A Cochrane review found no high quality evidence to support the efficacy of any dietary supplement for dysmenorrhea.
Standard treatment for dysmenorrhea includes non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which help reduce myometrial activity. Dietary supplements are a suggested alternative, including botanicals, vitamins, minerals, enzymes, and amino acids. Researchers from the Cochrane Gynecology and Fertility Group aimed to determine the efficacy and safety of dietary supplements for the treatment of dysmenorrhea.
They searched various registers and databases for randomized controlled trials of dietary supplements for moderate or severe primary or secondary dysmenorrhea. Studies in women with an intrauterine device were excluded from this review. Studies that compared other dietary supplements, placebo, no treatment, or conventional analgesics were eligible for analysis. The primary outcomes were pain intensity and adverse effects. The quality of evidence was established using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods.
A total of 27 RCTs evaluating 3,101 women were included. Study interventions included 12 different herbal supplements: 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 5 non-herbal supplements (fish oil, melatonin, vitamins B1 and E, and zinc sulphate) in various forms and doses. Other comparators included different supplements, placebo, no treatment, and NSAIDs.
Study authors reported pain scores (based on visual analog scale [VAS]) 0–10 points or rates of pain relief, or both, at the first post-treatment follow-up. All of the evidence was deemed low or very low quality. Only 4 out of the total studies reported adverse effects in both treatment groups. The main limitations were imprecision due to very small study samples, failure to report study methods, and inconsistency. Researchers concluded that for a few supplements where low quality evidence of efficacy was found (fenugreek, ginger, zataria, zinc sulphate, fish oil, valerian, vitamin B1), more research is warranted.
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