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Case History

image A 25-year-old woman attends complaining of heavy, painful periods. She is not keen to use conventional medication and asks about alternative and complementary therapies.

What are the available preparations?

What is the evidence of efficacy?

What is the safety profile of these preparations?


image The use of alternative and complementary therapies (ACTs) for a range of medical conditions is becoming increasingly popular. The National Omnibus Survey in the United Kingdom found that an estimated 10% of the population had used any ACT from a practitioner in the previous year, and more than half of these had not informed their general practitioner.1

Menstrual problems are very common in young women and for a number of reasons these women may be reluctant to use prescribed medicines to alleviate symptoms. Many women believe that ACTs are 'safer' but there are limited published data to confirm safety or, indeed, efficacy.2 Most ACTs (Table 10.1) have been used for the relief of symptoms of primary and secondary dysmenorrhoea.

Table 10.1Alternative and complementary therapies used for menstrual problems

Herbal preparations

Herbal and dietary therapies are often used to treat primary and secondary dysmenorrhoea. In the United States (US), herbs and other phytomedicinal products have been legally classified as dietary supplements since 1994.2

Sweet fennel has been compared with mefenamic acid for the treatment of primary dysmenorrhoea. In one study, efficacy was assessed using a self-scoring system over three cycles.3 Mefenamic acid had a more potent effect than fennel on the second and third menstrual days; however, the difference on the other days was not significant. Fennel was therefore concluded to be a safe and effective remedy, although may need to be used in higher dosages to increase potency.

Vitex agnus castus (VAC) is a deciduous shrub, native to Mediterranean Europe and Central Asia. VAC fruit extract has been used for the treatment of a range of gynaecological conditions and the German Commission E has approved its use for irregularities of the menstrual cycle, premenstrual disturbances and mastodynia.4 Available evidence suggests that adverse effects are mild and reversible, with few drug interactions.4

Rose tea ingestion has been used for the treatment of primary dysmenorrhoea. A study in Taiwan reported a reduction in menstrual pain, distress and anxiety and greater psychophysiologic well-being at one, three and six months after intervention in adolescents randomized to drinking rose tea compared to controls.5


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