http:// ijp.mums.ac.ir Systematic Review (Pages: 9657-9666) The Effect of Aromatherapy (with Lavender) on Dysmenorrhea: A Systematic Review and Meta –Analysis 1 2 3 Kaveh Mousavi Kani , Zakieah Mirzania , Fereshteh Mirhaghjoo , Robabeh Mousavi 4 5 61 nezhad , Samaneh Akbarzadeh , *Mahdieh Jafari 1Head and Neck Research Center, Facial Plastic Surgery Division, Tehran University of Medical Science, Tehran, Iran. 2Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran. 3MSc, Biotechnology, Department of Biotechnology, Bangalore University, Bangalore, India. 4Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 5Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran. 6Assistant Professor of Anesthesiology, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Abstract Background Dysmenorrhea is an important disease that affects physical, social and psychological functioning such as social, emotional and health performance. The lavender essential oils are being used in both combined and mere forms. The purpose of this meta-analysis is to investigate the effects of lavender alone and in combination with other aromatic plants on the attenuation of dysmenorrhea. Materials and Methods The previously published articles were searched on only English databases of Medline, Cochrane library and scouts. Headings (MeSH) using the main keywords of (Lavandula OR lavender) AND (Dysmenorrhea) since inception until March 15 2019. We also searched all Iranian Databases with the same English keywords. Results Meta-analysis of lavender alone ‘showed that dysmenorrhea intensity was lower in patient treated with lavender in comparison to control: standardized mean difference [SMD] = -1.17, 95% confidence interval: -1.72 to-0.629. Heterogeneity was 85% and significant (p<0.001). Our meta-analysis showed dysmenorrhea intensity was lower in patients treated with compound containing lavender in comparison to control: SMD =-1.04; (p<0.001). Conclusion Given the patient's interest in complementary medicine and the low cost of this therapeutic approach, this technique can be used as a useful way to improve dysmenorrhea. The findings of these studies should be interpreted with caution because of the high heterogeneity between studies and the small number of studies and small sample size. Key Words: Aromatherapy, Dysmenorrhea, Effect, Systematic review. *Please cite this article as: Mousavi Kani K, Mirzania Z, Mirhaghjoo F, Mousavi nezhad R, Akbarzadeh S, Jafari M. The Effect of Aromatherapy (with Lavender) on Dysmenorrhea: A Systematic Review and Meta– Analysis.IntJPediatr2019;7(7):9657-66.DOI:10.22038/ijp.2019.39624.3378 *Corresponding Author: Mahdieh Jafari (M.D), Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Email: [email protected] Received date: Jan.16, 2019; Accepted date: Mar.22, 2019 Int J Pediatr, Vol.7, N.7, Serial No.67, Jul. 2019 9657 Aromatherapy and Dysmenorrhea 1- INTRODUCTION medicine, including the use of dietary The term dysmenorrhea refers to supplements, vitamins, aromatherapy, menstrual cramps that often begin during herbal remedies, homeopathy, acupressure, ovulation in the year after the menarche exercise and massage. Herbal remedies about 1-2 years after the first menstrual and supplements have recently attracted period, which is one of the most common further attention because of greater complaints in women's diseases (1, 2). acceptability and tolerability, as well as Primary dysmenorrhea is a painful fewer side effects (10). Different herbal bleeding in the absence of confirmed remedies have been used to treat pelvic disorders, often associated with dysmenorrhea, including fennel (11), nausea, vomiting, headache, bruising, and ginger (12), valerian (13), cinnamon (12), a general feeling of being unwell. The pain and thyme (14). One of the common and may last from two days prior to onset for major compounds of these herbs is 1-3 days (3). The prevalence of flavonoids that are phenylalanine-derived dysmenorrhea is different throughout the herbal pigments (15). Multiple studies world (3), and is between 20 to 90% in have documented that the analgesic adolescents and young women, accounting properties of herbals, such as passion for 72% of girls and women in Iran (4). flowers (16), Bauhinia microstachy (17) and Tribulus terrestris (18) are due to The causes of primary dysmenorrhea can flavonoids. These compounds appear to be attributed to uterine contraction, apply analgesic properties with vasoconstriction, inflammation and release antiprostaglandin effects (15). of inflammatory mediators. Reducing the progesterone level at the late luteal phase Regarding the fact that any drug in leads to the activation of cyclooxygenase addition to unwanted side effects has a and the biosynthesis of prostaglandin. beneficial effect, it is preferable to choose Increasing the prostaglandin production a drug with the least side effects. Today, results in increased uterine potency and there is a great tendency to use contractions, and then dysmenorrhea complementary and alternative medicine occurs (5). The dysmenorrhea is an (CAM), and medicinal herbs in the important disease that affects physical, treatment of diseases, especially primary social and psychological functioning such dysmenorrhea, and one of the applications as social, emotional and health of the CAM is the treatment of primary performance (6), as well as quality of life dysmenorrhea. Aromatherapy from the (2, 7-9). Unfortunately, non-steroidal anti- extract of plants has a special usage in the inflammatory drugs (NSAIDs) have been CAM, which utilizes essential oils ineffective in 10 to 20% of patients with possessing specific compounds (19). primary dysmenorrhea. Many of these Different plant-derived compounds are drugs have been banned for various used as essential oils in the aromatherapy, reasons, or have been reported including mandarin, valerian, orange inappropriate due to complications such as spring, tea tree, geranium, rose, headache, nausea, dizziness, kidney peppermint, sage, lemon and lavender failure, fatigue, edema, irritation and (19). The lavender essential oils are being gastrointestinal bleeding. The used in both combined and mere forms. dysmenorrhea may be alleviated The purpose of this meta-analysis is to effectively by other therapies, such as investigate the effects of lavender thermotherapy, acupuncture or aloneand in combination with other transcutaneous electrical nerve stimulation aromatic plants on the attenuation of (TENS), as well as complementary dysmenorrhea. Int J Pediatr, Vol.7, N.7, Serial No.67, Jul. 2019 9658 Mousavi Kani et al. 2- MATERIALS AND METHODS that compared other interventions with aromatherapy, used a control group with 2-1. Search strategy no treatment of any kind, or used a placebo The previously published articles were group that used placebo oil. searched on only English databases of Medline, Cochrane library and Scopus. Outcome Headings (MeSH) using the main Studies were included in this review if keywords of (Lavandula OR lavender) they identified the effects of aromatherapy AND (Dysmenorrhea) since inception until with lavender on menstrual pain in March 15 2019. Additionally, the comparison to a placebo. references listed in the found articles were Table-1: Search strategy for Medline (via manually reviewed to find more literature. PubMed). This study is a systematic review. In a systematic review, searching terms are Search Terms used as a searching strategy in data ("lavandula"[MeSH Terms] OR "lavandula"[All collection. A search term is a set of MeSH Fields]) OR ("lavandula"[MeSH Terms] OR terms and text terms using the Boolean "lavandula"[All Fields] OR "lavender"[All operator, which includes populations, Fields]) AND ("dysmenorrhoea"[All Fields] OR intervention, comparator, outcome (PICO). "dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"[All Fields]) OR An extensive search was performed on the ("dysmenorrhea"[MeSH Terms] OR Medline, EMBASE, Scopus, Cochrane, "dysmenorrhea"[All Fields] OR ("menstrual"[All and Web of Science until March 2019. The Fields] AND "pain"[All Fields]) OR "menstrual search query in Medline (via PubMed) is pain"[All Fields]) AND ("odorants"[MeSH shown in Table.1. In addition, a manual Terms] OR "odorants"[All Fields] OR "aroma"[All Fields]) OR ("aromatherapy"[MeSH search was conducted in Google motor Terms] OR "aromatherapy"[All Fields]) engine, Google Scholar, and bibliography of related articles and reviews. Detailed 2-2. Inclusion Criteria search terms for the systematic literature review and patients, intervention, Inclusion criteria were all randomized comparator, and outcome (PICO) were as clinical trials (RCTs) evaluating the effect follows: of aromatherapy with lavender in comparison to a placebo. Participants 2-3. Data extraction The populations (patients) in the study consisted of girls and women who Two separate reviewers studied the experienced menstrual pain, excluding searched articles for the inclusion criteria, those with any genital, chronic, or mental extra references, and the data required for diseases, as well as those with the meta-analysis. Any disagreement was hypersensitivity to aromatherapy. discussed and resolved via consensus. Intervention 2-4. Quality Assessment and Data Extraction For the study, the aromatherapy intervention studies selected consisted