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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 12, Number 6, 2006, pp. 535–541 Š Mary Ann Liebert, Inc.

Effect of Aromatherapy on Symptoms of Dysmenorrhea in College Students: A Randomized Placebo-Controlled Clinical Trial SUN-HEE HAN, Ph.D., R.N.,1 MYUNG-HAENG HUR, Ph.D., R.N.,2 JANE BUCKLE, Ph.D., R.N,3 JEEYAE CHOI, D.N.Sc., R.N.,4 and MYEONG SOO LEE, Ph.D.5

ABSTRACT Objective: The purpose of this study was to explore the effect of aromatherapy on menstrual cramps and symptoms of dysmenorrhea. Design: The study was a randomized placebo-controlled trial. Subjects: The subjects were 67 female college students who rated their menstrual cramps to be greater than 6 on a 10-point visual analogue scale, who had no systemic or reproductive diseases, and who did not use contraceptive drugs. Intervention: Subjects were randomized into three groups: (1) an experimental group (n  25) who received aromatherapy, (2) a placebo group (n  20), and (3) a control group (n  22). Aromatherapy was applied topically to the experimental group in the form of an abdominal massage using two drops of lavender (Lavandula officinalis), one drop of clary sage (Salvia sclarea), and one drop of rose (Rosa centifolia) in 5 cc of almond oil. The placebo group received the same treatment but with almond oil only, and the control group received no treatment. Outcome measures: The menstrual cramps levels was assessed using a visual analogue scale and severity of dysmenorrhea was measured with a verbal multidimensional scoring system. Results: The menstrual cramps were significantly lowered in the aromatherapy group than in the other two groups at both post-test time points (first and second day of menstruation after treatment). From the multiple regression aromatherapy was found to be associated with the changes in menstrual cramp levels (first day: Beta  2.48, 95% CI: 3.68 to 1.29, p  0.001; second day: Beta  1.97, 95% CI: 3.66 to 0.29, p  0.02 and the severity of dysmenorrhea (first day: Beta  0.31, 95% CI: 0.05 to 0.57, p  0.02; second day: Beta  0.33, 95% CI: 0.10 to 0.56, p  0.006) than that found in the other two groups. Conclusions: These findings suggest that aromatherapy using topically applied lavender, clary sage, and rose is effective in decreasing the severity of menstrual cramps. Aromatherapy can be offered as part of the nursing care to women experiencing menstrual cramps or dysmenorrhea.

1School

of Nursing, Wonkwang Public Health College, Iksan, Korea. of Nursing, Eulji University, Daejeon, South Korea. 3Center for Complementary Medicine & Integrative Health, Faculty of Health and Human Science, Thames Valley University, London, United Kingdom. 4Clinical Informatician, Department of Professional Development, Spaulding Rehabilitation Hospital, Boston, MA. 5Center for Integrative Medicine, Institute of Medical Science, Wonkwang University, Iksan, Korea. Current address, Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, United Kingdom. 2School

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HAN ET AL.

INTRODUCTION

D

ysmenorrhea is defined as painful menstruation involving low abdominal pains (menstrual cramps), which may be accompanied by other symptoms such as nausea and fatigue. Menstrual cramps caused by dysmenorrhea are a common problem. Some studies suggest that 50–93% of women experience menstrual cramps caused by dysmenorrhea, and that 10–26% of women experience severe pain. In a recent study in Korea, 83% of college women complained of menstrual cramps, 18% rating their pain as very severe.1 In the most severe cases, the pain was rated 7.9 on a 10-point visual analogue scale (VAS). However, despite frequent occurrence and severity, menstrual cramps are not acknowledged as a serious problem or one requiring nursing intervention. However, Milsom et al.2 showed that the intra-uterine pressure (IUP) of a patient with dysmenorrhea was 55.3  3.8 mmHg in the relaxation phase and 175.0  6.1 mmHg in the contraction phase, and that the IUP during contraction is greater than in labor.1 Dysmenorrhea is usually treated with drugs, such as analgesics, sedatives, antispasmodics, prostaglandin inhibitors, uterine contraction inhibitors, nonsteroidal anti-inflammatory drugs, vasopressin antagonists, and medication to stop ovulation.3 In a review article, Dawood3 suggested that none of these therapies are particularly effective but some may lead to dependence or affect cognitive function. Bed rest, local heat therapy, surgical intervention, and psychotherapy have also been used.3 In a 1999 survey, Han and Hur1 found that the most common methods to cope with menstrual cramps were “endurance” and medication. Campbell and McGrath4 found that 70% of women with dysmenorrhea use medication. However, Chambers et al.5 noted that the medication might not be effective if not used regularly. Many studies suggest that menstrual cramps and dysmenorrhea are not managed efficiently despite their high occurrence and severity. A variety of alternative methods have been used to treat menstrual cramps. Some experimental studies have found alternative methods such as acupuncture6 and transcutaneous electrical nerve stimulation (TENS)7 to be fairly effective (e.g., 50% reduction in pain). Kotani et al.8 found that the herbal medicine Toki-shakuyaku-san [Japanese angelica root (Angelicae radix), peony root (Paeoniae radix), Poria (Hoelen spp.), Chinese atractylodes rhizome (Atractylodis lanceae rhizoma), Oriental water plantian rhizome (Alismatis rhizome), Cnidium (cnidii rhizoma)] was more effective than placebo in treating primary dysmenorrhea. Attempting to cure idiopathic menstrual pain, Kim* used a placebo in the form of a vitamin pill. Dawood and Ramos9 suggested that concurrent use of TENS and ibuprofen might be an effective treatment, and Harel et al.10 used supplements such as omega-3 fatty acids. TENS and ibuprofen to*Kim G. The Effect of Menstrual Pain Relief by Placebo [unpublished Master’s thesis]. Pusan, Korea; Department of Nursing, Pusan National University, 1985.

gether appear to be the most effective treatment for menstrual cramps. Vance et al.11 tried microwave diathermy, and Kim et al.12 tried biofeedback. However, many of these treatments cannot be prescribed by nurses, and many conventional drugs have side effects or their main effects do not last long. Because dysmenorrhea is so common and has been inadequately addressed, it is important to find an effective method that can be easily used. Aromatherapy is the therapeutic use of essential oils from plants. Essential oils can be absorbed into the body via the skin or the olfactory system. Aromatherapy is thought to be particularly efficacious against menstrual cramps or dysmenorrhea.13–15 In some countries aromatherapy products are sold and aromatherapy is used as a major complementary “caring” therapy.16 Aromatherapy is perceived to be a safe therapy.17 Essential oils have been used for several hundred years and are used regularly today by the public for stress-management and for minor ailments.18 However, the therapeutic effects of aromatherapy are not well supported by clinical studies.19 Keville and Green20 suggested that essential oils should be used for several days before dysmenorrhea or menstrual cramps are expected. They recommend that the essential oils of chamomile (Chamomelum nobile), clary sage (Salvia sclarea), lavender (Lavandula angustifolia), marjoram (Origanum majorana), melissa (Melissa officinalis), and geranium (Pelargonium graveolens) help in treating menstrual cramps. Tisserand15 suggested clary sage, lavender, rose (Rosa centifolia), marjoram, geranium, and ginger (Rhizoma zingiberis recens) as effective in treating dysmenorrhea. Dye13 suggested clary sage, chamomile, geranium, and rose, while Baker21 suggested geranium, Roman chamomile, rosemary, lavender, clary sage, and sage. The essential oil of lavender is thought to be an adrenocortical stimulant that stimulates menstruation and circulation and has anticonvulsive properties. Lavabre14 suggested that lavender is also useful as a sedative and to alleviate pain. Tisserand15 suggested that clary sage has functions similar to estrogen, such as normalizing the menstrual cycle, promoting menstruation, and strengthening the uterus. Tisserand15 also suggested that rose has a great affinity for the uterus and helps regulate the menstrual cycle and reduce excessive bleeding. In this study, we hypothesized that applying these three essential oils together would provide a synergistic blend that would have the highest chance of success in treating the pain of menstrual cramps. Different methods are used to deliver aromatherapy, such as diffusers, baths, massage, and compresses. Massage is believed to be an effective way to improve blood and lymph circulation and to reduce stress and ease stiff muscles. For massage, the essential oil is diluted in a cold-pressed vegetable oil, a popular choice being sweet almond oil.13,14,20 Massage appears to be a suitable method to deliver aromatherapy to treat menstrual cramps of dysmenorrhea. The purpose of this study was to investigate whether the combination of lavender, clary sage, and rose applied topically alleviates menstrual cramps. If the results were positive, this


AROMATHERAPY MASSAGE EFFECT ON SYMPTOMS OF DYSMENORRHEA method of aromatherapy might be adopted as a nursing intervention for patients with painful menstrual cramps.

MATERIALS AND METHODS Design The study consisted of a double-blind, three-group experimental pre-test/post-test design. Fifty-seven (57) participants were randomly assigned to one of three groups. The experimental group received aromatherapy in almond oil with massage, the placebo group received treatment with almond oil only and massage, and the control group received no treatment. The levels of dysmenorrhea and general and menstrual characteristics were measured before the study began. After the intervention, the levels of dysmenorrhea were measured for each group on the first and second days of menstruation. Subjects were told there were no side effects or contraindications to the treatment they were about to receive, but that, in rare instances, skin irritation could occur. The study received institutional approval from the Human Investigation Ethics Committee and administrative approval from the Human Subjects Review Board of Wonkwang University Hospital and School of Medicine before we approached the subjects and obtained written consent from them.

Participants The participants were college women enrolled in universities in Korea. A previous survey had identified 85 women who experienced dysmenorrhea. The selection criteria were: (1) pain of menstrual cramps greater than 6 points on the 10-point VAS (a line calibrated from 0–10, with 0 representing “no pain at all” and 10 representing “pain as bad as it could be”); (2) no systemic disease or disease of the genital organs; and (3) no use of contraceptives. Participants who failed to meet all of these criteria were excluded from the study. Patients with myoma or fibrocystadenoma were also excluded from the study. Of the 85 subjects who were originally screened, 67 entered the initial phase of the study. The experimental group (n  25; mean age, 20.6  1.27 years) received aromatherapy in almond oil with massage. The placebo group (n  20; mean age, 20.9  1.93) received treatment with almond oil only and massage, and the control group (n  22; mean age, 20.5  0.51) received no treatment. To randomize the study, each participant drew a piece of paper with either A, B, or C written on it from a closed box. When a participant drew A, she joined the experimental group; B, the placebo group; and C, the control group. In discussing the nature of aromatherapy and the experimental procedures, the subjects were informed that they would receive one of two types of aromatherapy, both of which had the potential to relieve menstrual cramps. Subjects were blinded as to whether they were receiving real or

537

sham aromatherapy, as were the clinical observers assessing the endpoints. Four assistants contacted the subjects and checked their responses.

Intervention The experimental group received aromatherapy in the treatment room every day beginning one week before the start of menstruation and continuing until the first day of menstruation. The experimental and placebo groups received 15 minutes of aromatherapy or placebo, respectively. The aromatherapy was provided in the form of abdominal massage with essential oils of lavender, clary sage, and rose in a 2:1:1 ratio, diluted in almond oil at a final concentration of 3%. The treatment room for abdominal massage was isolated and equipped with beds warmed by heating pads. Clients were requested to lie on the bed and rest after the abdominal massage. The clients in the placebo group had the same treatment with almond oil only. Each treatment lasted about 15 minutes for both groups. No treatment was provided to the control group, who continued their daily routine. Each subject received a 15-minute abdominal massage beginning with effleurage strokes in the shape of a flat diamond, working clockwise with a pressure of 4 on a scale of 0–10, where 0 is no pressure and 10 is crushing pressure. The masseur’s left hand was placed on the right hand and both hands were placed on the right lower abdomen. The stroke went to the ribs and then across the abdomen to the left lower abdomen. This was followed by gentle kneading at the left and right of the waist and then stroking across the abdomen. Following this, the effleurage flat diamond stroke began again. The strokes were slow, smooth, and continuous. A cushion was placed under the subject’s knees to keep the abdomen relaxed. Data such as the severity of menstrual cramps and the general and menstrual characteristics were collected from all participants before the experiment and designated as pretest data. Data on the severity of menstrual cramps were collected on the first and second days of menstruation after the experimental treatment and designated as post-test data.

Measurement of menstrual cramps The intensity of menstrual cramps was measured with a 10-point VAS, indicated by pointing to the appropriate value on a 10-cm horizontal ruler. The intensity of pain was rated to the first decimal place in centimeters. Higher scores reflected a greater severity of menstrual cramps.

Severity of dysmenorrhea To measure the effect of dysmenorrhea on daily life, a verbal multidimensional scoring system was applied as used by Andersch and Milsom22 and Sundell et al.23 The system uses four grades to indicate the extent to which dysmenorrhea influences daily life. According to this scoring system, mild dysmenorrhea is defined as menstruation


538

HAN ET AL. TABLE 1. CHARACTERISTICS

Characteristics Age (yr) Age at menarche (yr) Menstruation Cycle (days) Duration (days) Amount Profuse Moderate Scanty Pattern Regular Irregular Use of analgesics None Often Always

OF

SUBJECTS

ON

AROMATHERAPY, PLACEBO CONTROL,

AND

NO-TREATMENT CONTROL

Aromatherapy (n  25)

Placebo (n  20)

No treatment (n  22)

20.0 (20.0–21.0) 13.5 (13.0–14.0)

20.0 (20.0–21.0) 13.0 (12.0–14.0)

21.0 (20.0–21.0) 13.0 (13.0–14.0)

28.0 (28.0–30.0) 6.0 (5.0–7.0)

30.0 (27.0–30.0) 5.0 (5.0–6.8)

30.0 (26.8–34.0) 6.0 (5.0–6.5)

7 (28.0%) 16 (64.0%) 2 (8.0%)

2 (10.0%) 16 (80.0%) 2 (10.0%)

4 (18.2%) 14 (63.6%) 4 (18.2%)

17 (68.0%) 8 (32.0%)

11 (55.0%) 9 (45.0%)

10 (45.4%) 12 (54.6%)

5 (20.0%) 10 (40.0%) 10 (40.0%)

4 (20.0%) 12 (60.0%) 4 (20.0%)

8 (36.4%) 7 (31.8%) 7 (31.8%)

Values are expressed as median (interquartile ranges).

that is painful but seldom inhibits the woman’s normal activity and analgesics are seldom needed. Moderate dysmenorrhea affects daily activities and requires analgesics, but missing work or school is unusual. Severe dysmenorrhea clearly inhibits daily activity, is managed poorly by analgesics, and has associated somatic symptoms such as headache, tiredness, nausea, vomiting, or diarrhea. Symptoms were scored from 1 to 4 (1 none; 2 mild; 3 moderate; 4 severe), according to the intensity experienced by the subjects.

Data analysis The data were analyzed using SigmaStat (Systat Software, Richmond, CA) and SPSS software (SPSS, Chicago, IL). Since the data were not normally distributed, the results are presented as medians and interquartile ranges (IQRs). All outcomes were compared using the nonparametric Mann-Whitney rank test between groups and the Wilcoxon signed-rank test across treatment times for each group. Multiple regression analyses were used to estimate the effects and the validity of the hypothesis. We divided the analyses into two parts, analyzing the first- and second-day results TABLE 2. EFFECTS

OF

AROMATHERAPY

with respect to baseline. In each of these analyses, the change score (postintervention minus preintervention) was regressed on the baseline score with two dummy-variable indicators: one indicator was 1 for the placebo group and 0 otherwise, and the other was 1 for the aromatherapy group and 0 otherwise. The coefficients of these indicators therefore represent placebo versus control and aromatherapy versus control comparisons. This procedure was performed separately for the first- and second-day data. The severity of dysmenorrhea in each woman was dichotomized into either 1, representing improvement (meaning a strictly better postintervention score), or 0, representing no change or a lower postintervention score than preintervention score. We then applied generalized multiple linear regression modeling to this outcome.

RESULTS The participants reported no side effects from the treatment. The demographic characteristics of the participants are listed in Table 1. ON

SEVERITY

OF

MENSTRUAL CRAMPS

Time Group Aromatherapy Placebo No treatment

Change

Preintervention

First day

Second day

First day—pre

Second day—pre

7.0 (6.5–8.3) 7.0 (6.0–8.0) 7.5 (6.5–8.0)

5.0 (3.0–6.0)**,†‡ 7.0 (6.0–8.0) 7.0 (6.0–8.0)

3.0 (1.0–5.0)**,†‡ 7.0 (2.8–8.0)* 7.0 (5.0–8.0)

2.5 (5.0—1.5) 0.0 (0.0—1.0) 0.0 (1.0—0.3)

4.5 (5.0—2.0) 0.5 (5.0—1.0) 0.0 (3.0—0.0)

Values are expressed as median (interquartile ranges). *p  0.05; **p  0.001 by Wilcoxon signed rank test compared with baseline value; †p  0.01 by Mann-Whitney rank sum test compared with the placebo; ‡p  0.01 compared to no treatment groups.


539

AROMATHERAPY MASSAGE EFFECT ON SYMPTOMS OF DYSMENORRHEA Table 2 lists the medians and IQRs for the levels of menstrual cramps in the groups measured at three time points. The severity was significantly lower in the aromatherapy group than in the other two groups at both postintervention time points (first and second days of menstruation after treatment). Regression analyses were also applied to the changes in severity at each day (postintervention minus preintervention) using the baseline value, two indicators for aromatherapy, and placebo compared to control. Aromatherapy was most strongly associated with change in severity (Beta  2.48, 95% CI: 3.68 to 1.29, p  0.001), followed by the baseline value of level of menstrual cramps (Beta  0.62, 95% CI: 0.99 to – 0.26, P  0.001), with the weakest association being with placebo (Beta  0.42, 95% CI: 0.83 to 1.67, p  0.51) compared to control for the first day. The trend was the same for the second day. Aromatherapy was most strongly associated with change in severity (Beta  1.97, 95% CI: 3.66 to 0.29, p  0.02), the baseline value of level of menstrual cramps (Beta  0.52, 95% CI: – 1.04 to – 0.003, p  0.05), and placebo (with the weakest association being with placebo (Beta  0.27, 95% CI: 1.49 to 2.04, p  0.76) compared to the control group). Table 3 lists the severity of dysmenorrhea. We estimated and tested the trends by applying multiple linear regression modeling to the dichotomized severity of dysmenorrhea and the dummy-variable indicators. The results demonstrated that aromatherapy was associated with the change in severity (Beta  0.31, 95% CI: 0.05 to 0.57, p  0.02), the baseline value of severity (Beta  0.21, 95% CI: 0.04 to 0.37, p  0.02), and not for placebo (Beta  0.003, 95% CI: –0.29 to 0.28, p  0.98) compared to controls for the first day. The trend was the same for the second day. Aromatherapy was associated with the severity change (Beta  0.33, 95% CI: 0.10 to 0.56, p  0.006), the baseline value of severity (Beta  0.33, 95% CI: 0.18 to 0.48, p  0.001),

TABLE 3. EFFECT

Severity of dysmenorrhea Preintervention 1 2 3 4 First day 1 2 3 4 Second day 1 2 3 4

OF

and not for placebo (Beta  0.15, 95% CI: 0.40 to 0.10, p  0.23) compared to controls.

DISCUSSION One of the main goals of nursing is to enhance a patient’s quality of life, which might include providing proper nursing care for patients with menstrual cramps or dysmenorrhea. Because menstrual cramps and dysmenorrhea are personal topics, women may suffer from these symptoms without seeking help from a health care professional.4,24,25 In some extreme cases, the internal pressure from the uterine contraction during menstruation may be higher than that of labor.22 The participants reported a serious level of discomfort before the experimental treatment, as shown by the mean rating of menstrual cramps of 7.18  1.37 on the 10-point VAS. According to Sundell et al.23 and Han and Hur,1 greater menstrual flow is associated with more severe pain. The pretest data showed no differences in menstrual flow between the three groups. Han and Hur1 showed that variables such as age at menarche and the interval and duration of menstruation are not related to menstrual cramps. These variables did not differ significantly between groups and the age at menarche differed by only 0.3 of a year. In the experimental group, the abdominal massage was given using 3% essential oils consisting of lavender, clary sage, and rose (2:1:1 ratio) diluted in almond oil. Massage is thought to enhance essential oil penetration into the skin. The VAS was used to measure the effect of the experimental treatment on menstrual cramps. Our results showed that the levels of the menstrual cramps were reduced in the experimental group more significantly compared with those of other groups. In the experimental group, the menstrual cramps on the first menstruation day decreased from 7.40

AROMATHERAPY

Aromatherapy (n  25) n (%)

ON

SEVERITY

OF

DYSMENORRHEA

Placebo (n  20) n (%)

No treatment (n  22) n (%)

0 2 21 2

(0.0) (8.0) (84.0) (8.0)

0 4 12 4

(0.0) (20.0) (60.0) (20.0)

1 7 13 1

(4.5) (31.9) (59.1) (4.5)

4 12 7 2

(16.0) (48.0) (28.0) (8.0)

0 4 12 4

(0.0) (20.0) (60.0) (20.0)

0 9 11 2

(0.0) (40.9) (50.0) (9.1)

8 11 6 0

(32.0) (44.0) (24.0) (0.0)

1 4 11 4

(5.0) (20.0) (55.0) (20.0)

2 9 9 2

(9.1) (40.9) (40.9) (9.1)

1, no dysmenorrhea; 2, mild dysmenorrhea; 3, moderate dysmenorrhea; 4, severe dysmenorrhea.


540 to 4.26 after aromatherapy. The change of the severity of dysmenorrhea was significantly associated with aromatherapy, suggesting that aromatherapy has an alleviating effect on the severity of dysmenorrhea experienced during the first few days of menstruation. When the results of the study are compared with the outcome of relaxation treatment to alleviate menstrual cramps via biofeedback training, the reduction to 5.3 of menstrual treatment is higher than that of bio-feedback.12 In a study to verify the effects of herbal medicine on menstrual cramps, Kotani et al.8 reported a decrease in cramp severity from 6.2 to 4.4 on the 10-point VAS scale after one menstrual cycle and to 3.2 after the second cycle. The effect of aromatherapy treatment in our study produced a similar effect to those of the herbal medicine TSS and TENS, which decreases the incidence of sharp pains by 50%.7 Although no other clinical studies have been published on the effect of aromatherapy on menstrual cramps, our data appear to support claims that aromatherapy has beneficial effects in treating menstrual discomfort. Menstrual cramps and dysmenorrhea are believed to be “anemic pains” caused by reduced blood flow because of uterine hyperactivity. The pain is associated with increased prostaglandin and vasopressin production,26,27 which causes contraction and infarction of the endometrium. Menstrual cramps and dysmenorrhea can occur when the menstrual flow is constricted. Menstrual cramps are thought to be relieved by increased blood circulation and antispasmodic and hormoneregulatory drugs. The experimental group showed a significant association with the changes in the scores for menstrual cramps compared to the other groups after the intervention, suggesting that aromatherapy has a beneficial effect on the cramps experienced during the first few days of menstruation. The experimental group showed significant improvement of dysmenorrhea as assessed by the verbal multidimensional scoring system. The data suggest that topically applied diluted essential oils of lavender, clary sage, and rose are effective in alleviating the pain of menstrual cramps. Traditionally, lavender has been used as an analgesic, sedative, and anticonvulsant; clary sage as an anticonvulsant, regulator of menstruation, and to support the actions of estrogen; and rose to alleviate uterine problems.28 There is a limitation associated with the blinding used in this study. It is generally preferable to have participants randomized by a third party (often the project biostatistician or someone otherwise not associated with the study) using a computer-generated random-number procedure. Hence, the blinding procedure used in this study (i.e., of drawing slips from a box) is considered inadequate. In conclusion, this research suggests that aromatherapy has a significant effect on menstrual cramps or dysmenorrhea. Because there were no side effects, aromatherapy can be regarded as a safe, simple, cost-effective, and viable method of nursing care suitable for all patients. However, nurses should first undertake clinical training in aromatherapy before incorporating it into their practice.

HAN ET AL.

REFERENCES 1. Han S, Hur M. A study on the menstrual pain and dysmenorrhea, factors influenced to them and self-management method for them of college students. J Korean Acad Nurs Edu 1999;5:359–375. 2. Milsom I, Andersch B, Sundell G. The effect of flurbiprofen and naproxen sodium on intra-uterine pressure and menstrual pain in patients with primary dysmenorrhea. Acta Obstet Gynecol Scand 1988;67:711–716. 3. Dawood MY. Current concepts in the etiology and treatment of primary dysmenorrhea. Acta Obstet Gynecol Scand Suppl 1986;138:7–10. 4. Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med 1997;151:905–913. 5. Chambers CT, Reid GJ, McGrath PJ, Finley GA. Self-administration of over-the-counter medication for pain among adolescents. Arch Pediatr Adolesc Med 1997;151:449–455. 6. Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstet Gynecol 1987;69:51–56. 7. Lewers D, Clelland JA, Jackson JR, et al. Transcutaneous electrical nerve stimulation in the relief of primary dysmenorrhea. Phys Ther 1989;69:3–9. 8. Kotani N, Oyama T, Sakai I, et al. Analgesic effect of a herbal medicine for treatment of primary dysmenorrhea—a doubleblind study. Am J Chin Med 1997;25:205–212. 9. Dawood MY, Ramos J. Transcutaneous electrical nerve stimulation (TENS) for the treatment of primary dysmenorrhea: A randomized crossover comparison with placebo TENS and ibuprofen. Obstet Gynecol 1990;75:656–660. 10. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol 1996;174:1335–1338. 11. Vance AR, Hayes SH, Spielholz NI. Microwave diathermy treatment for primary dysmenorrhea. Phys Ther 1996;76: 1003–1008. 12. Kim K, Lee S, Choe M, Yi M. The effect on menstrual pain of relaxation therapy using biofeedback. Seoul J Nurs 1999;13:7–22. 13. Dye J. Aromatherapy for Women and Childbirth. Saffron Walden, UK: Caniel Company, 1997. 14. Lavabre MF. Aromatherapy Workbook. Rochester, VT: Healing Arts Press, 1990. 15. Tisserand M. Aromatherapy for Woman, A Practical Guide to Essential Oils for Health and Beauty. Rochester, VT: Healing Arts Press, 1996. 16. Cole A, Shanley E. Complementary therapies as a means of developing the scope of professional nursing practice. J Adv Nurs 1998;27:1171–1176. 17. Buckle J. Clinical Aromatherapy. New York: Churchill Livingstone, 2003. 18. Halcon L. Aromatherapy: therapeutic application of plant essential oils. Minn Med 2002;42–44. 19. Chez RA, Jonas WB. The challenge of complementary and alternative medicine. Am J Obstet Gynecol 1997;177:1156– 1161. 20. Keville K, Green M. Aromatherapy, A Complete Guide to the Healing Art. Freedom, CA: The Crossing Press, 1995.


AROMATHERAPY MASSAGE EFFECT ON SYMPTOMS OF DYSMENORRHEA 21. Baker S. Menstruation and related problems and concern. In: Youngkin EQ, Davis MS, eds. Women’s Health, A Primary Care Clinical Guide. Stamford, CT: Appleton & Lange, 1997, pp. 139–160. 22. Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982;144: 655–660. 23. Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990;97:588–594. 24. Griffith-Kennedy J. Contemporary Women’s Health. A Nursing Advocacy Approach. Menlo Park, CA: Addison-Wesley Publishing, 1986. 25. Rees M. Dysmenorrhoea. Br J Obstet Gynaecol 1988;95: 833–835. 26. Akerlund M. Can primary dysmenorrhea be alleviated by a vasopressin antagonist? Results of a pilot study. Acta Obstet Gynecol Scand 1987;66:459–461.

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27. Akerlund M. Modern treatment of dysmenorrhea. Acta Obstet Gynecol Scand 1990;69:563–564. 28. Buckle J. Clinical Aromatherapy in Nursing. London: Arnold, 1997.

Address reprint requests to: Myung-Haeng Hur, Ph.D., R.N. School of Nursing Eulji University 143-5 Yongdudong, Jung-gu Daejeon, 302-832 South Korea E-mail: mhhur@eulji.ac.kr Or: daeheelee@hanafos.com


Effect of aromatherapy on symptoms of dysmennrhea  

Effect of Aromatherapy on Symptoms of Dysmenorrhea in College Students: A Randomized Placebo-Controlled Clinical Trial by SUN-HEE HAN et. al...

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