Dysmenorrhea is a common problem experienced by most women that need to be addressed.1 Dysmenorrhea is defined as menstrual pain feeling cramps in the lower abdomen originating from the uterus, classified into two, namely primary dysmenorrhea that occurs in the absence of pathology and secondary dysmenorrhea that occurs in the presence of pathology.2 The discomfort felt from menstrual pain affects daily activities.3 For most young women, it is the cause of absenteeism from college/school.4

Several studies regarding the prevalence of dysmenorrhea in various countries, namely from a total of 20.813, are 71.1% experiencing dysmenorrhea.5 In a study in Ghana, the prevalence of dysmenorrhea was 68.1%, with the majority of the mean age 16–19 years with pain lasting more than 3 days.6 On the other hand, a study in North Central Ethiopia stated that 62.3% of women experienced primary dysmenorrhea that hindered daily activities, with the majority experiencing severe pain.7 The intense pain experienced during menstruation can limit daily activities.8

In managing dysmenorrhea, some women choose to consult a health professional about their condition, and some claim to use analgesic drugs to relieve dysmenorrhea pain without ever consulting a health professional.8 In addition to pharmacological treatment options, there are non-pharmacological treatment options as alternative therapies to complementary medicine.9 Complementary pain therapies include respiratory relaxation, essential oils, aromatherapy, music therapy, acupuncture, and acupressure. Complementary therapies can reduce pain and improve quality of life.10

Aromatherapy is a therapy that uses essential oils as aromatics from extracted plants to improve the health of the body, mind, and spirit.11 Aromatherapy can be an alternative used to treat dysmenorrhea.12 The purpose of this review is to determine the use of aromatherapy in primary dysmenorrhea.

This article is a literature review conducted to find out about aromatherapy as an alternative therapy in primary dysmenorrhea. The method used is a literature review with international and national literature searches carried out using a database. Search databases of relevant articles on aromatherapy in primary dysmenorrhea were identified by searching for articles through Google Scholar, PubMed, ScienceDirect, Microsoft Academic, ProQuest, Semantic Scholar. The selection period for the publication of the article is from 2015 to 2021. The search keywords used are “aromatherapy,” “dysmenorrhea,” “essential oil,” and “menstrual pain.” Search in English and Indonesian, which are considered relevant to the topic of discussion to be entered. The total articles obtained were 96 articles relevant to the title, then the articles retrieved in the search were filtered based on the relevant titles and abstract contents. With the inclusion criteria, namely: the article contains about aromatherapy used in dysmenorrhea, the research subject has dysmenorrhoea, and the article must contain full-text, the exclusion criteria are systematic review articles with meta-analysis, 30 articles met the inclusion criteria (Table 1).

Fig. 1.

Fig. 1.

Literature search flowchart.

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Based on 30 articles analyzed, it is known that aromatherapy effectively reduces the pain intensity of primary dysmenorrhea. The sample size of the 30 articles varied from 16 samples to 200 research samples, and the research design used experiments, clinical trials, and ex vivo, in vivo, and in vitro studies. In addition, there are three articles using mice as research samples.

Thirty articles were analyzed regarding the intervention that indicated that aromatherapy was administered by inhalation, oral, and dermal (massage or topical). Aromatherapy used includes lavender, clary sage, ginger, geranium, Cinnamomum cassia, chamomile, rosaceous, angelica, chuanxiong, cyperus, clove, salvia sclarea, Saussurea costus, citrus, ginger, Curcuma phaeocaulis, Ligusticum striatum, Leonurus japonicus (rhizomes), Curcuma longa (tuberous roots), Prunus persica, Carthamus tinctorius, Siphonostegia Chinensis, Salvia miltiorrhiza and Cyathula officinalis.

Primary dysmenorrhea is cramping of the lower abdomen in the uterus during menstruation caused by the uterus contracting. Primary dysmenorrhea occurs due to increased uterine contractions due to excessive production and release of prostaglandins.9 Due to the presence of PGF2α, blood vessels, and myometrium contract and cause tissue ischemia and pain.27

There were 10 essential oils (Curcuma phaeocaulis, Ligusticum striatum, Leonurus japonicus, Curcuma longa (rhizomes), Curcuma longa (tuberous roots), Prunus persica, Carthamus tinctorius, siphonostegia Chinensis, salvia miltiorrhiza, cyathula of terpenoids, disqui-aliphatic, and phthalates, decreased contractile activity, tension, and frequency (P<0.05 or P<0.01). Curcuma phaeocaulis essential oil can inhibit the entry of extracellular Ca 2+ and release intracellular Ca 2+, which supports uterine relaxation and can be used as an antidysmenorrhea treatment.38 In line with the research results of Sun et al. (2017), the content in Curcuma phaeocaulis essential oil can inhibit uterine smooth muscle contraction so that it can be used as an alternative treatment for dysmenorrhea.

An aromatherapy massage is a stimulation of the skin with gentle strokes coupled with essential oils. Aromatherapy massage on body organs can absorb optimally, which causes a relaxing effect. This occurs due to increased oxygen circulation, which can reduce pain intensity.17 Giving aromatherapy either by massage or inhalation can reduce menstrual pain.8 Here is a decrease in the duration of pain by providing aromatherapy with a massage.28,35

Aromatherapy triggers the limbic system to stimulate the hypothalamus to produce endorphins which result in pain reduction.20,24 Some essential oil molecules in the blood are able to interact with hormones or enzymes to help relieve pain.15 Aromatherapy given by inhalation can reduce the pain of dysmenorrhea, and there are no side effects that occur in research subjects so that aromatherapy by inhalation is a safe treatment.13 In the study of Hamranani and Sari (2020), aromatherapy given by inhalation with 3–5 drops of aromatherapy carried out for 5min can reduce pain and reduce menstrual pain (P<0.05).

The content of linalyl acetate and Linalool (C10H180) in lavender provides a relaxing effect that can reduce anxiety.26 In the study of Ertiana and Pratami (2021), respondents experienced menstrual pain that often occurred on the first to a third day with risk factors for dysmenorrhea, namely the duration of menstruation, excess body weight associated with fatty tissue in the reproductive organs that inhibits blood flow and experiencing stress as a result of stress. It is Triggers the excessive production of the hormones estrogen and adrenaline related to uterine contractions. Stress reduction by giving essential oils can be effective in improving the symptoms of primary dysmenorrhea.29

Aromatherapy is used for fragrance and healing. Lavender aromatherapy is proven to help overcome anxiety as a relaxing or calming effect that can help stress management. Chamomile aromatherapy can secrete cortisol and is an analgesic.43 Nikjou et al. (2016) stated that lavender aromatherapy was effective in reducing menstrual pain. According to Hamranani and Sari (2020), by giving 3–5 drops of lavender aromatherapy by inhalation for 5min, Savitri and Hardyanti (2019) Lavender aromatherapy 3 drop mixed with 20ml of water by inhalation effectively reduce the pain of dysmenorrhea.

Ginger essential oil 5 drops and ginger capsules 250mg every 6hours in the first 2 days of menstruation effectively relieve dysmenorrhea pain, but ginger essential oil is tolerated better than ginger capsules.41 In a study conducted by Pujiati, Siagian, and Hardivianty (2019), it was stated that aromatherapy of lavender, clary sage, ginger, geranium with effleurage massage performed for 3mi at 5, 10, 15, and 25min was effective in reducing dysmenorrhea pain but more effective than providing lavender aromatherapy alone with effleurage massage.

Aromatherapy is an effective alternative intervention that can be used to reduce the pain intensity of primary dysmenorrhea. However, the results of the analysis of articles with various research designs and aromatherapy interventions may be biased. Several studies on the measurement of primary dysmenorrheal pain still use VAS and NRS. So it is still necessary to do further research with different designs, interventions, and examinations other than VAS and NRS in future studies.

The authors declare no conflict of interest.