Comparison of Peppermint Oil and Mefenamic Acid for Relief of Dysmenorrhea Symptoms

Dysmenorrhea is associated with painful uterine contractions, nausea, vomiting, and diarrhea. Pain is thought to be caused by the release of prostaglandin F2α in the menstrual fluid. The main treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), prostaglandin inhibitors, and contraceptive pills. NSAIDs can be effective in relieving dysmenorrhea but commonly cause adverse side effects and are contraindicated in some people. Mefenamic acid is a mild analgesic and fever-reducing NSAID used for relief of moderate short-term menstrual pain. Peppermint (Mentha × Piperita, Lamiaceae) exerts its effect on the myometrium contractile activity by inhibiting prostaglandin F2α and oxytocin and has also been shown to have an analgesic and anti-inflammatory effect.1,2 In addition, menthol, a primary constituent in mint, reduces vomiting and diarrhea.3,4 The goal of this study was to compare the effects of peppermint oil and the NSAID mefenamic acid for relief of dysmenorrhea symptoms.

A prospective, randomized, crossover study was conducted for 2 months with 122 single, female Iranian university students aged 18-25 years who already had primary dysmenorrhea. Group 1 received 3 peppermint oil capsules (Colpermin™; Tillotts Pharma AG; Rheinfelden, Switzerland) once a day for 3 days after menstruation started, followed by a washout period during the next menstrual cycle. The actual dosage of peppermint oil was not disclosed. [Note: The Colpermin website states that each gastro-resistant hard-gelatin capsule contains 187 mg of peppermint oil.5] Then, in the third menstrual cycle, patients were given 1 capsule containing 250 mg mefenamic acid (Ponstan®; Razak Laboratories Co.; Tehran, Iran) every 8 hours for 3 days. Group 2 received the same treatments in reverse order.

There was no significant difference in age, the number of days of menstruation, age at first menstruation, or dysmenorrhea interval between groups. Patients were given questionnaires after taking each treatment. Pain intensity was assessed through visual analog scale (VAS) and dysmenorrhea timing through the Cox menstrual symptom scale. Bleeding amount was measured using a pictorial blood assessment chart (PBAC). The VAS and Cox scale were answered at the beginning and end of each menstruation. PBAC was completed on menstruation days. Patients were allowed to take sedatives 1 hour after treatment, but they had to record the intensity and duration of their pain first.

Consumption of both mefenamic acid and peppermint oil significantly reduced the severity of pain (P<0.05), and there was no significant difference between the 2 treatments. Mefenamic acid and peppermint oil both significantly reduced duration of pain (P<0.05); however, duration of pain was more greatly reduced by mefenamic acid than peppermint oil (P<0.05). Mefenamic acid significantly reduced bleeding (P<0.05), while there was a slight (nonsignificant) increase in bleeding after peppermint oil treatment (P>0.05). There was no significant difference in nausea and vomiting with the use of mefenamic acid (P>0.05), but both were significantly decreased by peppermint oil (P<0.05). Peppermint oil also showed a significantly greater reduction in diarrhea compared to mefenamic acid (13.5% and 3.8% decrease, respectively; P<0.05). Both groups had similar significant decreases in analgesic use during treatment periods (P<0.05).

The findings of this study show that peppermint oil can reduce the duration and severity of menstrual cramps. Mefenamic acid has been studied as a drug treatment for dysmenorrhea; yet, the results of this study show that peppermint oil has similar effects to mefenamic acid while achieving the additional benefits of significantly reducing nausea and vomiting. Due to the complications of mefenamic acid (some of which include gastrointestinal bleeding, ulcers, flatulence, indigestion, and stomach pain), peppermint oil may be a preferred treatment. Researchers urge future studies on peppermint oil for treatment of dysmenorrhea symptoms and suggest the use of higher dosages or treatment during the luteal phase of the fertility cycle.

References

1Jalilzadeh-Amin G, Maham M. Evaluation of pulegone on transit time and castor oil induced diarrhea in rat. Pharmaceutical Sciences. 2013;19(3):77-82.

2Taher YA. Antinociceptive activity of Mentha piperita leaf aqueous extract in mice. Libyan J Med. 2012;7(1). doi: 10.3402/ljm.v7i0.16205.

3Hiki N, Kaminishi M, Hasunuma T, et al. A phase I study evaluating tolerability, pharmacokinetics, and preliminary efficacy of L-menthol in upper gastrointestinal endoscopy. Clin Pharmacol Ther. 2011;90(2):221-228.

4Alves JGB, de Brito Rde CCM, Cavalcanti TS. Effectiveness of Mentha piperita in the treatment of infantile colic: A crossover study. Evid Based Complement Alternat Med. 2012;2012:981352. doi: 10.1155/2012/981352.

5What does Colpermin™ contain? Colpermin website. Available at: http://www.colpermin.eu/about-colpermin-sup-tm-sup-/what-does-colpermin-sup-tm-sup-contain-. Updated October 2015. Accessed April 16, 2017.

Fennel ‘Safe and Effective’ for Easing Menopause Symptoms

Although a normal phase of a woman’s life, menopause can have a wide range of inconvenient symptoms. New research suggests fennel may help to relieve these symptoms, with little to no side effects.
Clinical trial shows fennel is a safe and effective treatment for menopause symptoms, with no side effects.

The symptoms of menopause range from changes in mood, period, or sex drive to sleep trouble, anxiety, depression, and the well-known hot flashes. This stage in a woman’s life can also increase the risk of health issues, such as osteoporosis or heart disease.

Physicians often recommend hormonal therapy (HT) for managing menopausal symptoms, as well as preserving bone density. However, the National Institute on Aging (NIA) caution against the health risks that HT often poses, including that of a heart attack, stroke, and breast cancer.

Additionally, the United States Food and Drug Administration (FDA) recommend that women take the smallest dose of HT for the shortest period of time possible.

Because of the adverse health effects associated with HT, many women turn to complementary, plant-based medicine for symptom relief during menopause. Plants such as red clover or soy contain phytoestrogens – substances similar to the estrogen produced by the human body but derived from plants.

However, the American Association of Clinical Endocrinologists (AACE) report that the efficacy of phytoestrogens in relieving menopause symptoms has been inconsistent.

But new research – published in Menopause, the journal of The North American Menopause Society (NAMS) – suggests that the phytoestrogens found in fennel help manage postmenopausal symptoms and pose no adverse effects.

Fennel – or Foeniculum vulgare Mill – is a herb known for its culinary and medicinal uses. Fennel is commonly used as a spice, and fennel tea is known to relieve indigestion or premenstrual cramps.

Fennel led to reduction in menopause symptoms

The new research consisted of a randomized, triple-blind trial – an experiment in which the details are kept secret from the participants, those administering the intervention, as well as the committee of researchers in charge of evaluating the outcomes of the experiment.

The study comprised of 90 Iranian women between 45 and 60 years old who lived in Tehran. The average age at which Iranian women get their menopause is younger than that of American women. The former is 48.2 years, compared with 51 years in the U.S.

Participants were administered capsules containing 100 milligrams of fennel every day, twice per day, for a period of 8 weeks. The participants were divided into two groups of 45 women: one that received the treatment and one that received placebo.

Using the Menopause Rating Scale (MRS), the researchers compared the results of the treatment group with those of the placebo group at 4, 8, and 10-week intervals after the intervention began.

Based on the participants’ responses, fennel was found to be “an effective and safe treatment to reduce menopausal symptoms in postmenopausal women without serious side effects.”

The study revealed significantly lower MRS scores in patients who had received the treatment compared with the placebo group.

In the treatment group, a Friedman test revealed significantly lower scores at 4, 8, and 10 weeks, compared with the baseline. In the placebo group, the same test found no significant differences.

This is one of the first clinical trials to investigate the effects of fennel on menopausal symptoms.

This small pilot study found that, on the basis of a Menopause Rating Scale, twice-daily consumption of fennel as a phytoestrogen improved menopause symptoms compared with an unusual minimal effect of placebo. A larger, longer, randomized study is still needed to help determine its long-term benefits and side effect profile.”

Dr. JoAnn Pinkerton, executive director of NAMS

Atrial Fibrillation: Natural Treatments, Remedies, and Tips

The heart’s upper chambers normally beat in a regular, coordinated rhythm with the heart’s lower chambers. In atrial fibrillation, the heart’s upper chambers can quiver out of rhythm.

The result is an irregular heart rhythm that can cause symptoms, such as shortness of breath, weakness, and heart palpitations. The condition can also lead to blood clots developing in the upper chambers, which can cause a stroke.

Atrial fibrillation (A-fib) treatments can vary based on the symptoms that people experience. While it’s important for people to follow a doctor’s advice related to A-fib treatments, they might also choose to supplement medical treatments with natural ones.

Natural treatments

Acupuncture
Acupuncture may help control the heart rate of people with A-fib.

Although natural treatments are often not widely studied, there are several treatments and activities that may help to reduce the symptoms and effects of A-fib. Some of these treatments may include the following:

Acupuncture

Acupuncture, a traditional Chinese medicine approach, may help those with A-fib control their heart rates, according to a study published in the journal Evidence-Based Complementary and Alternative Medicine.

Acupuncture involves applying small needles to specific points on the body to promote energy flow. The acupuncture point is linked with controlling heart rhythm problems, but more research is still needed.

Yoga

Yoga is the practice of deep breathing, meditation, and body postures. Regular yoga practice for 1 hour, 3 days a week has been shown to reduce the amount of A-fib episodes, according to one study.

While the exact way that yoga reduces the incidence of A-fib isn’t known, researchers suggest that yoga could reduce stress and inflammation that damages the heart as well as reduce a person’s resting heart rate.

Herbs and supplements

One of the natural herbs reported to reduce A-fib and its symptoms are the Chinese herb extract Wenxin Keli (WXKL).

In a review of current studies regarding WXKL and its proposed effects, the authors found that taking the herb could have the following effects:

  • reduce changes to the heart that can occur as a result of A-fib
  • improve the maintenance of regular rhythm
  • have similar benefits as the beta-blocker sotalol in maintaining regular heart rhythms
  • reduce symptoms associated with A-fib, such as chest tightness, palpitations, and difficulty sleeping

However, the researchers noted that there are not a significant amount of studies or recommendations regarding a dosage for WXKL.

Another study studied the effects of traditional Chinese medicine (TCM) herbs compared with prescription medications in treating A-fib.

traditional chinese medicine herbs
Traditional Chinese medicine herbs may help to treat females that are younger than 65 who have A-fib. However, research on the use of TCM herbs is inconclusive.

At the conclusion of the study, researchers made the following conclusions:

  • The TCM users had a reduced risk for stroke (1.93 percent) compared with non-TCM users (12.59 percent).
  • TCM users who were female or younger than 65 experienced the greatest stroke reduction benefits.
  • Those older than age 65 did not experience a significantly reduced stroke risk.

However, it’s important to note that one Chinese herb called Dan Shen can interact harmfully with warfarin, a blood thinner that doctors often prescribe to people with A-fib.

The researchers noted that there were several limitations to the study. For example, they did not track any of the participants’ lifestyle factors that could have affected their risk. The participants could also have been using other herbal medicines that the researchers weren’t aware of.

Other herbs and supplements that may help treat Afib, according to the Journal of Thoracic Diseases, include:

  • barberry (berberis)
  • cinchona
  • hawthorn
  • motherwort
  • omega-3 fatty acids
  • shensongyangxin

Substances to avoid

Lifestyle habits and eating certain foods and drinks can potentially trigger episodes of A-fib. One such habit is smoking. Other examples include:

  • Drinking alcohol excessively: no more than 1 to 2 alcoholic drinks for a man each day and no more than 1 drink per day for women. People older than age 65 should have no more than 1 alcoholic drink per day. Moderate to heavy alcohol drinkers were 1.35 times more likely to have A-fib than non-drinkers.
  • Consuming excess amounts of caffeine. About 400 milligrams of caffeine is a safe upper limit for adults on a daily basis. This is roughly the same as four brewed cups of coffee.
  • Taking cough and cold medicines that contain stimulants, such as dextromethorphan or promethazine-codeine cough syrup.
  • Eating more than four servings of “dark” fish per week. According to one study, eating more than 4 servings of dark fish, such as salmon, swordfish, bluefish, mackerel, and sardines can actually increase the risk for A-fib.

Some people are more sensitive to medications and additives than others. If a person notices that eating a certain food or drink increases the incidence of irregular heart rhythms, they should talk to their doctor.

Lifestyle tips for living with A-fib

Many people with A-fib have a condition called sleep apnea. The most common form is obstructive sleep apnea, which causes a person to stop breathing for brief periods while they are asleep.

Sleep apnea can weaken the heart because the heart has to start working harder to make up for the lost oxygen when a person stops breathing.

Symptoms that suggest a person could be experiencing sleep apnea include:

  • being told they snore
  • waking themselves up at night with snoring or irregular breathing
  • having excessive daytime sleepiness

Anyone with these symptoms should see their doctor or a sleep medicine specialist.

A healthful lifestyle overall tends to promote heart health. As a result, a person may experience a reduced incidence of A-fib or lessen the risk of their symptoms getting worse.

Examples of healthful habits to follow include:

  • eating a healthy diet filled with fruits, vegetables, and whole grains
  • exercising regularly
  • managing high blood pressure through both medications and natural treatments, if desired
  • avoiding excess intakes of alcohol and caffeine
  • managing long-term conditions that could contribute to or worsen A-fib

Long-term conditions that could contribute to A-fib include high blood pressure, sleep apnea, thyroid disease, diabetes, and chronic lung disease.

According to the American Heart Association, a person with A-fib is five times more likely to have a stroke than someone who does not have a history of heart disease. By working to prevent cardiac complications, a person can live a healthier life with A-fib.

Black Cumin Does Not Decrease Levels of Oxidative Stress Markers in Women with Rheumatoid Arthritis

  • Black Cumin (Nigella sativa, Ranunculaceae)
  • Rheumatoid Arthritis
  • Inflammation
  • Oxidative Stress

Rheumatoid arthritis (RA) is a progressive, inflammatory autoimmune disease that causes pain, swelling, stiffness, and deformity of the joints. It is thought that the pathogenesis of RA involves chronic oxidative stress and chronic inflammation. Hence, treatments that have anti-inflammatory and antioxidant effects may be beneficial. Black cumin (Nigella sativa, Ranunculaceae) seed oil is used in Iranian traditional medicine. It has been shown to have anti-inflammatory and antioxidant activity in animal models of inflammation by suppressing the elevated levels of pro-inflammatory cytokines and pro-oxidants. The purpose of this randomized, double-blind, placebo-controlled study was to evaluate the effects of black cumin seed oil on the concentration of selected inflammatory cytokines and oxidative stress markers in women with RA.

Patients (n = 42, aged 20-50 years) were recruited from Sheykholrayis Outpatient Clinic, affiliated with Tabriz University of Medical Sciences, in Tabriz, Iran, from May 2012 to November 2013. Included patients had mild to moderate RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR-EULAR) criteria; were being treated with methotrexate, hydroxychloroquine, or prednisolone; were not receiving any non-steroidal anti-inflammatory drugs or cytokine inhibitors for ≥ 2 months prior to study entry; and had body mass index (BMI) < 40. Excluded patients were pregnant or lactating; were taking hormone therapy or oral contraceptives; had metabolic disorders such as diabetes mellitus, lactose intolerance, Cushing’s syndrome, or thyroid dysfunction; had kidney or liver disease; had chronic inflammatory disease including inflammatory bowel diseases; had a history of taking antioxidant or anti-inflammatory supplements 4 weeks prior to the study; or had a history of being on weight-reduction diets or smoking.

Patients received placebo (paraffin) or 1000 mg/day black cumin seed oil capsules for 8 weeks. Both placebo and black cumin seed oil soft gels were formulated, developed, and produced by Barij Asans of Kashan (Barij Essence Pharmaceutical Company); Kashan, Iran. The authors do not describe the composition or concentration of the black cumin seed oil. Physical activity level and psychological stress were assessed via International Physical Activity Questionnaire and State-Trait Anxiety Inventory Form Y (STAI-Y), respectively. Dietary intake was evaluated using a 3-day dietary record before and after the intervention, and the data was analyzed using Nutritionist IV software. Disease activity was monitored via the Disease Activity Score Calculator for Rheumatoid Arthritis. Fasting blood was collected at baseline and after 8 weeks of treatment. Serum levels of the inflammatory cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) and the oxidative stress indicators total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), and nitric oxide (NO) were measured.

Groups were similar at baseline. Fifty women were enrolled in the study and 42 completed the study. Of the 25 women in the placebo group, 7 dropped out for reasons not related to the intervention and 2 were excluded from the analysis due to infection or medication change, leaving 16 patients in the per-protocol analysis. In the black cumin group, 1 patient dropped out for reasons not related to the intervention and 1 was excluded due to the medication change, leaving 23 patients in the per-protocol analysis. The author’s power calculation indicated that 18 patients in each group were required for statistical significance. Compared with baseline, at 8 weeks, there were no significant changes in BMI, STAI-Y, physical activity, micronutrient intake, energy intake, or macronutrient intake.

At study end, disease activity score was significantly decreased in the black cumin group compared with baseline (P < 0.05), while there was no significant change in the placebo group (data not shown; the between-group difference was not reported). The black cumin group had a significant increase in IL-10 (P < 0.01) and significant decreases in malondialdehyde (MDA; P = 0.04) and NO (P = 0.01) compared to baseline; however, the difference between groups was not statistically significant. There were no significant effects on TNF-α, SOD, CAT, or TAC.

The authors conclude that black cumin “could improve inflammation and reduce oxidative stress in patients with RA … .” However, the data presented do not support their conclusion. Black cumin significantly increased the level of the inflammatory cytokine IL-10, indicating a pro-inflammation effect. Although black cumin decreased the levels of the oxidative stress markers MDA and NO compared to baseline, there was no significant difference in these parameters between the black cumin and placebo groups, and black cumin had no effect on the other 4 oxidative stress markers. Limitations of this study include the following: the size of the placebo group was too small to detect statistically significant treatment effects; relatively short study duration; lack of safety/adverse event and compliance reporting; and chemical composition and concentration of the black cumin seed oil was not reported. The authors declare no conflicts of interest; however, one of the authors *(Hosseini) is an employee of Barij Essence Pharmaceutical Company.

*Hadi V, Kheirouri S, Alizadeh M, Khabbazi A, Hosseini H. Effects of Nigella sativa oil extract on inflammatory cytokine response and oxidative stress status in patients with rheumatoid arthritis: a randomized, double-blind, placebo-controlled clinical trial. Avicenna J Phytomed. 2016;6(1):34-43.