital in Rasht, Iran in 2017-2018. Women were randomly allocated into intervention (n = 39) and control (n = 34) groups. The first intervention was performed 4 h after the episiotomy. This continued every 8 h for 10 days. The pain intensity of episiotomy was assessed by the Visual Analogue Scale (VAS) before intervention, 2 and 24 h after the beginning of intervention, and 5 and 10 days after childbirth. Descriptive and inferential statistics (Mann-Whitney, Fisher exact test, Independent t-test, Friedman test, and Chi-square) were performed for statistical analysis.

Results:

There were no significant differences among two groups in terms of demographic and obstetrics characteristics. The severity of pain in intervention and control group before the intervention was not statistically significant, but the variable depicted a meaningful difference between the groups 2 h after the intervention (U = 483.50, p = 0.021), 24 h after the intervention (U = 489.50, p = 0.019), as well as the 5^th day (U = 112.50, p < 0.001) and 10^th day postpartum (U = 136.50, p < 0.001).

Conclusions:

Based on the findings, Olea ointment could be used effectively for reducing of episiotomy pain. Similar studies are recommended.

Prevalence of dysmenorrhea and predictors of its pain intensity among Palestinian female university students

BACKGROUND

Few studies on gynaecological problems of young females in Arab countries were published. The aim of this study was to determine the prevalence of dysmenorrhea and predictors of its pain among university students in Palestine.

METHODS

A cross - sectional study was carried out on a randomly selected sample of An-Najah National University female students. A pre-designed questionnaire, which included questions regarding menstrual cycle, pain during menstruation, life style, nutritional habits, and symptoms associated with menstrual pain, was used. Pain intensity was measured using visual analogue scale.

RESULTS

A total of 956 female students were involved in the study. Of the total study sample, 846 (85.1%) reported having pain during menstruation; i.e. dysmenorrhea. Dysmenorrhea was significantly [(p = 0.027); OR = 1.5, 95% CI (1.05-2.19)] associated with age at menarche. The mean score of pain among dysmenorrhic females was 6.79 ± 2.64. The majority (654; 80.34%) of dysmenorrhic females reported having moderate/ severe pain. Univariate analysis using Chi-square test for factors associated with moderate/severe pain among dysmenorrhic females were irregular cycle [(p = 0.015); OR = 1.57, 95% CI = (1.09-2.30)], skipping breakfast [(p < 0.001); OR = 1.93, 95% CI = (1.33-2.79)], academic specialization [(p = 0.03; OR = 2.2, 95% CI = (1.21-3.98)] for medical specialization with reference to students in humanities), high stress level [(p = 0.036; OR = 1.53, 95% CI = (1.03-2.28)], and living in dormitories [(p = 0.034); OR = 1.72, 95% CI = (1.04-2.86)]. Multivariate analysis using binary logistic regression enter method showed that medical specialization [(p = 0.045); OR = 1.92, 95% CI = (1.02-3.64)] for medical students with reference to students in humanities), skipping breakfast [(p = 0.001); OR = 1.96, 95% CI = (1.35-2.86)], and irregular cycle [(p = 0.022); OR = 1.56, 95% CI = (1.07-2.29)] were the only significant predictors of moderate/severe dysmenorrhic pain.

CONCLUSION

There is a high proportion of dysmenorrhea among Palestinian female university students. Skipping breakfast was the strongest predictor for moderate/severe dysmenorrhea. Increased awareness regarding factors that might influence the intensity of dysmenorrhic pain is needed.