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Chinese herbal medicine for primary dysmenorrhoea

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Abstract

Background

Conventional treatment for primary dysmenorrhoea (PD) has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine (CHM) may be a suitable alternative.

Objectives

To determine the efficacy and safety of CHM for PD when compared with placebo, no treatment, and other treatment.

Search methods

The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to Dec 2006), and the Chinese BioMedicine Database (CBM, 1990 to Dec 2006) were searched. Citation lists of included trials were also reviewed.

Selection criteria

Any randomised controlled trials (RCTs) involving CHM versus placebo, no treatment, conventional therapy, heat compression, another type of CHM, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra‐uterine contraceptive device (IUD).

Data collection and analysis

Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta‐analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed‐effect statistical model was used, where suitable. If data were not suitable for meta‐analysis, any available data from the trial were extracted and presented as descriptive data.

Main results

Thirty‐nine RCTs involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for CHM compared to placebo were unclear as data could not be combined (3 RCTs). CHM resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self‐designed CHM resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months follow up when compared to commonly used Chinese herbal health products. CHM also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18).

Authors' conclusions

The review found promising evidence supporting the use of CHM for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

Chinese herbal medicine may help reduce menstrual pain.

Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in abdomen. Primary dysmenorrhoea refers to pain of an unknown cause (i.e. no medical condition is identified). Nonsteroidal anti‐inflammatory drugs or the contraceptive pill have been used successfully for treatment but more women are looking for non‐drug therapies. Chinese herbal medicine has been used for centuries in China and it is currently used in public hospitals in China for the treatment of primary dysmenorrhoea. The review found promising evidence for the use of Chinese herbal medicine in reducing menstrual pain in the treatment of primary dysmenorrhoea compared to conventional medicine such as NSAIDs and the oral contraceptive pill, acupuncture and heat compression. No significant adverse effects were identified in this review, however the findings should be interpreted with caution due to the generally low methodological quality of the included studies.