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Vol. 35. Núm. S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Páginas S591-S595 (enero 2020)
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The use of aromatherapy in primary dysmenorrhea
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Ristiania,
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, Aryadi Arsyada, Andi Nilawati Usmana, Saidah Syamsuddinb, Mardiana Ahmada, Andi Wardihan Sinranga
a Midwifery Study Program, Graduate School, Hasanuddin University, Indonesia
b Faculty of Medicine, Hasanuddin University, Indonesia
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Table 1. Analysis of aromatherapy articles on primary dysmenorrhea.
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Vol. 35. Núm S2

The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)

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Abstract
Objective

The purpose of this review is to determine the use of aromatherapy in primary dysmenorrhea.

Method

This is a literature review by searching article databases through Google Scholar, PubMed, ScienceDirect, Microsoft Academic, ProQuest, Semantic Scholar. The selection period for article publication is from 2015 to 2021. A total of 96 articles were obtained, and 30 articles could be entered according to the inclusion criteria.

Results

Thirty articles were analyzed, it is shown that aromatherapy effectively reduces the intensity of primary dysmenorrheal pain. 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.

Conclusion

Aromatherapy is an effective alternative intervention that can be used to reduce the intensity of primary dysmenorrhea pain.

Keywords:
Aromatherapy
Dysmenorrhea
Primary Dysmenorrhea
Menstruation
Texto completo
Introduction

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.

Method

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).

Table 1.

Analysis of aromatherapy articles on primary dysmenorrhea.

Author (year)  Research design and sample  Interventions provided  Research measurement tools  Research result 
Nikjou et al. (2016)13  Triple-blinded randomized clinical trial200 female students with primary dysmenorrhea  Three drops of lavender essential oil and three drops of diluted milk are given to a cotton swab by inhalation three times/day for 30min in the first three days of menstruation  QuestionnaireVAS  Lavender aromatherapy was effective in reducing menstrual pain (P<0.001) 
Hanfy et al. (2020)14  40 women with primary dysmenorrhea  Progressive relaxation trainingAromatherapy lavender and rosemary AromaGiven 3 times/week for 8 weeks  VAS  Progressive relaxation training and aromatherapy are effective in reducing menstrual pain 
Purwati (2018)15  Pre-experimental design with time series design40 students who experience menstrual pain  Effleurage massage with 2 drops of lavender essential oil and 1ml of olive oil, performed for 10min pre and post-test with an interval of 6NRS  Effleurage massage with lavender aromatherapy in relieving menstrual pain (P<0.000) 
Ari Adiputri et al. (2018)16  Pre-experimental design with time series design42 students with primary dysmenorrhea  Lavender essential oil therapy with effleurage massage four observations for 6VAS  Administration of lavender essential oil therapy with effleurage massage was effective in reducing the intensity of dysmenorrhoea pain (P<0.05) 
Pujiati et al. (2019)17  Randomized pretest-posttest design84 students with primary dysmenorrhea  Aromatherapy lavender, clary sage, ginger, geranium with effleurage massageLavender aromatherapy With effleurage massagePerformed for 3min at minute 5, 10, 15 and 25  NRS  Giving lavender, clary sage, ginger, geranium aromatherapy with effleurage massage was more effective in reducing dysmenorrhea pain than lavender aromatherapy with effleurage massage (P<0.001) 
Thenmozhi and Bhuvaneshwari (2020)18  Pre-experimental designSixty adolescent girls with primary dysmenorrhea  Inhalation of lavender aromatherapy on the 7th day of the menstrual cycle for 2 menstrual cycles with a post-test on the first day of menstruation  NRS  Lavender aromatherapy is effective in reducing menstrual distress in primary dysmenorrhea (P<0.001) 
Hamranani and Sari (2020) 19  Pre-experimental with one group pretest post-test design16 teenage girls with primary dysmenorrhea  Aromatherapy lavender 3–5 drops for 5min on the 2nd day of menstruation  NRS  Lavender aromatherapy is effective in reducing menstrual pain (P<0,05) 
Zayeri et al. (2019) 20  Double-blinded randomized clinical trial96 students with primary dysmenorrhea  Aromatherapy lavender 3 drops in the palm of the hand by inhalation for 5min with a distance of 7–10cm from the nose, every 6h for 3 days  VAS  Lavender aromatherapy was effective in reducing menstrual pain (P<0.001) 
Pramita et al. (2020)21  Quasi-experimental with one group pre-posttest design38 female students with primary dysmenorrhea  Lavender aromatherapy 2–4 drops of the lower abdomen with a massage for 10min performed 1 time/day for 3 days  Questionnaire  Lavender aromatherapy can reduce menstrual pain (P<0.05) 
Ertiana and Pratami (2021)22  Quasi-experimental with nonequivalent control group design22 adolescent girls with primary dysmenorrhea  Aromatherapy lavender 2 drops on the back of the hand and inhale for 10min  Questionnaire  Lavender aromatherapy can reduce dysmenorrhea pain (P<0.05) 
Sabrima et al. (2020)23  Quasi-experiment with one group pretest and post-test31 students with primary dysmenorrhea  Lavender aromatherapy  NRS  There is an effect of lavender aromatherapy on reducing dysmenorrhea pain (P<0.05) 
Nurak et al. (2020)24  Quasi-experiment with no control group40 students with primary dysmenorrhea  Aromatherapy lavender jasmine 4–5 drops into 10ml water for 10minutes  NRS  Lavender and jasmine aromatherapy was effective in reducing dysmenorrhea pain (P<0.001) 
Azizah (2019)25  Quasi-experiment with pre-post test nonequivalent control group design30 adolescent girls with primary dysmenorrhea  Lavender aromatherapy inhalation  VAS  Lavender aromatherapy can reduce menstrual pain (P<0.002) 
Savitri dan Hardyanti (2019)26  Pre-experimental design with one group pretest posttest34 students with primary dysmenorrhea  Inhalation of lavender aromatherapy 3 drops mixed with 20ml of water  NRS  There was a decrease in the intensity of dysmenorrhea pain using lavender aromatherapy (P<0.05) 
Sun et al. (2017)27  60 female rats induced by oxytocin  Cinnamomum cassia essential oil  ELISA kit and Power Lab recording system  Cinnamomum cassia essential oil can inhibit uterine smooth muscle contraction so that it can be used to reduce the pain intensity of dysmenorrhea. 
Azima et al. (2015)28  Randomized controlled trial102 students with primary dysmenorrhea  Group I: effleurage massage with lavender aromatherapyGroup II: isometric exercises  VAS  Isometric exercise and massage with aromatherapy can reduce the intensity of primary dysmenorrhea 
Azima et al. (2015)29  Controlled clinical trials102 students with primary dysmenorrhea  Reflexology was 20min/dayMassage with lavender aromatherapy for 15minutes  VAS  Aromatherapy massage and reflexology can reduce the intensity of primary dysmenorrhea pain 
Dadfar (2015)30  Clinical trial30 women with symptoms of dysmenorrhea and premenstrual syndrome  Chamomile extract 30 drops in a glass of water/8h for 3 days  Questionnaire Daily Record of Severity of Problems (DRSP)  Chamomile extract can reduce dysmenorrhea pain and premenstrual syndrome symptoms 
Ataollahi et al. (2015)31  Double-blind clinical trial110 students with primary dysmenorrhea  Rosaceous essential oil 10 drops 2 times/day for the first 3 days of menstruation  Questionnaire  Rosaceous aromatherapy can reduce the intensity of dysmenorrhea 
Chen et al. (2015)32  Animal experimentsMice with dysmenorrhea (using estradiol benzoate and oxytocin)  Essential oils (Angelica oil, Chuanxiong oil, Cyperus oil, Cinnamon oil, and Clove oil) and Ibuprofen  –  The essential oil was effective in penetrating Ibuprofen in treating dysmenorrhea (P<0.05) 
Salehian dan Safdari (2015)33  Clinical trial100 students with primary dysmenorrhea  Belly massage with cinnamon and lavender aromatherapyAbdominal massage with placeboPerformed 1 time/day for 7 days before menstruation  VAS  Abdominal massage with aromatherapy was effective in reducing menstrual pain (P<0.05) 
Bakhtshirin et al. (2015)34  Clinical trial80 students with primary dysmenorrhea  Lavender aromatherapy massageMassage with placebo  VAS  Massage with lavender aromatherapy was more effective than a massage with placebo in reducing primary dysmenorrhea (P<0.001) 
Beiravand et al. (2015)35  Randomized clinical trial60 students with primary dysmenorrhea  Massage with lavender essential oil 2 drops in 2.5ml almond oilMassage with almond oil placebo 2.5mlPerformed 15min 2 times/day for 2 menstrual cycles above the pubis  VAS  Massage with lavender aromatherapy was effective in reducing dysmenorrhea pain (P<0.001) 
Wong et al. (2020)36  Ex vivo and in vivo studyRat  Salvia sclarea essential oil  Analysis Western Blotting  Sclareol contained in Salvia sclarea essential oil can reduce dysmenorrhea 
Masoudi et al. (2020)37  Case series13 samples with primary dysmenorrhea  Qost Oil 15 drops (2.3ml) applied 2 times/day in the zone between the navel and pubis without massage for 6 weeks  VAS  Qost essential oil is effective for controlling dysmenorrhea 
Ni et al. (2021)38  In vitro studiesRat  10 essential oils Blood-activating and stasis-resolving herbs (BASRH)  Power Lab recording system  BASRH essential oil can relax uterine smooth muscles to reduce dysmenorrhea 
Bi et al. (2021)39  In vivo and in vitro studiesRat  Citrus essential oil  –  The citrus essential oil can effectively reduce primary dysmenorrhea in rats 
Yunianingrum et al. (2018)40  Quasi-experiment with two group comparison pretest–posttest design44 respondents with primary dysmenorrhea  Warm compresses 2 times for 60minutes at a temperature of 38.5°C-40°C using a warm water bagLavender aromatherapy candle for 60min  NRS  Warm compresses and lavender aromatherapy are effective in reducing the pain of dysmenorrhea 
Shirooye et al. (2017)41  Single-blind randomized trial70 students with primary dysmenorrhea  Ginger essential oil 5 drops eachGinger capsules 250mgGiven 6h in the first 2 days of menstruation  VAS  Ginger essential oil and ginger capsules effectively relieved dysmenorrhea pain, but ginger essential oil was tolerated better than ginger capsules by respondents. 
Uysal et al. (2016)42  Randomized clinical trial100 respondents with primary  Aromatherapy rose by inhalation for 10min  VAS  Aromatherapy with rose essential oil is effective in reducing the intensity of dysmenorrhoea pain 

Fig. 1.

Fig. 1.

Literature search flowchart.

(0.13MB).
Result

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.

Discussion

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.

Conclusion

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.

Conflicts of interest

The authors declare no conflict of interest.

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