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Effects of Fenugreek Seed on the Severity and Systemic Symptoms of Dysmenorrhea

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Effects of Fenugreek Seed on the Severity and Systemic Symptoms of Dysmenorrhea Original Article Effects of Fenugreek Seed on the Severity and Systemic Symptoms of Dysmenorrhea Sima Younesy 1, Sedigheh Amiraliakbari 1*, Somayeh Esmaeili 2,3, Hamid Alavimajd 4, Soheila Nouraei 1 1- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2- Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3- Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4- Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Abstract Background: Primary dysmenorrhea is a prevalent disorder and its unfavorable ef- fects deteriorates the quality of life in many people across the world. Based on some evidence on the characteristics of fenugreek as a medical plant with anti-inflammato- ry and analgesic properties, this double-blind, randomized, placebo controlled trial was conducted. The main purpose of the study was to evaluate the effects of fenu- greek seeds on the severity of primary dysmenorrhea among students. Methods: Unmarried Students were randomly assigned to two groups who received fenugreek (n=51) or placebo (n=50). For the first 3 days of menstruation, 2−3 cap- sules containing fenugreek seed powder (900 mg) were given to the subjects three times daily for two consecutive menstrual cycles. Pain severity was evaluated using a visual analog scale and systemic symptoms were assessed using a multidimension- al verbal scale. * Corresponding Author: Sedigheh Amiraliakbari, Results: Pain severity at baseline did not differ significantly between the two Department of Midwifery, groups. Pain severity was significantly reduced in both groups after the intervention; School of Nursing and however, the fenugreek group experienced significantly larger pain reduction Midwifery, Shahid (p<0.001). With respect to the duration of pain, there was no meaningful difference Beheshti University of Medical Sciences, Vali-asr between the two cycles in the placebo group (p=0.07) but in the fenugreek group, the and Niayesh Junction, duration of pain decreased between the two cycles (p<0.001). Systemic symptoms of Tehran, Iran dysmenorrhea (fatigue, headache, nausea, vomiting, lack of energy, syncope) de- E-mail: creased in the fenugreek seed group (p<0.05). No side effects were reported in the [email protected] fenugreek group. Received: Nov. 2, 2013 Conclusion: These data suggest that prescription of fenugreek seed powder during Accepted: Feb. 2, 2014 menstruation can reduce the severity of dysmenorrhea. Keywords: Dysmenorrhea, Fenugreek, Herbal medicine. To cite this article: Younesy S, Amiraliakbari S, Esmaeili S, Alavimajd H, Nouraei S. Effects of Fenugreek Seed on the Severity and Systemic Symptoms of Dysmenorrhea. J Reprod Infertil. 2014;15(1):41-48. Introduction ysmenorrhea, a Greek term, refers to painful ism, decreased quality of life, and reduced ability uterine contractions during menstruation (1). to carry out daily activities (3, 4). In primary dys- It is associated with spasmodic pain in the menorrhea, the pain is not accompanied by a pel- abdomen during menstrual bleeding (2). Primary vic disorder. In addition, it is more common in dysmenorrhea is the main cause of work absentee- younger women but may last until the fifth decade J Reprod Infertil. 2014;15(1):41-48 JRI Effects of Fenugreek Seed on Dysmenorrhea of life (5). Dysmenorrhea results from uterine in Egypt and Greece (20). Today, new infor- contractions associated with ischemia (6). In- mation has been achieved on the benefits and creased concentrations of prostaglandins, vaso- pharmacological effects of fenugreek on human pressin, leukotrienes, and emotional factors may wellbeing (21, 22). Fenugreek plant is native to also result in dysmenorrhea (7). the West Asia and Iran (23). The Food and Drug The prevalence of primary dysmenorrhea has Administration (FDA) in the USA lists it as being been reported to range from 42 to 95% in different a generally recognized as safe (GRAS) plant. It countries (8–11). Various non-invasive nutritional has been utilized around the world for centuries and psychological interventions have been sug- (18). Fenugreek is added to ordinary foods of In- gested as treatments. These include psychothera- dians, Egyptians, and Yemenis (13). py, yoga, hypnotherapy, massage, transcutaneous Fenugreek seeds are used as spices in food prep- electrical nerve stimulation, vitamins and nutri- arations to improve or impart flavor and are good tional supplements. Prescribed medications in- sources of protein, fat, minerals, and dietary fiber clude inhibitors of prostaglandin synthesis and (24). The use of fenugreek dates back to the an- non-steroidal anti-inflammatory drugs (NSAIDs) cient Egypt when it was used to facilitate child- for the relief of pain as well as oral contraceptives. birth and increase mother's milk. Egyptian women Non-pharmaceutical treatments include acupunc- still consume fenugreek for decreasing dysmenor- ture and surgery. Several of these treatments may rhea. Fenugreek was also used as a poultice to have adverse effects or may be contraindicated in treat gout, inflamed glands, tumors, scars, wounds, certain groups of women (5, 12). and various skin inflammations (25, 26). The ripe Due to the lack of side effects compared with and young fenugreek seeds are full of carbohy- synthetic drugs, approximately 60% of the world's drates and sugar, galactomannan, amino acid, fat- population is dependent almost entirely on plants ty acid, vitamins, folic acid and saponins (22). for medication. Natural products have been known The main chemical constituents of fenugreek are to be effective therapies (13). The use of herbal proteins rich in lysine and tryptophan, flavonoids medicines has been common hundred years before (eg., quercetin, trigonelline, saponins, and phytic pharmaceutical companies began to work, and acid), and polyphenols (24, 27). furthermore, many drugs have a herbal basis. The The well-documented therapeutic uses of fenu- consumption of herbal supplements has been in- greek are its activity against hypoglycemia and creased in the developed countries, especially the hypolipidemia (28−30). It also protects the gastro- USA, at different age groups for various reasons intestinal (31) and cardiovascular systems (32). (14, 15). Fenugreek seeds are also used in traditional medi- Traditional medicines like brewed herbs have cine to relieve common cold, arthritic pain, and been used to treat dysmenorrhea across the world hyperglycemia. The extracts and isolates of fenu- (16). Many women believe that dysmenorrhea is a greek seeds have antioxidant and anti-inflammato- normal cycle of menstruation and does not need ry activities (33). The anti-inflammatory and an- pharmacological treatment (14). Naturally occur- algesic effects of fenugreek have been demon- ring agents used to treat dysmenorrhea include strated in experimental models (34−37). A study herbal brews (eg., mint, chamomile, and oregano) proved the role of the serotonergic system in the the roots of plants (eg., carrots and turnips) and analgesic effect of the fenugreek extract on mice the petals of plants (marigold, hyacinth, and fenu- and introduced the probability for the existence of greek) (12, 17). In a study, 78% of the participants other analgesic mechanisms. It also mentioned the used the fenugreek, mint, and green tea among superficial similarities between fenugreek extract which fenugreek had been used more than the and non-steroidal anti-inflammatory drugs and the others (14). presence of their analgesic, anti-fever, and anti- Fenugreek [Trigonella foenum-graecum (Legu- inflammatory effects in combination (34). minosae)] is the most frequently used herbal Phytoestrogens are herbal compounds with es- galactagogue and is a member of the pea family trogenic activity; fenugreek contains phytoestro- (18). In Iran, fenugreek has been registered under gen compounds (38). The present study was con- the name "Shanbalile" (/Šambalile/) (19). Fenu- ducted to evaluate the effects of oral administra- greek is an annual herb with medicinal properties tion of fenugreek on the severity of primary dys- and has been known as the oldest herbal medicine menorrhea among students. The article also con- 42 J Reprod Infertil, Vol 15, No 1, Jan-Mar 2014 Younesy S, et al. JRI sidered the ongoing studies in the world in the were purchased from Zardband Pharmaceuticals field of traditional medicine and abundance of (Tehran, Iran). After identification and verifica- some plants that have been mentioned as herbs tion of the samples of fenugreek seeds in the Bo- with analgesic and anti-inflammatory effects tanical Laboratory at the Faculty of Traditional among Iranian traditional medicines. Medicine at Shahid Beheshti University of Medi- cal Sciences, samples were ground down. The Methods seed powder was placed into capsules (900 mg) This was a double-blind, randomized, placebo using an automated machine. The placebo cap- controlled trial investigation. It involved unmar- sules contained potato starch. The capsules were ried students living in a dormitory at Shahid similar with respect to shape, color, and packag- Beheshti University (Tehran, Iran) from October ing. Fenugreek and placebo capsules were taken 2010 to April 2011 who experienced moderate-to- three times a day [For the first 3 days of menstrua- severe dysmenorrhea. The
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