The Effect of Aromatherapy Alone or in Combination with Massage on Dysmenorrhea: A Systematic Review and Meta-analysis

Najafi, Mona Najaf; Najafi, Neshat Najaf; Fakari, Farzaneh Rashidi; Moeindarbary, Somayeh; Abdi, Fatemeh; Hoseini, Zeinab Sadat; Ghazanfarpour, Masumeh

doi:10.1055/s-0041-1740210

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article, Gynecological Endocrinology • Rev Bras Ginecol Obstet. 43 (12) • Oct 2021 • https://doi.org/10.1055/s-0041-1740210 copy

The Effect of Aromatherapy Alone or in Combination with Massage on Dysmenorrhea: A Systematic Review and Meta-analysis

O efeito da aromaterapia sozinha ou em combinação com massagem na dismenorreia: Uma revisão sistemática e meta-análise

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The aim of the present systematic review meta-analysis is to assess the effect of olfactory stimulation on reducing dysmenorrhea.

Methods

Systematic search was conducted in several databases, such as PubMed, Web of Science, Cochrane, and Scopus, to identify relevant research up to October 26, 2019. The identified studies were evaluated based on a modified Jadad scale. The intervention involves aromatherapy alone or in combination with essential oils. There was no restriction for the control group such as a placebo group or other common treatments. The Comprehensive Meta-Analysis Version 2 (Bio stat, Englewood, NJ, USA) was used for meta-analysis. Cochran’s Q and I2 tests were utilized.

Results

The findings of our meta-analysis, which contained 13 trials (15 data), showed that dysmenorrhea decreased significantly in the group receiving aromatherapy with herbal compared with the control group (standardized mean difference [SMD] =-0.795; 95% confidence interval [CI]: -0.922 to- 0.667; 17 trials O < 0.001); heterogeneity; I2 = 19.47%; p = 0.236). In addition, four studies with insufficient data were not included in our meta-analysis. The results of all studies suggested that aromatherapy with herbal medicine group compared with control group is effective.

Conclusion

Aromatherapy with herbal medicine decreased dysmenorrhea. This treatment was particularly effective when aroma oil was combined with massage or when a mixture of aroma oil was used for the treatment of dysmenorrhea.

Keywords
dysmenorrhea; herbal medicine; aroma oil; aromatherapy

	Registration code	Randomization mention	Random sequence generation	Blinding of participants and personnel	Blinding of outcome assessment	Description of withdrawals and dropouts	Clear description of the inclusion and exclusion criteria	Description of the method used to assess adverse effects	The method of statistical analysis	Tota l score
Apay et al. (2012)²²22 Apay SE, Arslan S, Akpinar RB, Celebioglu A. Effect of aromatherapy massage on dysmenorrhea in Turkish students. Pain Manag Nurs. 2012;13(04):236–240. Doi: 10.1016/j.pmn.2010. 04.002 https://doi.org/10.1016/j.pmn.2010. 04.0...	–	1	0	1	0	1	1	1	1	6
Amiri Farahani et al. (2012)²⁴24 Amiri Farahani L, Heidari T, Roozbahani N, Attarha M, Akbari TorkestaniN, Bekhradi R, et al. Effect of aromatherapy on pain severity in primary dysmenorrhea. J Arak Univ Med Sci. 2012;15 (04):1–9	IRCT138902153869N13869	1	0	1	0	1	1	1	1	6
Ataollahi et al. (2015)²¹21 Ataollahi M, Akbari SA, Mojab F, Roshanaie G. Effects of aromatherapy by Rosaceous on the severity and systemic symptoms of primary dysmenorrhea. Adv Nurs Midwifery.. 2015;25(89): 59–67	IRCT201311216807N10	1	1	1	1	1	1	1	1	8
Azima et al. (2015)¹⁰10 Azima S, Bakhshayesh HR, Mousavi S, Ashrafizaveh A. Comparison of the effects of reflexology and massage therapy on primary dysmenorrheal. Biomed Res (Aligarh). 2015;26(03): 471–476	IRCT2013022611945N2	1	1	0	1	1	1	0	1	6
Bakhtshirin et al. (2015)¹⁵15 Bakhtshirin F, Abedi S, YusefiZoj P, Razmjooee D. The effect of aromatherapy massage with lavender oil on severity of primary dysmenorrhea in Arsanjan students. Iran J Nurs Midwifery Res. 2015;20(01):156–160	–	1	0	1	1	1	1	0	1	6
Beiranvand et al. (2015)³¹31 Beiranvand S, Hosseinabadi R, Anbari K, Pirdadeh Beiranvand S, Asti P. The effect of lavender aromatherapy massage on severity andsymptomsofprimarydysmenorrheal. ComplementMedJFac Nurs Midwifery. 2015;5(01):1028–1041	IRCT201310297697N2	1	1	1	1	1	1	0	1	7
Davari et al. (2014)²³23 Davari M, Reihani M, Khoshrang N. The aromatherapy effect of rosemary and lavander on primary dysmenorrhea: a clinical controlled trial. Majallah-i Danishkadah-i Pizishki-i Isfahan. 2014;32(290):929–937	–	1	0	1	1	1	1	1	1	7
Raisi Dehkordi et al. (2014)⁴⁷47 Raisi Dehkordi Z, Hosseini Baharanchi FS, Bekhradi R. Effect of lavender inhalation on the symptoms of primary dysmenorrhea and the amount of menstrual bleeding: A randomized clinical trial. Complement Ther Med. 2014;22(02):212-219. Doi: 10.1016/j.ctim.2013.12.011 https://doi.org/10.1016/j.ctim.2013.12.0...	IRCT201105086412N1	1	1	1	1	1	1	1	1	8
Kim et al. (2011)¹⁸18 Kim YJ, Lee MS, Yang YS, Hur MH. Self-aromatherapy massage of the abdomen for the reduction of menstrual pain and anxiety during menstruation in nurses: a placebo-controlled clinical trial. Eur J Integr Med. 2011;3(03):e165–e168. Doi: 10.1016/j. eujim.2011.08.007 https://doi.org/10.1016/j. eujim.2011.08...	–	0	0	0	0	1	1	1	1	4
Marzouk et al. (2013)²⁵25 Marzouk TM, El-Nemer AM, Baraka HN. The effect of aromatherapy abdominal massage on alleviating menstrual pain in nursing students: a prospective randomized cross-over study. Evid Based Complement Alternat Med. 2013;2013:742421. Doi: 10.1155/2013/742421 https://doi.org/10.1155/2013/742421...	–	1	1	1	1	1	1	1	1	8
Ou et al. (2012)²⁶26 Ou MC, Hsu TF, Lai AC, Lin YT, Lin CC. Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial. J Obstet Gynaecol Res. 2012;38(05):817–822. Doi: 10.1111/j.1447-0756.2011.01802.x https://doi.org/10.1111/j.1447-0756.2011...	–	1	1	1	1	1	1	0	1	7
Uysal et al. (2016)³3 Uysal M, Dogru HY, Sapmaz E, Tas U, Çakmak B, Ozsoy AZ, et al. Investigating the effect of rose essential oil in patients with primary dysmenorrhea. Complement Ther Clin Pract. 2016; 24:45–49. Doi: 10.1016/j.ctcp.2016.05.002 https://doi.org/10.1016/j.ctcp.2016.05.0...	–	1	1	0	0	1	1	0	1	5
Hur et al. (2012)¹1 Hur MH, Lee MS, Seong KY, Lee MK. Aromatherapy massage on the abdomen for alleviating menstrual pain in high school girls: a preliminary controlled clinical study. Evid Based Complement Alternat Med. 2012;2012:187163. Doi: 10.1155/2012/187163 https://doi.org/10.1155/2012/187163...	–	0	0	0	0	1	1	1	1	4
Nikjou et al. (2016)⁴⁸48 Nikjou R, Kazemzadeh R, Rostamnegad M, Moshfegi S, Karimollahi M, Salehi H. The effect of lavender aromatherapy on the pain severity of primary dysmenorrhea: a triple-blind randomized clinical trial. Ann Med Health Sci Res. 2016;6(04):211-215. Doi: 10.4103/amhsr.amhsr_527_14 https://doi.org/10.4103/amhsr.amhsr_527_...	IRCT201470616252N2	1	1	1	1	1	1	1	1	8
Rizk (2013)²⁷27 Rizk SA. Effect of aromatherapy abdominal massage using peppermint versus ginger oils on primary dysmenorrhea among adolescent girls. J Am Sci. 2013;9(11):497–505	–	1	0	1	0	1	1	0	1	5
Sadeghi Aval Shahr et al. (2015)²⁰20 Sadeghi Aval Shahr H, Saadat M, Kheirkhah M, Saadat E. The effect of self-aromatherapy massage of the abdomen on the primary dysmenorrhoea. J Obstet Gynaecol. 2015;35(04):382–385. Doi: 10.3109/01443615.2014.958449 https://doi.org/10.3109/01443615.2014.95...	–	1	0	1	0	1	1	1	1	6
Sajjadi et al. (2018)²⁸28 Sajjadi M, Bahri N, Abavisani M. Aromatherapy massage with geranium essence for pain reduction of primary dysmenorrhea: a double blind clinical trial. Majallah-i Zanan, Mamai va Nazai-i Iran. 2018;20(12):50–57. Doi: 10.22038/ijogi.2017.10430 https://doi.org/10.22038/ijogi.2017.1043...	IRCT2017013132329N1	1	0	1	1	1	1	0	1	6
Han et al. (2006)¹⁶16 Han SH, Hur MH, Buckle J, Choi J, Lee MS. Effect of aromatherapy on symptomsofdysmenorrheaincollegestudents:A randomized placebo-controlled clinical trial. J Altern Complement Med. 2006; 12(06):535–541. Doi: 10.1089/acm.2006.12.535 https://doi.org/10.1089/acm.2006.12.535...	–	1	0	1	0	1	1	1	1	6

Study (year)	Type of study	Participants	Age (mean)	Intervention (n)	Control (n)	Duration of study	Sample drop (%)	Measurement method	Inclusion	outcome
Apay et al.(2012)²²22 Apay SE, Arslan S, Akpinar RB, Celebioglu A. Effect of aromatherapy massage on dysmenorrhea in Turkish students. Pain Manag Nurs. 2012;13(04):236–240. Doi: 10.1016/j.pmn.2010. 04.002 https://doi.org/10.1016/j.pmn.2010. 04.0...	Quasiexperimental crossover	Midwifery/nursing students	20	Lavender/ abd. Massage, 1st day of menses, 15 minutes, 1 time (n = 44)	Placebo/abd. Massage 1st day of menses, 15 minutes, 11 time	3 cycles	0	VAS-100 points	VAS > 60	Massage is effective. The effect of aromatherapy massage is higher than placebo massage (p<0.001).
Amiri Farahani et al. (2012)²⁴24 Amiri Farahani L, Heidari T, Roozbahani N, Attarha M, Akbari TorkestaniN, Bekhradi R, et al. Effect of aromatherapy on pain severity in primary dysmenorrhea. J Arak Univ Med Sci. 2012;15 (04):1–9	RCT	Medical university students	21	Massage + mixture of lavender/peppermint essential oil (n = 36) a week before menses up to the presence of pain, onetime, 1 5 minutes, daily	1.almond oil (n = 36) 2.massage alone (n = 36) a week before menses up to the presence of pain, one time, 1 5 minutes, daily	2 cycles	reported	VAS-10points	multidimensional spoken criteria = 2 or 3	Severity of dysmenorrhea decreased in massage and aromatherapy groups(p = 0.014)
Ataollahi et al. (2015)²¹21 Ataollahi M, Akbari SA, Mojab F, Roshanaie G. Effects of aromatherapy by Rosaceous on the severity and systemic symptoms of primary dysmenorrhea. Adv Nurs Midwifery.. 2015;25(89): 59–67	RCT	Medical student	21	Rosaceous extract (n = 55), First 3 days of menses, two times daily	Placebo (n=55) First 3 days of menses, two times daily	2 cycles	0	VAS-10points	Intermediate/ sever pain	Severity of dysmenorrhea decreased in both groups, but this reduction was more significant in the Rosaceous group (p<0.001).
Azima et al. (2015)⁴⁶46 Azima S, Bakhshayesh HR, Kaviani M, Abbasnia K, Sayadi M. Comparison of the effect of massage therapy and isometric exercises on primary dysmenorrhea: a randomized controlled clinical trial. J Pediatr Adolesc Gynecol. 2015;28(06):486-491. Doi: 10.1016/j.jpag.2015.02.003 https://doi.org/10.1016/j.jpag.2015.02.0...	RCT	Non-medical university students	21	Lavender/massage (n = 34) First 2 days of menses, one time daily	1) Reflexology (n = 34), 20 minutes daily, 10 days before menses 2) Control (n = 34)	2 cycles	0	VAS-10points	VAS>5	pain reduction was more in the lavender/ massage group (p<0.001)
Bakhtshirin et al. (2015)¹⁵15 Bakhtshirin F, Abedi S, YusefiZoj P, Razmjooee D. The effect of aromatherapy massage with lavender oil on severity of primary dysmenorrhea in Arsanjan students. Iran J Nurs Midwifery Res. 2015;20(01):156–160	RCT, cross over	Midwifery/nursing students	20	Lavender/ massage (n = 40)	placebo/ massage (n = 40)	2 cycles	0	VAS-10points	VAS>6	A significant pain reduction in lavender/massage in comparison with placebo/massage.
Beiranvand et al. (2015)³¹31 Beiranvand S, Hosseinabadi R, Anbari K, Pirdadeh Beiranvand S, Asti P. The effect of lavender aromatherapy massage on severity andsymptomsofprimarydysmenorrheal. ComplementMedJFac Nurs Midwifery. 2015;5(01):1028–1041	RCT cross over	Students	21	Lavender/ 48 hours before and after menstruation/ 15 minutes twice a day (n = 30)	Placebo (almond oil)/ 48 hours before and after menstruation/ 15 minutes twice a day (n = 30)	2 cycles	reported	VAS-10points	VAS>5	A significant pain reduction in lavender/massage in comparison with placebo/massage (p<0.001).
Davari et al. (2014)²³23 Davari M, Reihani M, Khoshrang N. The aromatherapy effect of rosemary and lavander on primary dysmenorrhea: a clinical controlled trial. Majallah-i Danishkadah-i Pizishki-i Isfahan. 2014;32(290):929–937	RCT	Students	22	Rosemary (n = 30), Lavender (n = 30), rosemary + lavender (n = 30), first 3 days of menses 15 minutes, twice a day	mefenamic acid (n = 30), placebo (n = 30)	2 cycles	reported	VAS-10points	MDQ	significant reductions in pain in rosemary (p < 0.001 ), lavender, both, and mefenamic acid (p <0.01) compared with placebo.
Raisi Dehkordi et al. (2014)⁴⁷47 Raisi Dehkordi Z, Hosseini Baharanchi FS, Bekhradi R. Effect of lavender inhalation on the symptoms of primary dysmenorrhea and the amount of menstrual bleeding: A randomized clinical trial. Complement Ther Med. 2014;22(02):212-219. Doi: 10.1016/j.ctim.2013.12.011 https://doi.org/10.1016/j.ctim.2013.12.0...	RCT Crossover	Students	20	Lavender first 3 days of menses, every 6 hours (n = 48)	Placebo first 3 days of menses, every 6 hours (n = 48)	2 cycles	reported	Scoring from 1 to 4 1: none, 2: mild, 3: moderate, 4: severe	VMS: 2 or 3	significant reductions in pain in lavender (p<0.001)
Kim et al. (2011)¹⁸18 Kim YJ, Lee MS, Yang YS, Hur MH. Self-aromatherapy massage of the abdomen for the reduction of menstrual pain and anxiety during menstruation in nurses: a placebo-controlled clinical trial. Eur J Integr Med. 2011;3(03):e165–e168. Doi: 10.1016/j. eujim.2011.08.007 https://doi.org/10.1016/j. eujim.2011.08...	Non-Random CT	Nurses	25	Aroma¹ 1Aroma: otto (Rosa damascena), clary sage (Salvia sclarea), rose geranium (Pelargonium graveolens), and ginger (Zingiber officinale) in almond, jojoba, and evening primrose oil. + self-massage (n = 26) twice a day, 2 days	Placebo (n= 18) No treatment (n= 19)	1 cycle	reported	VAS-10points	VAS>5	significant reductions in pain (p<0.001)
Marzouk et al. (2013)²⁵25 Marzouk TM, El-Nemer AM, Baraka HN. The effect of aromatherapy abdominal massage on alleviating menstrual pain in nursing students: a prospective randomized cross-over study. Evid Based Complement Alternat Med. 2013;2013:742421. Doi: 10.1155/2013/742421 https://doi.org/10.1155/2013/742421...	RCT Crossover	Nursing students	17-20	Aroma² 2Aroma: cinnamon, clove, rose, and lavender in a base of almond oil. + massage (n = 48), once daily, 7 days before menses	Placebo+ massage (n = 47), once daily, 7 days before menses	2 cycles	reported	VAS-10points	VAS>5	significant reductions in pain
Ou et al. (2012)²⁶26 Ou MC, Hsu TF, Lai AC, Lin YT, Lin CC. Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial. J Obstet Gynaecol Res. 2012;38(05):817–822. Doi: 10.1111/j.1447-0756.2011.01802.x https://doi.org/10.1111/j.1447-0756.2011...	RCT	Patients	24	Aroma³ 3Aroma: lavender, clary sage, and marjoram oils, in jojoba cream. + massage (n = 24) Once daily, 3 days	Placebo+ massage (n = 24) Once daily, 3 days	1 cycle	0	VAS-10points	VAS>5	Duration of pain significantly decreased
Uysal et al. (2016)³ 3Aroma: lavender, clary sage, and marjoram oils, in jojoba cream.	RCT	Patients admitted to the emergency unit	21	rose essential oil + diclofenac, 75 mg ampule (n = 52)	Placebo + diclofenac, 75 mg ampule (n = 53)	continuously spray every 10 minutes [img]	reported	VAS-10points	VAS>5	significant reductions in pain after 30 minute (p = 0.019)
Hur et al.(2012)¹ 1Aroma: otto (Rosa damascena), clary sage (Salvia sclarea), rose geranium (Pelargonium graveolens), and ginger (Zingiber officinale) in almond, jojoba, and evening primrose oil.	RCT	High school students	?	Aroma⁴ 4Aroma: clary sage, marjoram, cinnamon, ginger, and geranium in almond oil. + massage (n = 32)	acetaminophen (n = 32)	1 cycle	reported	VAS-10points	VAS>5	significant reductions in pain after 24 hour (p< 0.001)
Nikjou et al.(2016)⁴⁸48 Nikjou R, Kazemzadeh R, Rostamnegad M, Moshfegi S, Karimollahi M, Salehi H. The effect of lavender aromatherapy on the pain severity of primary dysmenorrhea: a triple-blind randomized clinical trial. Ann Med Health Sci Res. 2016;6(04):211-215. Doi: 10.4103/amhsr.amhsr_527_14 https://doi.org/10.4103/amhsr.amhsr_527_...	RCT Triple blind	Students	19-29	Lavender (n = 100) once a day, 30 minutes, 3 days	Placebo (n=100) once a day, 30 minutes, 3 days	2 cycles	0	VAS-10points	Intolerable, limits activities exclude	significant reductions in pain (p<0.001)
Rizk(2013)²⁷27 Rizk SA. Effect of aromatherapy abdominal massage using peppermint versus ginger oils on primary dysmenorrhea among adolescent girls. J Am Sci. 2013;9(11):497–505	RCT	Nursing students	17-21	Peppermint oil + massage (n = 40) ginger oil + massage (n = 40), once daily, 15 minutes, 5 days before menses	Placebo + massage (n = 40)	2 cycles	reported	VAS-10points	Moderate or severe dysmenorrhea	Significant reductions in severity of pain in Int. groups.
Sadeghi Aval Shahr et al. (2015)²⁰20 Sadeghi Aval Shahr H, Saadat M, Kheirkhah M, Saadat E. The effect of self-aromatherapy massage of the abdomen on the primary dysmenorrhoea. J Obstet Gynaecol. 2015;35(04):382–385. Doi: 10.3109/01443615.2014.958449 https://doi.org/10.3109/01443615.2014.95...	RCT	Students	18-35	Rose essential oil (n = 25) on the first day of menses, 15 minutes	almond oil + massage (n = 25) massage (n = 25)	2 Cycles	reported	VAS-10points	VAS>5	Significant reductions of pain in rose essential oil comparison to massage only (p< 0.001) or almond oil +massage (p < 0.05)
Sajjadi et al. (201 8)²⁸28 Sajjadi M, Bahri N, Abavisani M. Aromatherapy massage with geranium essence for pain reduction of primary dysmenorrhea: a double blind clinical trial. Majallah-i Zanan, Mamai va Nazai-i Iran. 2018;20(12):50–57. Doi: 10.22038/ijogi.2017.10430 https://doi.org/10.22038/ijogi.2017.1043...	RCT	Students	18-35	Geranium essential oil (n = 30) on the first day of menses, 15 minutes	1) Almond oil (n = 30) 2) No treatment (n = 30)	2 cycles	reported	VAS-10points	VAS>5	Significant reduction in Geranium essential oil group comparison to others (p<0.001).
Han et al. (2006)¹⁶16 Han SH, Hur MH, Buckle J, Choi J, Lee MS. Effect of aromatherapy on symptomsofdysmenorrheaincollegestudents:A randomized placebo-controlled clinical trial. J Altern Complement Med. 2006; 12(06):535–541. Doi: 10.1089/acm.2006.12.535 https://doi.org/10.1089/acm.2006.12.535...	RCT	Students	20	Aromatherapy⁵ 5Aroma: lavender (Lavandula officinalis), clary sage (Salvia sclarea), and rose (Rosa centifolia) in almond oil. + massage (n = 25) 15 minutes on the first day of menses	1) Almond oil + massage (n = 20) 2) No treatment (n = 22)	2 cycles	0	VAS-10points	VAS>6	The severity was significantly lower in the aromatherapy group than in the other two groups

Variable	Number of RCTs	Sample size (treatment/control)	Test of heterogeneity		P-value	Fixed =effect model
Variable	Number of RCTs	Sample size (treatment/control)	P	I²(%)	P-value	SMD (95% CI)
Types of treatment
Massage + aromatherapy	9	540	0.7	0%	< 0.001	-0.915 (-1.09 to -0.73)
Aromatherapy alone	9	729	0.13	34%	< 0.001	-0.741 (-0.89 to -0.58)
Test for subgroup difference						p<0.001
Types of treatment
A mixture of aroma oils	7	452	0.410	3%	< 0.001	-0.865 (-1.01 to -0.715)
Single oil	11	817	0.273	20%	< 0.001	-0.75 (-0.97 to -0.53)
Test for subgroup difference						p = 0.34

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[1] Address for correspondence Masumeh Ghazanfarpour, PhD, Kerman, Kerman Province, Iran (e-mail: Masumeh.ghazanfarpour@yahoo.com).