Effectiveness of Zingiber Officinale(ginger) compared with non-steroidal anti-inflammatory drugs and complementary therapy in primary dysmenorrhoea: A systematic review

Problem considered: The empirical evidence suggested the usage of ginger (zingiber officinale), complementary therapies and Non-steroidal anti-inflammatory drugs (NSAIDs) for dysmenorrhoea compared to self-administration of NSAIDs alone in alleviating the symptoms of dysmenorrhoea. However, there is a need for strong evidence to compare the effectiveness of ginger to that of complementary therapies like exercise, herbs (other than ginger) and NSAIDs. Thus, this systematic review aimed to compare the effectiveness of ginger with NSAIDs and other complementary therapies and suggests an effective dose of ginger in oral form that can be taken during dysmenorrhoea. Methods: A systematic literature search was conducted using electronic databases, namely MEDLINE via PubMed, Cochrane central, Scopus, CINHAL, EBSCOhost, ProQuest Central, and Google Scholar search engine. The search terms were combined keywords related to menstrual pain, complementary therapy, NSAIDs, and ginger. Randomized or quasi-randomized controlled trials that included ginger as a comparator to assess the effect on primary dysmenorrhea were included in this systematic review. Data were extracted, and the findings were narratively synthesised. Result: An initial search from the electronic database identified 394 studies, of which eleven studies met the eligibility criteria, where seven were randomised controlled trials, and four were quasi-experimental studies. There was no significant difference between ginger and NSAIDs in decreasing pain intensity during menstruation. Ginger and exercises like muscle relaxation techniques, stretching, and sub-maximal aerobic exercise effectively reduce pain when combined. Dill seeds (Anethum graveolens, an aromatic herb used for flavouring and medical purposes) and ginger alone were effective in dysmenorrhoea, but no effect of valerian, peppermint and cumin (spices) seeds were observed. The effect of ginger was inclusive compared to placebo. Conclusion: The usage of ginger up to two grams per day in divided doses of powder or dietary form for three days from the first day of the menstrual cycle can be used safely for primary dysmenorrhoea. Ginger can be combined with complementary therapies like exercise for increased effectiveness in relieving menstrual pain. The alternative therapy can reduce dependency on synthetic drugs for controlling dysmenorrhoea. However, there is a need to carry out rigorous randomized controlled trials of longer duration to evaluate the effectiveness of ginger and auxiliary therapies other than ginger in controlling menstrual pain.