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Snipe RMJ, Brelis B, Kappas C, Young JK, Eishold L, Chui JM, Vatvani MD, Nigro GMD, Hamilton DL, Convit L, Carr A, Condo D. Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: Systematic literature review and meta-analysis. Nutr Diet 2024; 81:94-106. [PMID: 37545015 DOI: 10.1111/1747-0080.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
AIM This systematic literature review with meta-analysis aimed to determine the effect of omega-3 long chain polyunsaturated fatty acids on prostaglandin levels and pain severity in women with dysmenorrhoea and identify adverse side effects. METHODS A literature search was conducted in Embase, Scopus, Web of Science, MEDLINE complete, CINAHL and AMED databases (PROSPERO CRD42022340371). Included studies provided omega-3 long chain polyunsaturated fatty acids compared to a control in women with dysmenorrhoea and reported pain and/or prostaglandin levels. A random effects meta-analysis with Cohen's d effect size (95% confidence interval) was performed in SPPS for studies that reported pain outcomes. Study quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. RESULTS Twelve studies (n = 881 dysmenorrhoeal women) of predominantly neutral quality (83%) were included that provided daily supplementation of 300-1800 mg omega-3 long chain polyunsaturated fatty acids over 2 or 3 months. Meta-analysis (n = 8 studies) showed a large effect of omega-3 long chain polyunsaturated fatty acids (d = -1.020, 95% confidence interval -1.53 to -0.51) at reducing dysmenorrhoea pain. No studies measured prostaglandin levels, 86% of studies measuring analgesic use showed a reduction with omega-3 long chain polyunsaturated fatty acids and few studies reported mild adverse side effects in individual participants. CONCLUSIONS Findings suggest that daily supplementation of 300-1800 mg omega-3 long chain polyunsaturated fatty acids over 2-3 months are generally well tolerated and reduces pain and analgesic use in women with dysmenorrhoea. However, the neutral quality of research is limited by methodological issues and the mechanism of action remains to be determined.
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Affiliation(s)
- Rhiannon M J Snipe
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Benjamin Brelis
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Christina Kappas
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Julie K Young
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Lucy Eishold
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Jie M Chui
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Meher D Vatvani
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Gabriella M D Nigro
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - D Lee Hamilton
- School of Exercise and Nutrition Science, Deakin University, Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Lilia Convit
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Amelia Carr
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Dominique Condo
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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2
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Osmanlıoğlu Ş, Sanlier N. The relationship between endometriosis and diet. HUM FERTIL 2023; 26:649-664. [PMID: 34706611 DOI: 10.1080/14647273.2021.1995900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Endometriosis is an oestrogen dependent, benign, chronic inflammatory disease characterised by ectopic endometrial implants. Current medical practices for the treatment of the disease are associated with several side effects over long periods, making the effect of diet on endometriosis an important aspect. To alleviate this need, we review related literature to identify the association between nutrients and endometriosis and to find the probable therapeutic effects of the nutrients and foods on endometriosis. Despite variations among the findings, several of the prior studies point to an inverse relationship between endometriosis and the consumption of fruits, vegetables, dairy products, and omega-3 fatty acids. Another common finding among the studies is the increased risk of endometriosis with higher consumption of trans-unsaturated fatty acids and red meat. Due to the limited size of the samples in existing literature, however, significance of the association between diet and endometriosis is not conclusive. Further research is needed to better identify the role of diet on endometriosis.
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Affiliation(s)
- Şeyma Osmanlıoğlu
- Department of Gynaecology and Obstetrics, University Faculty of Medicine, Ankara Medipol University, Altındağ/Ankara, Turkey
| | - Nevin Sanlier
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara Medipol University, Altındağ/Ankara, Turkey
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Matsas A, Sachinidis A, Lamprinou M, Stamoula E, Christopoulos P. Vitamin Effects in Primary Dysmenorrhea. Life (Basel) 2023; 13:1308. [PMID: 37374091 DOI: 10.3390/life13061308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Primary dysmenorrhea is considered to be one of the most common gynecological complaints, affecting women's daily activities and social life. The severity of dysmenorrhea varies among women, and its management is of high importance for them. Given that non-steroidal anti-inflammatory drugs (NSAIDs), the established treatment for dysmenorrhea, are associated with many adverse events, alternative therapeutic options are under evaluation. Emerging evidence correlates management of dysmenorrhea with micronutrients, especially vitamins. PURPOSE The aim of this narrative review is to highlight and provide evidence of the potential benefits of vitamins for the management of dysmenorrhea. METHODS The articles were searched on PubMed, Scopus and Google Scholar. The searching process was based on keywords, such as "primary dysmenorrhea", "vitamins", "supplementation", "vitamin D", "vitamin E" and others. Our search focused on data derived from clinical trials, published only during the last decade (older articles were excluded). RESULTS In this review, 13 clinical trials were investigated. Most of them supported the anti-inflammatory, antioxidant and analgesic properties of vitamins. Particularly, vitamins D and E revealed a desirable effect on dysmenorrhea relief Conclusion: Despite the scarcity and heterogeneity of related research, the studies indicate a role of vitamins for the management of primary dysmenorrhea, proposing that they should be considered as alternative therapeutic candidates for clinical use. Nevertheless, this correlation warrants further research.
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Affiliation(s)
- Alkis Matsas
- Second Department of Obstetrics and Gynaecology, Medical School, "Aretaieion'' University Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athanasios Sachinidis
- Fourth Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Malamatenia Lamprinou
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Eleni Stamoula
- Department of Biotechnology, Centre of Systems Biology, Biomedical Research Foundation of the Academy of Athens, 115 27 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynaecology, Medical School, "Aretaieion'' University Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece
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Naraoka Y, Hosokawa M, Minato-Inokawa S, Sato Y. Severity of Menstrual Pain Is Associated with Nutritional Intake and Lifestyle Habits. Healthcare (Basel) 2023; 11:healthcare11091289. [PMID: 37174831 PMCID: PMC10178419 DOI: 10.3390/healthcare11091289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Recently, the employment rate of women in Japan has steadily increased. Approximately 80% of women experience menstrual pain and premenstrual syndrome (PMS). These symptoms decrease a woman's quality of life and her work productivity, leading to an economic loss. This cross-sectional study of 321 healthy Japanese women aged 20-39 years aimed to clarify the lifestyle-related factors or nutrient intake that might cause menstrual pain. The participants underwent body composition measurements and completed meal survey sheets and lifestyle questionnaires, including menstrual status, exercise, sleep and breakfast consumption. Based on the questionnaire results, participants were divided into two groups according to the severity of menstrual pain, namely, heavy and light. Chi-square and Wilcoxon signed-rank sum tests were used to compare the severity of menstrual pain in the two groups. In the heavy group, the intake of animal proteins, including fish, vitamin D and vitamin B12, was significantly lower (p < 0.05), as was the frequency of breakfast consumption and bathing (p < 0.05). The rate of PMS symptoms was significantly higher in the heavy group (p < 0.05). This study suggests that a lack of animal protein, the accompanying vitamins and fatty acids, and the frequency of breakfast or bathing are associated with the severity of menstrual pain.
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Affiliation(s)
- Yuna Naraoka
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Japanese Center for Research on Woman in Sport, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
| | - Momo Hosokawa
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
| | - Satomi Minato-Inokawa
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
- Laboratory of Community Health and Nutrition, Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama 790-8566, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuichi Sato
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
- Obstetrics and Gynecology, Tatedebari Sato Hospital, Takasaki 370-0836, Japan
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Kanchibhotla D, Subramanian S, Singh D. Management of dysmenorrhea through yoga: A narrative review. FRONTIERS IN PAIN RESEARCH 2023; 4:1107669. [PMID: 37063942 PMCID: PMC10098011 DOI: 10.3389/fpain.2023.1107669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
Menstrual pain also known as dysmenorrhea is one of the most common and underrated gynecological disorders affecting menstruating women. Although the symptoms and impact might vary greatly, it is defined by cramps in the lower abdomen and pain that radiates to lower back and thighs. In some cases it is also accompanied by nausea, loose stool, dizziness etc. A primary narrative review was conducted on the impact of yoga on dysmenorrhea experienced by women. The English-language literature published until 2022 was searched across databases such as PubMed, Google Scholar and Scopus. “Yoga” and “menstrual pain” OR “dysmenorrhea” were used as keywords for the search across several databases. A total of 816 title searches were obtained across all the database searches. This review article included 10 studies based on the selection criteria. The studies examined the impact of a varied set of 39 asanas, 5 pranayamas and Yoga nidra on dysmenorrhea. The studies demonstrated a significant relief in dysmenorrhea among those who practiced Yoga (asanas/pranayama/yoga nidra) with improved pain tolerance and reduced stress levels. Regulating the stress pathways through yoga was found to be a key in regulating hormonal balance and reduction in dysmenorrhea.
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Cai H, Zhang Y, Ding X, Zhu S, Ding X, Deng Y, Ma X, Gan J, Wang Y, Sun A. Metabonomic Study of the Effect of Dingkundan Intervention Comparing with Oral Contraceptives on Primary Dysmenorrhea Using the UPLC-MS Technique. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6708200. [PMID: 36033559 PMCID: PMC9402312 DOI: 10.1155/2022/6708200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Primary dysmenorrhea (PD) is a prevalent problem in gynecologic clinics among adolescents and women of reproductive age. Several therapy modalities, including traditional Chinese medicine, are deemed adequate (TCM) and have been in practice for a long time. In China, Dingkundan (DKD), a multicomponent gynecological treatment, has been used to treat PD for centuries. However, the fundamental process remains poorly understood. Comparing plasma samples acquired from DKD-treated and oral contraceptive- (OC-) treated subjects, we performed an integrated plasma metabonomic analysis utilizing the UPLC-MS technology to study the therapeutic mechanisms of DKD in PD patients. Thirty possible biomarkers and metabolic pathways were discovered, primarily steroid hormone production, glycerophospholipid metabolism, and bile secretion. The results suggested that DKD may have therapeutic benefits for PD patients via modulation of various metabolic pathways. This study is envisaged to provide detailed metabolite information regarding the etiology of PD, an assessment of the efficacy of DKD, and a comparison of DKD and OC.
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Affiliation(s)
- Hong Cai
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006 Zhejiang, China
| | - Yijing Zhang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006 Zhejiang, China
| | - Xiaoxia Ding
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006 Zhejiang, China
| | - Shiyang Zhu
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuesong Ding
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Deng
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao Ma
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingwen Gan
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanfang Wang
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Aijun Sun
- National Clinical Research Center for Obstetrics & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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The impact of omega-3 polyunsaturated fatty acids on primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2022; 78:721-731. [DOI: 10.1007/s00228-021-03263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
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D'Ornelas AG, Siqueira BAD, Tobaldini G, Naliwaiko K, Iagher F, Fischer L. Short- and Long-Term Effects of Dietary Supplementation with Fish Oil on Inflammatory Pain in Rats. J Am Coll Nutr 2021; 41:453-461. [PMID: 34156913 DOI: 10.1080/07315724.2021.1911006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dietary supplementation with fish oil is promising as a complementary therapy for inflammatory pain. However, further studies are needed to support its therapeutic potential. For example, the antinociceptive effect of fish oil is widely suggested to be dependent on decreased prostaglandin E2 (PGE2) synthesis, but no previous study has investigated if it affects PGE2-induced nociceptive response. Similarly, beneficial long-term effects on inflammatory response are related to early exposure to fish oil, however, whether these effects include decreased inflammatory pain throughout life is not known. OBJECTIVE The aim of this study was to investigate the short- and long-term effects of fish oil on inflammatory pain. METHODS Dietary fish oil supplementation was performed through two protocols: in adult rats, during 20 days, or in dams, during pregnancy and lactation, with tests performed in adult offspring. The hyperalgesic response induced by carrageenan and its final mediators PGE2 and norepinephrine was used to model inflammatory pain. RESULTS The findings demonstrated for the first time that dietary fish oil (1) decreases the hyperalgesia induced by carrageenan; (2) but not that induced by its final mediator PGE2 and norepinephrine; (3) increase omega-3 polyunsaturated fatty acids in peripheral neural tissue; and (4) attenuates inflammatory pain in individuals exposed to fish oil during pre-natal life and lactation. CONCLUSION Together, these findings support that fish oil decreases inflammatory pain either when consumed during adult life or during prenatal development. Future studies should confirm the therapeutic potential of fish oil in humans, which is essential for the development of public policies to encourage a fish oil richer diet.
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Affiliation(s)
- Alana Gabrielle D'Ornelas
- Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Betina Aisengart de Siqueira
- Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Glaucia Tobaldini
- Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Katya Naliwaiko
- Department of Cell Biology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Fabiola Iagher
- Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Luana Fischer
- Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
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Mehravar S, Amir Ali Akbari S, Nasiri M, Mojab F, Abbasi H. The effect of Triticum sativum (wheat) germ on postpartum pain: A double-blind clinical trial. AVICENNA JOURNAL OF PHYTOMEDICINE 2021; 11:576-588. [PMID: 34804895 PMCID: PMC8588961 DOI: 10.22038/ajp.2021.18179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postpartum pain (PP pain) is a common problem after vaginal delivery. Some herbs are used to reduce PP pain. Due to the anti-inflammatory properties of Triticum sativum (wheat) germ, this study was conducted to investigate the effect of wheat germ on PP pain. MATERIALS AND METHODS This is a randomized, double-blind, placebo-controlled clinical trial performed on 90 women who had a vaginal delivery and complained of moderate to severe PP pain. The participants were randomly divided into two groups. In the intervention group, a capsule containing 500 mg of wheat germ was taken every 6 hr for 2 days and in the control group, a placebo capsule was taken in the same order. The severity of PP pain was measured before and one hour after receiving the capsule by using the Visual Analogue Scale. RESULTS The two groups were not different in terms of pain severity before the intervention. The PP pain in women with moderate pain was significantly reduced in both groups, the reduction was greater in the wheat germ group (GEE=0.04) but this reduction was not significant. The PP pain in women with severe pain was significantly reduced in both groups, however, the reduction was significantly greater in the wheat germ group (GEE=0.63, p=0.007). Moreover, the results showed that the use of mefenamic acid in the wheat germ group was significantly lower than the control group (p=0.04). Moreover, no side effect was reported after consuming the wheat germ. CONCLUSION It seems that wheat germ reduces severe PP pain. Further research on this plant is recommended.
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Affiliation(s)
- Samira Mehravar
- Department of Midwifery & Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Amir Ali Akbari
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author: Tel: +982188202512, Fax: +982188202512,
| | - Malihe Nasiri
- Department of Basic sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faraz Mojab
- Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hajar Abbasi
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fernández-Martínez E, Fernández-Villa T, Amezcua-Prieto C, Suárez-Varela MM, Mateos-Campos R, Ayán-Pérez C, Molina de la Torre AJ, Ortíz-Moncada R, Almaraz A, Blázquez Abellán G, Delgado-Rodríguez M, Alonso-Molero J, Martínez-Ruíz V, Llopis-Morales A, Valero Juan LF, Cancela Carral JM, Martín-Peláez S, Alguacil J. Menstrual Problems and Lifestyle among Spanish University Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207425. [PMID: 33053847 PMCID: PMC7599672 DOI: 10.3390/ijerph17207425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
Menstrual problems affect many young women worldwide, conditioning both their academic performance and quality of life. This study sought to analyse the prevalence of menstrual problems and their possible relationship with lifestyle among Spanish university women, as part of a research project (UniHcos Project) involving a cohort of 11 Spanish universities with 7208 university students. A descriptive analysis was performed using the bivariate chi-square test and the Student’s t-test together with a binary logistic regression, in which the dependent variable was ‘suffering from menstrual problems’. Menstrual problems were identified in 23.8% of the students, representing women who paid more visits to the doctor and to emergency rooms, and who consumed more painkillers and contraceptives. In relation to dietary preferences, menstrual problems were 1.39 (CI 95% 1.22–1.61; p = 0.000) times more likely among women classified as high-risk alcohol users according to the AUDIT questionnaire, and 1.187 (CI 95% 1.029–1.370; p = 0.019) times greater among those who consumed sweets daily, 1.592 (CI 95% 1.113–2.276; p = 0.011) times more frequent among those who eat fish daily, and 1.199 (CI 95% 1.004–1.432; p = 0.045) times greater among those who were dieting. Menstrual problems affect many college students and potentially modifiable lifestyle variables exist which may influence their prevalence. It would be interesting to develop programmes to promote women’s health in the university context.
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Affiliation(s)
- Elia Fernández-Martínez
- Department of Nursing, University of Huelva, 21071 Huelva, Spain
- Correspondence: (E.F.-M.); (T.F.-V.)
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health (GIIGAS)/Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain;
- Correspondence: (E.F.-M.); (T.F.-V.)
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.A.-P.); (V.M.-R.); (S.M.-P.)
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biosanitary Research Institute ibs., 18014 Granada, Spain
| | - María Morales Suárez-Varela
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University of Valencia, 46100 Valencia, Spain; (M.M.S.-V.); (A.L.-M.)
| | - Ramona Mateos-Campos
- Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | | | - Antonio José Molina de la Torre
- Research Group on Gene-Environment Interactions and Health (GIIGAS)/Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain;
| | - Rocío Ortíz-Moncada
- Area of Preventive Medicine and Public Health, Food and Nutrition Research Group, University of Alicante, 03550 Alicante, Spain;
| | - Ana Almaraz
- Preventive Medicine and Public Health, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
| | - Gemma Blázquez Abellán
- Departament of Medical Sciences, Faculty of Pharmacy, University of Castilla-La Mancha, 02071 Albacete, Spain;
| | - Miguel Delgado-Rodríguez
- Department of Preventive Medicine and Public Health, University of Jaen, 23071 Jaén, Spain;
- CIBERESP, Institute of Health Carlos III, Ministry of Health, 28029 Madrid, Spain
| | - Jéssica Alonso-Molero
- CIBERESP, Institute of Health Carlos III, Ministry of Health, 28029 Madrid, Spain
- University of Cantabria–IDIVAL, 39011 Santander, Spain;
| | - Virginia Martínez-Ruíz
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.A.-P.); (V.M.-R.); (S.M.-P.)
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biosanitary Research Institute ibs., 18014 Granada, Spain
| | - Agustín Llopis-Morales
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University of Valencia, 46100 Valencia, Spain; (M.M.S.-V.); (A.L.-M.)
| | - Luis Félix Valero Juan
- Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | - José Mª Cancela Carral
- Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, HealthyFit Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36310 Pontevedra, Spain;
| | - Sandra Martín-Peláez
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.A.-P.); (V.M.-R.); (S.M.-P.)
- Biosanitary Research Institute ibs., 18014 Granada, Spain
| | - Juan Alguacil
- CIBERESP, Institute of Health Carlos III, Ministry of Health, 28029 Madrid, Spain
- Natural Resources, Health and Environment Research Center (RENSMA), University of Huelva, 21071 Huelva, Spain;
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Onieva-Zafra MD, Fernández-Martínez E, Abreu-Sánchez A, Iglesias-López MT, García-Padilla FM, Pedregal-González M, Parra-Fernández ML. Relationship between Diet, Menstrual Pain and other Menstrual Characteristics among Spanish Students. Nutrients 2020; 12:E1759. [PMID: 32545490 PMCID: PMC7353339 DOI: 10.3390/nu12061759] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
This study sought to describe and compare adherence to the Mediterranean diet and consumption of local foods from the Huelva region among Spanish university women in relation to menstrual pain and other menstrual characteristics. This cross-sectional study included 311 health science students. The study variables were sociodemographic and gynecologic characteristics, adherence to the Mediterranean diet using the KIDMED questionnaire, alcohol consumption (SDU) and consumption of local food. A descriptive bivariate analysis and multiple binary regression were performed for menstrual pain. Up to 55.3% of participants had moderate adherence to the Mediterranean diet and only 29.6% had high adherence. Women with low adherence had longer menstrual cycles (p < 0.01). Eating less than two pieces of fruit per day (OR = 3.574; 95%CI = 1.474-8.665; p < 0.05) and eating pulses more than one day a week (OR = 2.320; 95%CI = 1.006-5.348) raised the probability of suffering menstrual pain. A positive correlation between SDU and cycle length was identified (r = 0.119, p = 0.038), and menstrual bleeding was lower in women who consumed olive oil daily (p = 0.044). In conclusion, the Mediterranean diet, alcohol consumption and consuming typical foods from southern Spain appear to influence cycle length, menstrual flow and menstrual pain. Further research is necessary to confirm and expand these findings.
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Affiliation(s)
- María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (M.D.O.-Z.); (M.L.P.-F.)
| | - Elia Fernández-Martínez
- Department of Nursing, University of Huelva, 21004 Huelva, Spain; (A.A.-S.); (F.M.G.-P.); (M.P.-G.)
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, 21004 Huelva, Spain; (A.A.-S.); (F.M.G.-P.); (M.P.-G.)
| | - María Teresa Iglesias-López
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Crta. Pozuelo-Majadahonda km 1,800, 28223 Pozuelo de Alarcón (Madrid), Spain;
| | | | - Miguel Pedregal-González
- Department of Nursing, University of Huelva, 21004 Huelva, Spain; (A.A.-S.); (F.M.G.-P.); (M.P.-G.)
- Multiprofessional Unit of Family and Community Care of Huelva, 21007 Huelva, Spain
| | - María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (M.D.O.-Z.); (M.L.P.-F.)
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12
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Saei Ghare Naz M, Kiani Z, Rashidi Fakari F, Ghasemi V, Abed M, Ozgoli G. The Effect of Micronutrients on Pain Management of Primary Dysmenorrhea: a Systematic Review and Meta-Analysis. J Caring Sci 2020; 9:47-56. [PMID: 32296659 PMCID: PMC7146731 DOI: 10.34172/jcs.2020.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 01/21/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction: Primary dysmenorrhea is considered as one of the main problems in women. This review study aimed to characterize the effect of micronutrients on primary dysmenorrhea. Methods: In this systematic and meta‐analysis study, the articles were searched at Cochrane library, PubMed, Scopus, Web of Science databases. The searching process was conducted with the key terms related to dysmenorrhea and micronutrients. Risk of bias assessment was performed, using Rev Man 5.3 software. In view of the heterogeneity of some of the studies, they were analyzed, using a qualitative method (n=10), and only 6 studies were included in Meta analyze. STATA statistical software version 11 was used for the analysis. Results: In this study, finally 16 clinical trials were investigated. Most micronutrients studied in the relevant articles had anti-inflammatory and analgesic properties with a desirable effect on dysmenorrhea pain relief. Vitamins (K, D, B1, and E) and calcium, magnesium, zinc sulfate and boron contributed effectively to dysmenorrhea pain management. Two months after the intervention, there was a significant mean decrease in the pain score for the vitamin D intervention group (SMD: -1.02, 95% CI: -1.9 to – 0.14, P =0.024) , as well as in the vitamin E intervention group compared to placebo group (SMD: -0.47,95% CI:-0.74 to – 0.2, P = 0.001). Conclusion: Despite the paucity of related research, the studies indicated the potential effects of micronutrients on reducing the pain severity in primary dysmenorrhea. But more studies are needed to confirm the safety and effectiveness of various types of micronutrients on primary dysmenorrhea.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Department of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Kiani
- Department of Midwifery, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Rashidi Fakari
- Department of Midwifery, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vida Ghasemi
- Department of Midwifery, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Abed
- Department of Gynecology and Obstetrics, School of Medicine, Alborz University of Medical Sciences, Alborz, Iran
| | - Giti Ozgoli
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Biro FM, Bloemer NL. "Complementary Medicine": Complementary and Alternative Health Approaches in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2019; 32:3-6. [PMID: 30399399 DOI: 10.1016/j.jpag.2018.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
Complementary and alternative health care approaches are prevalent in the patients and families served by practitioners in pediatric and adolescent gynecology. This article addresses gaps in knowledge, including new terminology, prevalence of use, rates of and reasons behind nondisclosure, and potential interactions of herbal products with prescribed medication. It closes with practical complementary health approaches to the adolescent with dysmenorrhea.
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Affiliation(s)
- Frank M Biro
- Child Life and Integrative Care, Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Nancy L Bloemer
- Child Life and Integrative Care, Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Sharghi M, Mansurkhani SM, Larky DA, Kooti W, Niksefat M, Firoozbakht M, Behzadifar M, Azami M, Servatyari K, Jouybari L. An update and systematic review on the treatment of primary dysmenorrhea. JBRA Assist Reprod 2019; 23:51-57. [PMID: 30521155 PMCID: PMC6364281 DOI: 10.5935/1518-0557.20180083] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 10/02/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Primary dysmenorrhea is a painful uterine contraction caused by endometrial laceration. Drug therapies and complementary medicine have been used to treat dysmenorrhea. The aim of this study was to investigate and offer an updated perspective on the treatments for dysmenorrhea. METHODS The present study was conducted in accordance with the PRISMA checklist for systematic reviews and meta-analyses. The required information was collected based on searches for the following keywords: treatment, primary dysmenorrhea, medicinal plants, chemical drugs, and herbs. Searches were performed on databases Pubmed, Web of Sciences, Scopus, Iran medex, and SID by March 2018 to find literature in the English and Persian languages on this subject without a time limit. RESULTS This review included 17 papers, 10 of which on complementary medicine, three on drug therapies, and four on acupuncture and acupressure. The largest and smallest samples had 303 and 24 patients, respectively. Length of treatment ranged from one to six months and the measures most commonly used in the studies were the visual analogue scale and clinical efficacy. Reported complications included gastrointestinal events, nausea, vomiting, diarrhea, abdominal pain, and liver and kidney disorders. CONCLUSION Medicinal plants, drugs, and acupressure seem to suppress pain by reducing the level of prostaglandins, mediating nitric oxide, increasing beta-endorphin levels, blocking the calcium channel, and enhancing circulatory flow through the uterine pathway. Further trials are required to confirm the benefits of the procedures described and ensure the absence of complications.
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Affiliation(s)
- Maedeh Sharghi
- Student Research Committee, Kurdistan University of Medical
Sciences, Sanandaj, IR Iran
| | | | - Damoon Ashtary Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, IR Iran
| | - Wesam Kooti
- Cellular and Molecular Research Center, Sabzevar University of
Medical Sciences, Sabzevar, IR Iran
| | - Mehdi Niksefat
- Student Research Committee, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, IR Iran
| | - Mohammad Firoozbakht
- Student Research Committee, Dezful University of Medical Sciences,
Dezful, IR Iran
| | - Masoud Behzadifar
- Health Management and Economics Research Center, Iran University of
Medical Sciences, Tehran, IR Iran
| | - Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR
Iran
| | - Karo Servatyari
- Student Research Committee, Kurdistan University of Medical
Sciences, Sanandaj, IR Iran
| | - Leila Jouybari
- Nursing Research Center, Golestan University of Medical Sciences,
Gorgan, IR Iran
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15
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Pattanittum P, Kunyanone N, Brown J, Sangkomkamhang US, Barnes J, Seyfoddin V, Marjoribanks J. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev 2016; 3:CD002124. [PMID: 27000311 PMCID: PMC7387104 DOI: 10.1002/14651858.cd002124.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Dysmenorrhoea refers to painful menstrual cramps and is a common gynaecological complaint. Conventional treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which both reduce myometrial activity (contractions of the uterus). A suggested alternative approach is dietary supplements. We used the term 'dietary supplement' to include herbs or other botanical, vitamins, minerals, enzymes, and amino acids. We excluded traditional Chinese medicines. OBJECTIVES To determine the efficacy and safety of dietary supplements for treating dysmenorrhoea. SEARCH METHODS We searched sources including the Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO (all from inception to 23 March 2015), trial registries, and the reference lists of relevant articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) of dietary supplements for moderate or severe primary or secondary dysmenorrhoea. We excluded studies of women with an intrauterine device. Eligible comparators were other dietary supplements, placebo, no treatment, or conventional analgesia. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, performed data extraction and assessed the risk of bias in the included trials. The primary outcomes were pain intensity and adverse effects. We used a fixed-effect model to calculate odds ratios (ORs) for dichotomous data, and mean differences (MDs) or standardised mean differences (SMDs) for continuous data, with 95% confidence intervals (CIs). We presented data that were unsuitable for analysis either descriptively or in additional tables. We assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS We included 27 RCTs (3101 women). Most included studies were conducted amongst cohorts of students with primary dysmenorrhoea in their late teens or early twenties. Twenty-two studies were conducted in Iran and the rest were performed in other middle-income countries. Only one study addressed secondary dysmenorrhoea. Interventions included 12 different herbal medicines (German chamomile (Matricaria chamomilla, M recutita, Chamomilla recutita), cinnamon (Cinnamomum zeylanicum, C. verum), Damask rose (Rosa damascena), dill (Anethum graveolens), fennel (Foeniculum vulgare), fenugreek (Trigonella foenum-graecum), ginger (Zingiber officinale), guava (Psidium guajava), rhubarb (Rheum emodi), uzara (Xysmalobium undulatum), valerian (Valeriana officinalis), and zataria (Zataria multiflora)) and five non-herbal supplements (fish oil, melatonin, vitamins B1 and E, and zinc sulphate) in a variety of formulations and doses. Comparators included other supplements, placebo, no treatment, and NSAIDs.We judged all the evidence to be of low or very low quality. The main limitations were imprecision due to very small sample sizes, failure to report study methods, and inconsistency. For most comparisons there was only one included study, and very few studies reported adverse effects. Effectiveness of supplements for primary dysmenorrhoea We have presented pain scores (all on a visual analogue scale (VAS) 0 to 10 point scale) or rates of pain relief, or both, at the first post-treatment follow-up. Supplements versus placebo or no treatmentThere was no evidence of effectiveness for vitamin E (MD 0.00 points, 95% CI -0.34 to 0.34; two RCTs, 135 women).There was no consistent evidence of effectiveness for dill (MD -1.15 points, 95% CI -2.22 to -0.08, one RCT, 46 women), guava (MD 0.59, 95% CI -0.13 to 1.31; one RCT, 151 women); one RCT, 73 women), or fennel (MD -0.34 points, 95% CI -0.74 to 0.06; one RCT, 43 women).There was very limited evidence of effectiveness for fenugreek (MD -1.71 points, 95% CI -2.35 to -1.07; one RCT, 101 women), fish oil (MD 1.11 points, 95% CI 0.45 to 1.77; one RCT, 120 women), fish oil plus vitamin B1 (MD -1.21 points, 95% CI -1.79 to -0.63; one RCT, 120 women), ginger (MD -1.55 points, 95% CI -2.43 to -0.68; three RCTs, 266 women; OR 5.44, 95% CI 1.80 to 16.46; one RCT, 69 women), valerian (MD -0.76 points, 95% CI -1.44 to -0.08; one RCT, 100 women), vitamin B1 alone (MD -2.70 points, 95% CI -3.32 to -2.08; one RCT, 120 women), zataria (OR 6.66, 95% CI 2.66 to 16.72; one RCT, 99 women), and zinc sulphate (MD -0.95 points, 95% CI -1.54 to -0.36; one RCT, 99 women).Data on chamomile and cinnamon versus placebo were unsuitable for analysis. Supplements versus NSAIDSThere was no evidence of any difference between NSAIDs and dill (MD 0.13 points, 95% CI -1.01 to 1.27; one RCT, 47 women), fennel (MD -0.70 points, 95% CI -1.81 to 0.41; one RCT, 59 women), guava (MD 1.19, 95% CI 0.42 to 1.96; one RCT, 155 women), rhubarb (MD -0.20 points, 95% CI -0.44 to 0.04; one RCT, 45 women), or valerian (MD points 0.62 , 95% CI 0.03 to 1.21; one RCT, 99 women),There was no consistent evidence of a difference between Damask rose and NSAIDs (MD -0.15 points, 95% CI -0.55 to 0.25; one RCT, 92 women).There was very limited evidence that chamomile was more effective than NSAIDs (MD -1.42 points, 95% CI -1.69 to -1.15; one RCT, 160 women). Supplements versus other supplementsThere was no evidence of a difference in effectiveness between ginger and zinc sulphate (MD 0.02 points, 95% CI -0.58 to 0.62; one RCT, 101 women). Vitamin B1 may be more effective than fish oil (MD -1.59 points, 95% CI -2.25 to -0.93; one RCT, 120 women). Effectiveness of supplements for secondary dysmenorrhoea There was no strong evidence of benefit for melatonin compared to placebo for dysmenorrhoea secondary to endometriosis (data were unsuitable for analysis). Safety of supplements Only four of the 27 included studies reported adverse effects in both treatment groups. There was no evidence of a difference between the groups but data were too scanty to reach any conclusions about safety. AUTHORS' CONCLUSIONS There is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhoea, and evidence of safety is lacking. However for several supplements there was some low quality evidence of effectiveness and more research is justified.
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Affiliation(s)
- Porjai Pattanittum
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public HealthMitraparp RoadMueng DistrictKhon KaenKhon KaenThailand40002
| | - Naowarat Kunyanone
- Chiangrai Prachanukroh HospitalMedical Technology Department1039 Satanpayabarn RdChaingraiThailand57000
| | - Julie Brown
- The University of AucklandLiggins InstitutePark RdGraftonAucklandNew Zealand1142
| | - Ussanee S Sangkomkamhang
- Khon Kaen HospitalDepartment of Obstetrics and GynaecologySrichan RoadMaungKhon KaenThailand40000
| | - Joanne Barnes
- University of AucklandSchool of PharmacyPrivate Bag 92019Grafton CampusAucklandNew Zealand
| | - Vahid Seyfoddin
- University of AucklandMolecular Medicine and Pathology DepartmentPark RdGraftonAuckland‐ None ‐New Zealand1142
| | - Jane Marjoribanks
- University of AucklandDepartment of Obstetrics and GynaecologyPark RdGraftonAucklandNew Zealand1003
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