Cyclic perimenstrual pain and discomfort and the role of complementary and alternative medicine in its treatment

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Background: There is a high prevalence of cyclic perimenstrual pain and discomfort (CPPD) with up to 97% of women experiencing problems such as premenstrual syndrome (PMS) and dysmenorrhoea, during their menstruating years. This can impair women’s ability to fully participate in all aspects of life. Conventional medicine has limitations in treating affected women and evidence suggests women are increasingly exploring complementary and alternative medicines (CAMs) for support. Aims: To determine the associated use of CAM by women with CPPD, their user-rated efficacy and the significance this use may have for public health providers. Method: A literature review of cross-sectional data provided a baseline of CAM use, and its associated efficacy, reported by women with CPPD. Patterns of CAM use and CPPD prevalence were examined using 2012 data collected from women aged 28 to 33 years in the Australian Longitudinal Study on Women’s Health. This cohorts’ changes in CAM use and associated CPPD from 2006 to 2012, provided further insights into this association. Western herbal medicine emerged as one CAM favoured by women with CPPD. Western Herbalists (WHs) were surveyed on their perceptions of their treatment for CPPD regarding its efficacy, costs and duration and the herbs preferred in treating symptoms. An assessment based on clinical evidence was undertaken for the main nominated herbs. Results: From the literature review, cross-sectional studies of CAM use for CPPD have increased sharply in recent years, however overall data were highly variable. Across studies, CPPD prevalence was high, with a mean prevalence of CAM used as treatment of 32% and up to 70% user-prevalence of herbal medicine. CAM efficacy was well rated, at between 33%-97%, mostly adopted through self-prescription. At least 41.2% of ALSWH participants experienced CPPD and frequent sufferers of PMS were significantly more likely to consult a naturopath/herbalist (OR = 2.11), or self-prescribe herbal medicines (OR = 1.72) compared to non-sufferers. Over the years 2006 to 2012 the only significant positive association found was for naturopath/herbalist consultations and women suffering PMS. Between 61% and 84% of WHs rated their treatment of four common CPPD symptoms as ‘always effective’, this being highest for PMS. WHs’ treatment appeared cost-effective and of short duration. However, scientific evidence for the main herbs used in CPPD treatment was limited. Conclusion: CAM is increasingly being used by women to treat CPPD. Whilst herbal medicine may be an additional, effective and economical treatment, more well-designed, rigorous clinical trials are needed to confirm safety and efficacy before it gains mainstream credibility.
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