Period pain hurts? Try Chinese herbs

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October 19, 2007  
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CM NEWS – Got enough of that terrible period pain? Traditional Chinese medicine might offer hope for relief, according to a large scale review on the effectiveness of Chinese herbal medicine on primary dysmenorhoea.

What is dysmenorrhoea? 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.

The condition affects up to half of all adolescent girls and women of reproductive age. The pain is not due to an underlying medical problem but can have a significant impact on women’s lives.

Non-specified dysmenorrhoea is one of the most common gynaecological complaints in young women. The prevalence rate for dysmenorrhoea varies worldwide; estimates were from 44% in China, 51% in Singapore, 52–64% in Mexico, 60–80% in the United States, 73% in Sweden, 80% in Western Australia, to 45–95% in Britain.

An estimated 42–51% of dysmenorrheic women reported missing either school or work due to severe menstrual pain. There is a subset of women who do not respond to conventional treatment and turn to alternative medicine or therapy. But information on the use of alternative treatments is not clearly known. In spite of several effective therapies, such as analgesics and oral contraceptives, the morbidity from dysmenorrhoea remains a challenge to public health worldwide.

The Cochrane review was led by Xiaoshu Zhu of the University of Western Sydney, Australia. They believe that many women would prefer a non-drug alternative to their condition, as “conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women.”

The researchers believe that: “Chinese herbal medicine offers new options for treatment, an individualised approach, and has the potential to avoid the harshness of drugs and surgery.”

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 researchers analysed trials comparing Chinese herbal medicine against placebo, conventional drugs such as non-steroidal anti-inflammatories (NSAIDs), and other traditional Chinese therapies – acupuncture and Chinese massage.

The trials they pulled up were from: 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.

They selected 39 trials including a total of 3,475 women. Analysis suggested that Chinese herbal medicine gave “significant improvements in pain relief when compared to pharmaceutical drugs”.

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.

Zhu said: “All available measures of effectiveness confirmed the overall superiority of Chinese herbal medicine to placebo, no treatment, NSAIDs, acupuncture and heat compression, and, at the same time, there were no indications that it caused any adverse events.”

Si Wu Tang (???, 4 agents ) is a popular TCM formula that Chinese women take to help “nourish the yin“. The contains 4 herbs and has been documented for over 800 years (during the Song Dynasty in the 12th century).

The formula is composed of dry roots of four plants native to Mainland China: prepared Radix Rehmanniae praeparata (Shou di huang, ???), Radix Paeoniae Alba (Bai Shu, ??), Radix Angelicae Sinensis (Dang Gui, ??), and Rhizoma Ligustici (Chuanxiong, ??), which can be obtained at Chinese medicine shops without seeking consultation from traditional Chinese medicine practitioners.

A Taiwan study published earlier this year (PLoS ONE. 2007 Aug 15;2(1):e719) says Si Wu Tang may sooth period pain if taken at a longer term basis. Si Wu Tang is also available in tea bag form in Taiwan.

In that study, 78 primary dysmenorrheic young women were enrolled after 326 women with self-reported menstrual discomfort in the Taipei metropolitan area of Taiwan were screened by a questionnaire and subsequently diagnosed by two gynaecologists concurrently with pelvic ultrasonography.

At the end of treatment, both the overall-pain and peak-pain decreased in the Si Wu Tang group and increased in the placebo group; however, the differences between the two groups were not statistically significant. The trends persisted to follow-up phase. Statistically significant differences in both peak-pain and overall-pain appeared in the first follow-up cycle, at which the reduced peak-pain in the Si Wu Tang group did not differ significantly by treatment length.

However, the reduced peak-pain did differ profoundly among women treated for four menstrual cycles. There was no difference in adverse symptoms between the Si Wu Tang and placebo groups.

An older Cochrane review showed that other supplements might also relieve mentrual pain:

MAGNESIUM: Three small trials were included that compared magnesium and placebo. Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less. There was no significant difference in the number of adverse effects experienced.

VITAMIN B6: One small trial of vitamin B6 showed it was more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6.

MAGNESIUM AND VITAMIN B6: Magnesium was shown to be no different in pain outcomes from both vitamin B6 and a combination of vitamin B6 and magnesium by one small trial. The same trial also showed that a combination of magnesium and vitamin B6 was no different from placebo in reducing pain.

VITAMIN B1: One large trial showed vitamin B1 to be more effective than placebo in reducing pain.

VITAMIN E: One small trial comparing a combination of vitamin E (taken daily) and ibuprofen (taken during menses) versus ibuprofen (taken during menses) alone showed no difference in pain relief between the two treatments.

OMEGA-3 FATTY ACIDS: One small trial showed fish oil (omega-3 fatty acids) to be more effective than placebo for pain relief.

JAPANESE HERBAL COMBINATION: One small trial showed the herbal combination to be more effective for pain relief than placebo, and less additional pain medication was taken by the treatment group.

[Cochrane Database of Systematic Reviews 2007, Issue 3]