Comparing the Effect of Herbal Drugs and Non-steroidal Anti-Inflammatory Drugs on Primary Dysmenorrhea in Iran: a Systematic Review and Meta-Analysis

Document Type : Original Article


1 Assistant professor, PhD of Reproductive Health, School of Midwifery and Nursing, Ilam University of Medical Sciences, Ilam, Iran

2 Professor, Departments of Community Medicine, Faculty of Medicine, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran

3 Associate professor, Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran

4 BSc of Nursing, Faculty of Nursing and Midwifery, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran

5 MSC of nursing Medical-Surgical, Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran


Several studies have been conducted to investigate the effects of herbal drugs and Non-steroidal anti-inflammatory drugs on the primary dysmenorrhea, but their results have been different.The aim of this study was to compare the effects of herbal drugs and NSAIDon the primary dysmenorrheausing meta-analysis method.A literature search was conducted in Scopus, Pub med, and Google scholar databases from1996 to December 2016 in English and Persian languages using the search keywordsof primary dysmenorrhea combined with herbal and NSAID. The random effect model was adoptedto combine the results of the studies, and I2 index was used to check heterogeneity. One hundred and ninety-nine studies were obtained, and after reading the abstracts, 21 articles were included in the study. The total number of samples was 2041 people. The standard mean difference(SMD)betweenherbal drugs and Non-steroidal anti-inflammatory drugs in the pain reduction in the first intervention was estimated atSMD= 0.2(95%CI:(-0.340.74 ),  z=0.73, p=0.463), and in second intervention it was SMD=-0.59(95%CI: (-1.650.47),Z=1.09 and p=0.278). also, the SMD for the duration of menstrual variable SMD=0.18(95%CI:( 0.02 0.34) , z=2.20, p=0.027) in favor of NSAID drugs and interval cycle of menstrual variable was SMD=0.07(95%CI:(-0.140.28), z=0.68,  p=0.496).Mean difference of pain intensity reduced relatively better by administering herbal medicines, which is supported by the majority of studies, and the herbal drugs were found to be more effective than the NSAIDs drugs. Finally, given the many side effects of non-steroidal anti-inflammatory drugs, herbal drugs can be used at the standard dosageand considering the side effects.


1. NamavarJahromi B., Tartifizadeh A., Khabnadideh S., 2003. Comparison of fennel and mefenamic acid for the treatment of primary dysmenorrhea. International Journal of Gynaecology Obstetrics. 80(2),153-7.
2. Modaress Nejad V., Motamedi B., 2006. Comparison between the pain-relief effect of fennel and mefenamic acid on primary dysmenorrhea. Journal of Rafsanjan University of Medical Sciences.5(1),1-6.
3. Ju H., Jones M., Mishra G., 2013.The prevalence and risk factors of dysmenorrhea. Epidemiologic reviews.36(1), 104-13.
4.Rehman H., Begum W., Tabasum H., Anjum F., 2014. Primary dysmenorrhea: a review with special reference to Unani concepts. Research &Reviews: A Journal of Unani, Siddha and Homeopathy.1(1), 29-37.
5. Kalvandi R., Alimohammadi S., Pashmakian Z., Rajabi M.,2014. The effects of medicinal plants of melissa officinalis and salvia officinalis on primary dysmenorrhea. Avicenna Journal of Clinical Medicine. 21(2), 105-11.
6. Bokaie M., Farajkhoda T., Enjezab B., Khoshbin A., Karimi-Zarchi M.,  2013. Oral fennel (Foeniculumvulgare) drop effect on primary dysmenorrhea: Effectiveness of herbal drug. Iranian Journal of Nursing and Midwifery Research. 18(2), 128-32.
7. Moslemi L., Bekhradi R., GaliniMoghaddam T., Gholamitabar Tabari M., 2012.Comparative effect of fennel extract on the intensity of primary dysmenorrhea. African Journal of Pharmacy and Pharmacology.6, 1770-3.
8. Salmalian H., Saghebi R., Moghadamnia A.A., Bijani A., Faramarzi M., NasiriAmiri F., Bakouei F., Behmanesh F., Bekhradi R., 2014.Comparative effect of thymus vulgaris and ibuprofen on primary dysmenorrhea: A triple-blind clinical study. Caspian Journal of  International Medicine. 5(2), 82–88.
9. Karimian Z., Sadat Z., Abedzadeh M., Sarafraz N., Kafaei Atrian M., Bahrami N., 2013.Comparison the Effect of Mefenamic Acid and MatricariaChamomilla on Primary Dysmenorrhea in Kashan Medical University Students. Journal of Ardabil University of Medical Sciences.13(4), 413-20.
10. Shirvani M.A., Motahari-Tabari N., Alipour A., 2015. The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial. Archives of Gynecology and Obstetrics. 291(6), 1277-81.
11. Heidarifar R., Mehran N., Heidari A., Koohbor M., Mansourabad M.K., 2014. Effect of Dill (Anethumgraveolens) on the severity of primary dysmenorrhea in compared with mefenamic acid: A randomized, double-blind trial. Journal of research in medical sciences.Journal of Isfahan University of Medical Sciences.19(4), 326-30.
12. Bani S., Hasanpour S., Mousavi Z., Garehbaghi P.M., Gojazadeh M., 2014. The Effect of Rosa Damascena Extract on Primary Dysmenorrhea: A Double-blind Cross-over Clinical Trial. Iranian Red Crescent Medical Journal.16(1), 1-3.
13. Direkvand-MoghadamA., Khosravi A., 2012.The impact of a novel herbal Shirazi Thymus Vulgaris on primary dysmenorrhea in comparison to the classical chemical Ibuprofen. Journal of Research in Medical Sciences. 17(7), 668-70.
14. Shobeiri F., Zeraati F., Mansouri Z., Araghchian M., Nazari M.,2012.The comparative effect of herbal extract of vitagnus and mefenamic acid on primary dysmenorrhea. Zahedan Journal of Research in Medical Sciences. 14(5), 30-3.
15. Park J.S., Park S., Cheon C.H., Go H.Y., Sun S.H., Shin Y.C., Jang B.H., Ko S.G.,2012. Effects of Gyejibongnyeong-hwan on dysmenorrhea caused by blood stagnation: study protocol for a randomized controlled trial. Trials.13(3), 1-6.
16. Mohammadinia N., Rezaei M., Salehian T., Dashipoor A., 2013. Comparing the effect of Anethumgravolens with mefenamic acid consumption on treatment of primary dysmenorrhea.Journal of ShahrekordUuniversity of Medical Sciences.15(5), 57-64.
17. Salehian T., Safdari F., Pirak A., Ataradi Z., 2011. Evaluation of the use of herbal medicine to relieve dysmenorrhea in students Iranshahr. Journal of Herbal Drugs.1(4), 57-63.
18. Jenabi E., Asle T.M., Hejrati P., 2012.The comparison of the effects of antiplain of Valerianaofficinalisrisom and mefenamic acid in relief of primary dismenorrhea. Iranian Journal of Obstetrics, Gyneocology and Infertility. 15(2), 44- 8.
19. Modarres M., Mirmohhamad A.M., Oshrieh Z., Mehran A., 2011.Comparison of the effect of Mefenamic Acid and MatricariaCamomilla Capsules on primary dysmenorrhea. Journal of Babol University of Medical Sciences (JBUMS). 13(3), 50-8.
20. Mohajeri M., Bakhshi S.,Behzadian N.,Tanha A., Nikzad M., 2006.Comparison of therapeutic effect between the herb fennel and mefenamic acid in the treatment of primary dysmenorrhea. Journal of Medical Science of Islamicazad University of Mashhad. 2(7), 355-9. [InPersian].
21. Delaram M., SadeghianDehkordi Z., Parvin N., Kazemiyan A., Shams S., 2015.Comparison of Analgesic Effect of Agnogol with Mefenamic Acid in the Treatment of Primary Dysmenorrhea. Journal of Research Development in Nursing and Midwifery.12(1),1-7.
22. Jaafarpour M., Hatefi M., Khani A., Khajavikhan J., 2015. Comparative effect of cinnamon and Ibuprofen for treatment of primary dysmenorrhea: a randomized double-blind clinical trial. Journal of Clinical Diagnosis Research. 9(4), QC04-7. doi: 10.7860 /JCDR /2015/12084.5783.
23. Tavasoli F., Sharifian J., Mazloom S.,2000.Comparison of mefenamic acid and Zereh for the treatment of primary dysmenorrhea. Persian Journal ofGonabadUniversity of MedicalSciences. 6(2),1-7.
24. Roozbahani N., Jabbari Z., Yazdi S., 2006. The comparison of Shirazi Thymus Vulgaris and Mefenamic acid effects on primary dysmenorrhea.Arak Medical University Journal. 8(3), 23-7.
25. Khodakarami N., Fariborz M., Ataolah G., Solokian S., 2009. The effect of an Iranian herbal drug on primary dysmenorrhea: a clinical controlled trial.Journal of Midwifery Women Health.  54(5), 401-4.
26. Nazarpour S., Azimi H., 2007.Comparison of therapeutic effects of Fennelin and Mefenamic Acid on Primary Dysmenorrhea.  Journal of Mazandaran University of Medical Sciences. 17(61), 54-61.
27. Shobeiri F., Zeraati F., Mansouri Z., Araghchian M., Nazari M., 2012. The Comparative Effect of Herbal Extract of Vitagnus and Mefenamic Acid on Primary Dysmenorrhea.Zahedan Journal of Research in Medical Sciences.14(5), 30-3.
28. Rezaeyan M., Abdali N., Araban M.,2014. Comparing analgesic effects of extra virgin olive oil and Ibuprofen on the intensity of primary dysmenorrhea: A crossover clinical trial. Iranian Journal of Nutrition Sciences and Food Technology. 9(2), 67-74.
29. Ozgoli G., Goli M., Moattar F., Valaie N.,2007.Comparing ginger with mefenamic acid and ibubrofen for the treatment of primary dysmenorrhea. Research in Medicine. 31(1), 61-5.
30. Zeraati F., Shobeiri F., Nazari M., Araghchian M., Bekhradi R., 2014.Comparative evaluation of the efficacy of herbal drugs (fennelin and vitagnus) and mefenamic acid in the treatment of primary dysmenorrhea. Iranian Journal of Nursing And Midwifery Research.19(6), 581-584.
31. Omomiroknabadi M., Sarafraz N.,2011.The effect of super mint (Mentha extract) compared with ibuprofen on primary dysmenorrhea: a randomized clinical trial. Journal of Medical Science of Qom. 5(3), 37-41.
32. Manouchehritareshizi E., Montazeri S., Abedi P., 2005. Comparing the effects of ibuprofen tablets and fennel on primary dysmenorrhea in high school students. Journal of Medical Science of Islamic Azad University of Mashhad.1(3), 17-26. [In Persian].
33. Hejazi S., Amin G., Mahmoudi M., Movaghar M., 2002.Comparison of herbal and chemical drugs on primary dysmenorrhea. Journal of Nursing and Midwifery Shahid Beheshti University of Medical Sciences. 12(42), 54-9.
34. Khabnadide S., Tartifizade A., Namavarjahromi B., 2003. ComparisonofFennel with mefenamic acid in the treatment of primary dysmenorrhea. International Journal of Gynecology & Obstetrics. 80(2), 153-7.
35. Alcaraz M., Hoult J., 1985. Actions of flavonoids and the novel anti-inflammatory flavone, hypolaetin-8-glucoside, on prostaglandin biosynthesis and inactivation. Biochemical Pharmacology. 34(14), 2477-82.
36. Toker G., Küpeli E., Memisoğlu M., Yesilada E., 2004. Flavonoids with antinociceptive and anti-inflammatory activities from the leaves of Tilia argentea (silver linden). Journal of Ethnopharmacology. 95(2-3), 393-7.
37. Özek M., Üresin Y., Güngör M., 2003. Comparison of the effects of specific and nonspecific inhibition of nitric oxide synthase on morphine analgesia, tolerance and dependence in mice. Life sciences.72(17), 1943-51.
38. Vasigh A., Abdi A., Borji M., Tarjoman A., 2019 .The prevalence of neuropathy among type 1 diabetic adolescents in Iran: a systematic review and meta-analysis. Int J Adolesc Med Health . DOI: 
39. Azami M., Parizad N., Sayehmiri K., 2016. Prevalence of Hypothyroidism, Hypoparathyroidism and the Frequency of Regular Chelation Therapy in Patients with Thalassemia Major in Iran: A Systematic Review and Meta-analysis study. Iran J Ped Hematol Oncol. 6(4), 261-276.
40. Hatefi M., Abdi A., Tarjoman A., Borji  M., 2019. Prevalence of depression and pain among patients with spinal cord injury in iran: a systematic review and meta-analysis. Trauma Mon.24(4), 1-8.
41. Azami M., Nikpey S., Pakzad I., Sayehmiri K., 2016. Effects of immunization on hepatitis B vaccine in Iranian health staff: A systematic review and meta-analysis study. Koomesh. 17(4), 789-795.
Volume 11, Issue 1
March 2021
Pages 41-53
  • Receive Date: 05 November 2019
  • Revise Date: 02 December 2019
  • Accept Date: 16 September 2020
  • First Publish Date: 22 February 2021