Chinese Herbs Ease Menstrual Cramps Better than NSAIDs

SYDNEY, Australia, Oct. 16 -- Traditional Chinese remedies may ease painful menstrual cramps better than nonsteroidal anti-inflammatories (NSAIDs) and other drugs, according to a Cochrane systematic review.

Chinese herbal medicine for primary dysmenorrhea roughly doubled pain relief and improvement in overall symptoms compared with conventional Western pharmaceuticals, reported Xiaoshu Zhu, M.Med., of the Chinese Medicine Program at the University of Western Sydney here, and colleagues in the fourth issue for 2007 of The Cochrane Library.

The herbal remedies were also significantly better at relieving painful cramps and other symptoms than acupuncture or a hot water bottle, with overall promising findings, they said.

"However, the small number and the low quality of included studies did not allow for any definite conclusion for their use in clinical practice," Zhu and colleagues wrote.

Herbal medicine has been used for centuries in China and continues to be used in public hospitals there to treat primary dysmenorrhea, whereas Western medicine has relied on pharmaceutical treatment, such as NSAIDs and the contraceptive pill, they said.

But, "more women are looking for non-drug therapies," they added, particularly those women who have a contraindication for or cannot tolerate these drugs.

So, the researchers conducted a systematic review and identified 39 randomized controlled trials of Chinese herbal medicine with a total of 3,475 women treated for self-reported primary dysmenorrhea.

All of the trials were of parallel design. One trial each was conducted in Taiwan, Japan, and the Netherlands, while the rest were done in China.

The majority of trials used complicated herbal formulas with more than five of six herbs, most commonly including Danggui (Chinese angelica root), Chuanxiong (Szechuan lovage root), Chishao (red peony root), and Baishao (white peony root), in a traditional cooked decoction.

These herbs could affect hormones and microcirculation hemorrheology, the researchers said.

Herbal interventions were usually started five to seven days before menstruation and continued for about 10 to 15 days -- until the first or second day of menstruation or throughout menstruation.

Most trials compared one herbal medicine with another (18 trials) or with conventional therapy, such as NSAIDs or oral contraceptives (14 trials).

Three trials compared Chinese herbal medicine with placebo, one compared it with no treatment, two compared it with acupuncture, and one compared it with heat compression.

For reduction in pain, the findings included:

• Chinese herbs overall, whether standardized or tailored, yielded better pain relief than conventional pharmaceutical therapies (RR 1.99, 95% CI 1.52 to 2.60) typically for up to three months of follow-up.
• Chinese herbal medicine relieved pain significantly better than over-the-counter herbal health products (RR 2.06, 95% CI 1.80 to 2.36).
• Chinese herbal medicine improved pain significantly better than acupuncture (RR 1.75, 95% CI 1.09 to 2.82).
• No consistent advantage was seen for acupuncture in the placebo-controlled trials, which could not be combined.
• Chinese herbs beat heat compression using a hot water bottle (RR 32.08, 95% CI 2.06 to 499.18).

For symptom reduction, the findings were similar and included:

• Chinese herbal medicine was significantly better than placebo in the one trial that reported this outcome (RR 5.59, 95% CI 0.32 to 97.87).
• Overall symptoms improved more with Chinese herbal medicine than with conventional pharmaceutical therapy, which was sustained through three months of follow-up (RR 2.17, 95% CI 1.73 to 2.73).
• Chinese herbal medicine was significantly better than over-the-counter herbal medicine through up to three months of follow-up (RR 1.99, 95% CI 1.65 to 2.40).

Chinese herbal medications were also associated with less frequent need of additional medication compared with Western pharmaceutical therapy (RR 1.58, 95% CI 1.30 to 1.93).

Although individually tailored Chinese herbal formulations were significantly better than commonly used over-the-counter herbal health products on several measures, Zhu and colleagues said their review could not explicitly answer if one was more beneficial.

No significant adverse effects were identified in the studies, but "the safety of Chinese herbal medicine in clinical practice was not addressed adequately in the reviewed trials," they said. Measurement and reporting of adverse effects was poor, and only two trials had adequate overall methodological quality.

"An attempt towards evidence-based Chinese medicine practice has been made," the investigators concluded. "However, more research trials with high quality design -- especially in terms of laboratory tests -- are needed."