See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/6903136

Effect o f A r o m a t h e r a p y o n S y m p t o m s o f D y s m e n o r r h e a in C o l l e g e St udents: A
R a n d o m i z e d P l a c e b o - C o n t r o l l e d C l i ni c a l Trial

Article in Journal of alternative and complementary medicine (New York, N.Y.) · July 2006
DOI: 10.1089/acm.2006.12.535 · Source: PubMed

CITATIONS READS
115 3,797

5 authors, including:

Sun-Hee Han Myung-Haeng Hur

Eulji University Eulji University
3 PUBLICATIONS 213 CITATIONS 67 PUBLICATIONS 1,484 CITATIONS

SEE PROFILE SEE PROFILE

Jeeyae Choi Myeong Soo Lee

University of North Carolina at Wilmington Korea Institute of Oriental Medicine
45 PUBLICATIONS 343 CITATIONS 711 PUBLICATIONS 15,247 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

PRISMA for acupuncture View project

euljji university 2017 View project

All content following this page was uploaded by Myeong Soo Lee on 11 June 2015.

The user has requested enhancement of the downloaded file.

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 12, Number 6, 2006, pp. 535–541
© 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 con-
traceptive drugs.
Intervention: Subjects were randomized into three groups: (1) an experimental group (n ϭ 25) who received
aromatherapy, (2) a placebo group (n ϭ 20), and (3) a control group (n ϭ 22). Aromatherapy was applied top-
ically 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 ϭ Ϫ2.48, 95% CI: Ϫ3.68 to Ϫ1.29, p Ͻ 0.001; second day: Beta ϭ Ϫ1.97, 95% CI: Ϫ3.66 to Ϫ0.29,
p ϭ 0.02 and the severity of dysmenorrhea (first day: Beta ϭ 0.31, 95% CI: 0.05 to 0.57, p ϭ 0.02; second day:
Beta ϭ 0.33, 95% CI: 0.10 to 0.56, p ϭ 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 nurs-
ing care to women experiencing menstrual cramps or dysmenorrhea.

1School of Nursing, Wonkwang Public Health College, Iksan, Korea.

2School of Nursing, Eulji University, Daejeon, South Korea.
3Center for Complementary Medicine & Integrative Health, Faculty of Health and Human Science, Thames Valley University, Lon-
don, 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.

535
536 HAN ET AL.

INTRODUCTION gether appear to be the most effective treatment for men-

strual cramps. Vance et al.11 tried microwave diathermy, and
ysmenorrhea is defined as painful menstruation in- Kim et al.12 tried biofeedback. However, many of these
volving low abdominal pains (menstrual cramps), treatments cannot be prescribed by nurses, and many con-
which may be accompanied by other symptoms such as ventional drugs have side effects or their main effects do not
nau- sea and fatigue. Menstrual cramps caused by last long. Because dysmenorrhea is so common and has
dysmenorrhea are a common problem. Some studies been inadequately addressed, it is important to find an
suggest that 50–93% effective method that can be easily used.
of women experience menstrual cramps caused by dysmen- Aromatherapy is the therapeutic use of essential oils from
orrhea, and that 10–26% of women experience severe pain. plants. Essential oils can be absorbed into the body via the
In a recent study in Korea, 83% of college women com- skin or the olfactory system. Aromatherapy is thought to be
plained of menstrual cramps, 18% rating their pain as very particularly efficacious against menstrual cramps or dys-
severe.1 In the most severe cases, the pain was rated 7.9 on menorrhea. 13–15 In some countries aromatherapy products
a 10-point visual analogue scale (VAS). However, despite are sold and aromatherapy is used as a major complemen-
frequent occurrence and severity, menstrual cramps are not tary “caring” therapy. 16 Aromatherapy is perceived to be a
acknowledged as a serious problem or one requiring nurs- safe therapy. 17 Essential oils have been used for several hun-
ing intervention. However, Milsom et al.2 showed that the dred years and are used regularly today by the public for
intra-uterine pressure (IUP) of a patient with dysmenorrhea stress-management and for minor ailments. 18

was 55.3 Ϯ 3.8 mmHg in the relaxation phase and 175.0 Ϯ However, the therapeutic effects of aromatherapy are not
6.1 mmHg in the contraction phase, and that the IUP dur- well supported by clinical studies.19 Keville and Green20
ing contraction is greater than in labor.1 sug- gested that essential oils should be used for several
Dysmenorrhea is usually treated with drugs, such as anal- days be- fore dysmenorrhea or menstrual cramps are
gesics, sedatives, antispasmodics, prostaglandin inhibitors, expected. They recommend that the essential oils of
uterine contraction inhibitors, nonsteroidal anti-inflammatory chamomile (Chamomelum nobile), clary sage (Salvia
drugs, vasopressin antagonists, and medication to stop ovu- sclarea), lavender (Lavandula an- gustifolia), marjoram
lation.3 In a review article, Dawood3 suggested that none of (Origanum majorana), melissa (Melissa officinalis), and
these therapies are particularly effective but some may lead geranium (Pelargonium graveolens) help in treating
to dependence or affect cognitive function. Bed rest, local heat menstrual cramps. Tisserand15 suggested clary sage,
therapy, surgical intervention, and psychotherapy have also lavender, rose (Rosa centifolia), marjoram, geranium, and gin-
been used.3 In a 1999 survey, Han and Hur1 found that the ger (Rhizoma zingiberis recens) as effective in treating dys-
most common methods to cope with menstrual cramps were menorrhea. Dye13 suggested clary sage, chamomile, geranium,
“endurance” and medication. Campbell and McGrath4 found and rose, while Baker21 suggested geranium, Roman
that 70% of women with dysmenorrhea use medication. How- chamomile, rosemary, lavender, clary sage, and sage.
ever, Chambers et al.5 noted that the medication might not The essential oil of lavender is thought to be an adreno-
be effective if not used regularly. Many studies suggest that cortical stimulant that stimulates menstruation and circula-
men- strual cramps and dysmenorrhea are not managed tion and has anticonvulsive properties. Lavabre14 suggested
efficiently despite their high occurrence and severity. that lavender is also useful as a sedative and to alleviate
A variety of alternative methods have been used to treat pain. Tisserand 15 suggested that clary sage has functions
menstrual cramps. Some experimental studies have found similar to estrogen, such as normalizing the menstrual cy-
alternative methods such as acupuncture6 and transcuta- cle, promoting menstruation, and strengthening the uterus.
neous electrical nerve stimulation (TENS)7 to be fairly ef- Tisserand 15 also suggested that rose has a great affinity for
fective (e.g., 50% reduction in pain). Kotani et al.8 found the uterus and helps regulate the menstrual cycle and reduce
that the herbal medicine Toki-shakuyaku-san [Japanese an- excessive bleeding. In this study, we hypothesized that ap-
gelica root (Angelicae radix), peony root (Paeoniae radix), plying these three essential oils together would provide a
Poria (Hoelen spp.), Chinese atractylodes rhizome (Atracty- synergistic blend that would have the highest chance of suc-
lodis lanceae rhizoma), Oriental water plantian rhizome cess in treating the pain of menstrual cramps.
(Alismatis rhizome), Cnidium (cnidii rhizoma)] was more Different methods are used to deliver aromatherapy, such
ef- fective than placebo in treating primary dysmenorrhea. as diffusers, baths, massage, and compresses. Massage is
At- tempting to cure idiopathic menstrual pain, Kim* be- lieved to be an effective way to improve blood and
used a placebo in the form of a vitamin pill. Dawood and lymph circulation and to reduce stress and ease stiff
Ramos9 suggested that concurrent use of TENS and muscles. For massage, the essential oil is diluted in a cold-
ibuprofen might be an effective treatment, and Harel et pressed veg- etable oil, a popular choice being sweet
al.10 used supple- ments such as omega-3 fatty acids. almond oil. 13,14,20 Massage appears to be a suitable
TENS and ibuprofen to- method to deliver aro- matherapy to treat menstrual
cramps of dysmenorrhea.
*Kim G. The Effect of Menstrual Pain Relief by Placebo [un- The purpose of this study was to investigate whether the
published Master’s thesis]. Pusan, Korea; Department of Nursing, combination of lavender, clary sage, and rose applied topically
Pusan National University, 1985. 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
inter- vention for patients with painful menstrual cramps.
MATERIALS AND METHODS
Design
The study consisted of a double-blind, three-group ex-
perimental pre-test/post-test design. Fifty-seven (57) partic-
ipants were randomly assigned to one of three groups. The
experimental group received aromatherapy in almond oil
with massage, the placebo group received treatment with al-
mond 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 contraindi-
cations to the treatment they were about to receive, but that,
in rare instances, skin irritation could occur. The study re-
ceived institutional approval from the Human Investigation
Ethics Committee and administrative approval from the Hu-
man Subjects Review Board of Wonkwang University Hos-
pital and School of Medicine before we approached the sub-
jects and obtained written consent from them.
Participants
The participants were college women enrolled in uni-
versities in Korea. A previous survey had identified 85
women who experienced dysmenorrhea. The selection cri-
teria 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 contra-
ceptives. Participants who failed to meet all of these cri-
teria 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 en-
tered the initial phase of the study.
The experimental group (n ϭ 25; mean age, 20.6 Ϯ 1.27
years) received aromatherapy in almond oil with massage.
The placebo group (n ϭ 20; mean age, 20.9 Ϯ 1.93) re-
ceived treatment with almond oil only and massage, and the
control group (n ϭ 22; mean age, 20.5 Ϯ 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 ex-
perimental group; B, the placebo group; and C, the control
group. In discussing the nature of aromatherapy and the ex-
perimental 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. Sub-
jects were blinded as to whether they were receiving real or
537
sham aromatherapy, as were the clinical observers assess-
ing the endpoints. Four assistants contacted the subjects and
checked their responses.
Intervention
The experimental group received aromatherapy in the treat-
ment room every day beginning one week before the start of
menstruation and continuing until the first day of menstrua-
tion. The experimental and placebo groups received 15 min-
utes of aromatherapy or placebo, respectively. The aro-
matherapy 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 re- quested to lie on the bed and rest after the
abdominal mas- sage. 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 di-
amond, 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 continu-
ous. 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 pre-
test data. Data on the severity of menstrual cramps were col-
lected 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 re- flected 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 Milsom 22 and Sundell et al.23 The
system uses four grades to indicate the extent to which
dysmenorrhea influences daily life. According to this scor-
ing system, mild dysmenorrhea is defined as menstruation
538 HAN ET AL.

T ABLE 1. C HARACTERISTICS OF S UBJECTS ON A ROMATHERAPY , P LACEBO C ONTROL , AND N O -T REATMENT C ONTROL

Aromatherapy Placebo No treatment

Characteristics (n ϭ 25) (n ϭ 20) (n ϭ 22)

Age (yr) 20.0 (20.0–21.0) 20.0 (20.0–21.0) 21.0 (20.0–21.0)

Age at menarche (yr) 13.5 (13.0–14.0) 13.0 (12.0–14.0) 13.0 (13.0–14.0)
Menstruation
Cycle (days) 28.0 (28.0–30.0) 30.0 (27.0–30.0) 30.0 (26.8–34.0)
Duration (days) 6.0 (5.0–7.0) 5.0 (5.0–6.8) 6.0 (5.0–6.5)
Amount
Profuse 7 (28.0%) 2 (10.0%) 4 (18.2%)
Moderate 16 (64.0%) 16 (80.0%) 14 (63.6%)
Scanty 2 (8.0%) 2 (10.0%) 4 (18.2%)
Pattern
Regular 17 (68.0%) 11 (55.0%) 10 (45.4%)
Irregular 8 (32.0%) 9 (45.0%) 12 (54.6%)
Use of analgesics
None 5 (20.0%) 4 (20.0%) 8 (36.4%)
Often 10 (40.0%) 12 (60.0%) 7 (31.8%)
Always 10 (40.0%) 4 (20.0%) 7 (31.8%)

Values are expressed as median (interquartile ranges).

that is painful but seldom inhibits the woman’s normal ac-
tivity and analgesics are seldom needed. Moderate dys-
menorrhea affects daily activities and requires analgesics,
but missing work or school is unusual. Severe dysmenor-
rhea clearly inhibits daily activity, is managed poorly by
analgesics, and has associated somatic symptoms such as
headache, tiredness, nausea, vomiting, or diarrhea. Symp-
toms were scored from 1 to 4 (1 none; 2 mild; 3 moder-
ate; 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 out-
comes were compared using the nonparametric Mann-Whit-
ney rank test between groups and the Wilcoxon signed-rank
test across treatment times for each group.
Multiple regression analyses were used to estimate the
ef- fects and the validity of the hypothesis. We divided the
analy- ses into two parts, analyzing the first- and second-day are listed in Table 1.
results
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 other- wise. The coefficients of these indicators
therefore represent placebo versus control and aromatherapy
versus control com- parisons. This procedure was
performed separately for the first- and second-day data.
The severity of dysmenorrhea in each woman was di-
chotomized into either 1, representing improvement (mean-
ing a strictly better postintervention score), or 0, represent-
ing 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 treat-
ment. The demographic characteristics of the participants

T ABLE 2. E FFECTS OF A ROMATHERAPY ON S EVERITY OF M ENSTRUAL C RAMPS

Time Change

Group Preintervention First day Second day First day—pre Second day—pre

Aromatherapy 7.0 (6.5–8.3) 5.0 (3.0–6.0)**,†‡ 3.0 (1.0–5.0)**,†‡ Ϫ2.5 (Ϫ5.0—Ϫ1.5) Ϫ4.5 (Ϫ5.0—Ϫ2.0)
Placebo 7.0 (6.0–8.0) 7.0 (6.0–8.0) 7.0 (2.8–8.0)* 0.0 (0.0—1.0) Ϫ0.5 (Ϫ5.0—1.0)
No treatment 7.5 (6.5–8.0) 7.0 (6.0–8.0) 7.0 (5.0–8.0) 0.0 (Ϫ1.0—0.3) 0.0 (Ϫ3.0—0.0)

Values are expressed as median (interquartile ranges).

*p Ͻ 0.05; **p Ͻ 0.001 by Wilcoxon signed rank test compared with baseline value; † p Ͻ 0.01 by Mann-Whitney rank sum test
compared with the placebo; ‡p Ͻ 0.01 compared to no treatment groups.
AROMATHERAPY MASSAGE EFFECT ON SYMPTOMS OF DYSMENORRHEA 539

Table 2 lists the medians and IQRs for the levels of men-
strual 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 ϭ Ϫ2.48, 95% CI: Ϫ3.68 to Ϫ1.29, p Ͻ
0.001), followed by the baseline value of level of menstrual
cramps (Beta ϭ Ϫ0.62, 95% CI: Ϫ0.99 to – 0.26, P ϭ 0.001),
with the weakest association being with placebo (Beta ϭ
0.42, 95% CI: Ϫ0.83 to 1.67, p ϭ 0.51) com- pared 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 ϭ Ϫ1.97, 95% CI: Ϫ3.66 to
Ϫ0.29, p ϭ 0.02), the baseline value of level of menstrual
cramps (Beta ϭ Ϫ0.52, 95% CI: – 1.04 to – 0.003, p ϭ 0.05),
and placebo (with the weakest association being with placebo
(Beta ϭ 0.27, 95% CI: Ϫ1.49 to 2.04, p ϭ 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 sever-
ity (Beta ϭ 0.31, 95% CI: 0.05 to 0.57, p ϭ 0.02), the base-
line value of severity (Beta ϭ 0.21, 95% CI: 0.04 to 0.37,
p ϭ 0.02), and not for placebo (Beta ϭ Ϫ0.003, 95% CI:
–0.29 to 0.28, p ϭ 0.98) compared to controls for the first
day. The trend was the same for the second day. Aro-
matherapy was associated with the severity change (Beta ϭ
0.33, 95% CI: 0.10 to 0.56, p ϭ 0.006), the baseline value
of severity (Beta ϭ 0.33, 95% CI: 0.18 to 0.48, p Ͻ 0.001),
and not for placebo (Beta ϭ Ϫ0.15, 95% CI: Ϫ0.40 to 0.10,
p ϭ 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. Be- cause menstrual cramps and
dysmenorrhea are personal top- ics, women may suffer
from these symptoms without seek- ing help from a
health care professional.4,24,25 In some extreme cases, the
internal pressure from the uterine contrac- tion 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 Ϯ 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 be-
tween 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 experi-
mental 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

T ABLE 3. E FFECT OF A ROMATHERAPY ON S EVERITY OF D YSMENORRHEA

Aromatherapy (n ϭ 25) Placebo (n ϭ 20) No treatment (n ϭ 22)

Severity of dysmenorrhea n (%) n (%) n (%)
Preintervention
1 0 (0.0) 0 (0.0) 1 (4.5)
2 2 (8.0) 4 (20.0) 7 (31.9)
3 21 (84.0) 12 (60.0) 13 (59.1)
4 2 (8.0) 4 (20.0) 1 (4.5)
First day
1 4 (16.0) 0 (0.0) 0 (0.0)
2 12 (48.0) 4 (20.0) 9 (40.9)
3 7 (28.0) 12 (60.0) 11 (50.0)
4 2 (8.0) 4 (20.0) 2 (9.1)
Second day
1 8 (32.0) 1 (5.0) 2 (9.1)
2 11 (44.0) 4 (20.0) 9 (40.9)
3 6 (24.0) 11 (55.0) 9 (40.9)
4 0 (0.0) 4 (20.0) 2 (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 aromather-
apy, 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 out-
come of relaxation treatment to alleviate menstrual cramps via
biofeedback training, the reduction to 5.3 of menstrual treat-
ment is higher than that of bio-feedback.12 In a study to ver-
ify 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 uter-
ine 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
hormone- regulatory drugs. The experimental group showed
a signifi- cant 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 di-
luted essential oils of lavender, clary sage, and rose are ef-
fective in alleviating the pain of menstrual cramps. Tradi-
tionally, lavender has been used as an analgesic, sedative,
and anticonvulsant; clary sage as an anticonvulsant, regula-
tor 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 ran-
domized 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 dysmenor-
rhea. 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 aromather-
apy before incorporating it into their practice.
HAN ET AL.
REFERENCES
1. Han S, Hur M. A study on the menstrual pain and dysmenor-
rhea, 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 Gy-
necol 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-admin-
istration of over-the-counter medication for pain among ado-
lescents. Arch Pediatr Adolesc Med 1997;151:449–455.
6. Helms JM. Acupuncture for the management of primary dys-
menorrhea. Obstet Gynecol 1987;69:51–56.
7. Lewers D, Clelland JA, Jackson JR, et al. Transcutaneous
elec- trical 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 double-
blind study. Am J Chin Med 1997;25:205–212.
9. Dawood MY, Ramos J. Transcutaneous electrical nerve stim-
ulation (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. Supple-
mentation with omega-3 polyunsaturated fatty acids in the
management of dysmenorrhea in adolescents. Am J Obstet
Gy- necol 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: Heal-
ing 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 Liv-
ingstone, 2003.
18. Halcon L. Aromatherapy: therapeutic application of plant es-
sential oils. Minn Med 2002;42–44.
19. Chez RA, Jonas WB. The challenge of complementary and al-
ternative 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 541

21. Baker S. Menstruation and related problems and concern. In: 27. Akerlund M. Modern treatment of dysmenorrhea. Acta Obstet
Youngkin EQ, Davis MS, eds. Women’s Health, A Primary Gynecol Scand 1990;69:563–564.
Care Clinical Guide. Stamford, CT: Appleton & Lange, 1997, 28. Buckle J. Clinical Aromatherapy in Nursing. London: Arnold,
pp. 139–160. 1997.
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
Address reprint requests to:
prevalence and severity of dysmenorrhoea in young women. Myung-Haeng Hur, Ph.D., R.N.
Br J Obstet Gynaecol 1990;97:588–594. School of Nursing
24. Griffith-Kennedy J. Contemporary Women’s Health. A Nurs- Eulji University
ing Advocacy Approach. Menlo Park, CA: Addison-Wesley 143-5 Yongdudong, Jung-gu
Publishing, 1986. Daejeon, 302-832
25. Rees M. Dysmenorrhoea. Br J Obstet Gynaecol 1988;95: South Korea
833–835.
26. Akerlund M. Can primary dysmenorrhea be alleviated by a va- E-mail: mhhur@eulji.ac.kr
sopressin antagonist? Results of a pilot study. Acta Obstet Gy- Or:
necol Scand 1987;66:459–461. daeheelee@hanafos.com

View publication stats