Int J Pharma Bio Sci 2018 January; 9(1): (P) 120 - 131

Review Article Pharmacognosy

International Journal of Pharma and Bio Sciences ISSN

0975-6299

TREATMENT OF MENSTRUAL DISORDERS: A SHIFT FROM SYNTHETIC

DRUGS TO DRUGS OF NATURAL ORIGIN
VISHAKHA DEORAY1 AND AMIT PAGE2*
1
PG Student, pursuing Master Degree in Pharmaceutics, SPTM NMIMS Shirpur-425405, Dhule, Maharashtra, India.
2
Department of Pharmaceutics, SPTM NMIMS Shirpur-425405, Dhule, Maharashtra, India.

ABSTRACT
As our lifestyle changes, we have to face number of diseases or disorders, especially in case of the
women. They face various gynecological problems like the menstrual disorders. Menstruation often brings
various uncomfortable symptoms such as mild cramps and fatigue. These problems usually go away
when periods begin. Sometimes more serious menstrual problems arise such as complete absence of
menstrual cycle, dysmenorrhea, menorrhagia, amenorrhea, oligomenorrhea and premenstrual syndrome.
All these problems are signs of abnormal menstrual cycle. Present day drugs, available for treatment of
these problems, have one thing in common – they act through the hormonal regulation. This interference
in hormonal regulation by these drugs can result in overall hormonal imbalance, which invites other
associated health problems. Hence, the focus of the treatment of menstrual disorders and related
diseases is shifting from synthetic drugs to the drugs of natural origin. In our ancient ayurvedic system,
some plants or shrubs which have the medicinal properties are used to treat such type of gynecological
disorders. In this present review we attempt to give an overview of the causes of the menstrual disorders
and provide insights to natural drugs in the pipeline for such a treatment.

KEYWORDS: Menstruation, reproductive cycle, menstrual disorders, natural herbs.

AMIT PAGE *

Department of Pharmaceutics, SPTM NMIMS Shirpur-425405,

Dhule, Maharashtra, India.

Received on: 02-May-17

Revised and Accepted on: 04-Jan-18
DOI: http://dx.doi.org/10.22376/ijpbs.2018.9.1.p120-131

Creative commons version 4.0

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INTRODUCTION
Menstruation is the period of flow of blood from uterus cycle. The menstrual cycle starts from the first day of the
via cervix and out through the vagina. Menstruation is period and continues up to 28 days. In adults it ranges
the phase of a woman’s life between puberty and from 21 to 35 days and in case of teenagers it ranges
menopause. Menstrual periods are regulated monthly by from 21 to 45days.2
hormones.1 Uterine linings are renewed by menstrual
3
Phases of the menstrual cycle
The menstrual cycle can be divided into four main phases as shown in Figure 1.

Figure 1
Phases of menstrual cycle
Menstrual phase (from day 1 to 5), Follicular phase (from day 1 to 13),
Ovulation phase (day 14), Luteal phase (from day 15 to 28)

DIFFERENT TYPES OF MENSTRUAL DISORDERS

There are various disorders ranging from heavy painful
periods to no periods at all. These are
discussed in briefly in the following section:
Dysmenorrhea (Painful Cramps)
● It is severe, frequent cramping during the menstrual
flow. Pain occurs in lower abdomen and spreads to
lower back and thighs.
● Primary dysmenorrhea – in this case, the pain
occurs from contractions in the uterus during heavy
bleeding
● Secondary dysmenorrhea – it is due to
4
endometriosis or uterine fibroids
Menorrhagia (Heavy Bleeding)
● In this case, heavy bleeding occurs in women and
lasts for longer duration .i.e. more than 7 days.
● Women lose excessive amount of blood i.e. more
than 80 ml.
Amenorrhea (Absence of Menstruation)
● Primary amenorrhea – in this case, women do not
begin menstruation by the age of 16. They do not
show signs of sexual developments like breast
developments and growth of pubic hairs.
● Secondary amenorrhea – refers to periods that
were previously regular but stopped for 3 months.
Oligomenorrhea
● In this case, the menstrual cycle is infrequent,
greater than 35 days apart.
5
● It is very common in adolescence
Premenstrual syndrome (PMS)
● It is a set of physical, emotional and behavioral
symptoms, which occurs during the last week of
luteal phase.

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ROLE OF HORMONES IN MENSTRUAL CYCLE

Figure 2
Female reproductive hormones and target tissues
(Reproduced from https://basicmedicalkey.com/the-reproductive-systems, accessed on Dec, 2017)

In case of female reproductive system oestrogen and of ovarian follicle takes place at this time oestrogen is
progesterone play a vital role. Hypothalamus and secreted by the follicle. After ovulation, the corpus
anterior pituitary control the release of FSH and LH. luteum secretes the progesterone, with some oestrogen
Under the follicular stimulating hormone, the maturation as shown in Figure 2

Figure 3
Role of hormones in reproductive cycle
(Reproduced from http://asanafoods.com/wp-content/uploads/menstrual_periods.png?x30939, accessed on Feb, 2017)

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In reproductive cycle, the secretions of hormones are
regulated by negative feedback mechanism.
Hypothalamus secretes luteinizing hormone releasing
hormone (LHRS) which stimulates the anterior pituitary
to secrete the FSH and LH hormone. Within the ovary,
the primordial follicle undergoes maturity under the
follicular stimulating hormone. This follicle secretes the
oestrogen which results into ovulation. LH triggers the
ovulation and stimulates the development of the corpus
luteum which secretes the progesterone as shown in
Figure 3 and if the secretion of hormone from any of this
change, it results in menstrual disorders.
CAUSES OF PAINFUL MENSTRUATION CRAMPS
Hormonal imbalance
Prostaglandin is the hormone like substance which
triggers off the contraction in the uterine muscles which
results into pain. Higher the range of prostaglandin
6
higher the pain.
Uterine fibroids
It is the non cancerous growths of fibroids that develop
in the muscular wall of uterus as shown in Figure 4.
Their size vary from very tiny (a quarter of an inch) to
larger than a cantaloupe. The size and location of
fibroids can causes pain and heavy bleeding in some
7
women.

Figure 4
Uterine fibroids
(Reproduced from http://wwwMadisonradiologists.com/SvcUterineArteryEmbolization.htm, accessed on Feb, 2017)

Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease it refers to serious
complication of sexually transmitted diseases in women
which can lead to irreversible damage to uterus, ovaries,
fallopian tube, or other parts of female reproductive
system as shown in Figure 5. It causes cramps as well
8
as infertility in women.

Figure 5
Pelvic Inflammatory Diseases
(Reproduced from Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and
treatment.)

Cervical Stenosis Adenomyosis

In this case, the opening of cervix is quite small which In this condition, the endometrium breaks through the
results in increase pressure in uterus; causes pain muscle wall of uterus as shown in Figure 6. This causes
during menstruation. menstrual cramps as well as heavy periods.9

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Figure 6
Adenomyosis
(Reproduced from https://www.pinterest.com/dheaw/obgyne-images/adenomyosis.htm accessed on Feb, 2017)

Endometriosis
It is a painful condition, in which the tissues that are Herbal drugs for disorders
supposed to line the walls of uterus get implanted in The list of herbal drugs used for treating or managing
other parts of the body mainly in the fallopian tubes, the various menstrual disorders are given as in Table 1.
10
pelvis tissues and ovaries.

Table 1
List of herbal drugs for managing various menstrual disorders

S.N Name of drugs Family Parts Chief Chemical Uses Referen

o used constituents ce
11,12
1 AbromaaugustaLinn. Sterculiaceae Root, Abromine, Sterol, Metrorrhagia,
root bark Friedelin, Choline, dysmenorrhea ,
Betaine, β-Sitosterol, ammenorrhea,
Stigmasterol, Masilinic emmenogogue,
acid, α-Amyrin, regulate menstrual
Protocalechuic acid, flow
vanillic and caffeic
acids.
11,13
2 Acacia Mimosaceae Bark Tannins, Leucorrhea,
catechuLinn.fWilld. phlobatannins, menorrhagia
catechutannic acid,
flavonides- quercetin,
quercitrin.
13,14,15
3 Achilleamille folium Compositae, Whole Tannins, triterpenoids, heavy
Linn Asteraceae Herb flavonoid- apigenin, menstruation,
alkaloids- Achilleine, emmenagogue,
betoncine antihaemorrhagic
16,17
4 Alchemilla vulgaris Linn Rosaceae Root or Flavonoid glycosides, reduce
herb triterpenoides. menorrhagia
11,13
5 AristolochiabracteataRi Aristolochiace Leaf, aristolochic Amenorrhea,
tz. ae root acid and magnoflorine dysmenorrheal,
Oxytocic,
abortifacient,
emmenagogue
11,13,18
6 Artemisia vulgaris Linn. Compositae Leaves, cineol, thujone, Dysmenorrhea,
flowers, thujyl and citral, amenorrhea
seed, quercitin 3-O-
stem, glucoside, rutin and
root isorhamnetin 3-O-
glucoside
11,13
7 Asparagus Liliaceae Rhizome Steroid saponins, Leucorrhea,
adscendensRoxb asparagin, general debility
Sapogenins A and B
11,13,19
8 Asparagus Liliaceae Roots Shatavarins I–IV, Tonic,
racemosusWild. and dried root yields galactagogue,
leaves sitosterol; 4,6- used in
dihydroxy-2–O-(2 - gonorrheae,

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hydroxyisobutyl) leucorrhead,
benzaldehyde and threatened
undecanylcetanoate abortion
11,13,20
9 BambusabambosDruce Gramineae Stem, Bamboo oil, amino Dysmenorrhea,
leaf, root acids, concealing
cyanogenicglucoside- amenorrhea, post
taxiphyllin. partum bleeding,
emmenogogue
11,21
10 BombaxmalabricumDC Bombacaceae Flower bombamalones A–D, Menorrhogia,
powder bombamaloside, leucorrhea,
isohemigossypol‐1‐me metrorrhagia
thyl ester, oxytocic
2‐Omethylisohemigos
sylic acid lactone,
bombaxquinone B and
lacinilene C
11,13,22
11 BoswelliaserrataRoxb. Burseraceae Bark Oleo-gum resins, 3- Menorrhea,
gum keto-methylbeta- dysmenorrhea,
boswellic ester, emmenogogue
triterpenes of
oleanane, ursane and
euphane series
11,13,23
12 Buteamonosperma(La Fabaceae Flower flavonoids such as Gum–leucorrhea,
m.) Kurtze isobutrin, butrin, dysmenorrhea,
coreopsin, menorrhagia
monospermoside and
sulphurein; also
chalcones
11,13,24
13 Carica papaya Linn. Caricaceae Seed, Seeds contain Menstrual disorder
unfruitpu carpasemine and Dysmenorrhea,
lp alkaloid carpaine. concealing
amenorrhea
13,25
14 Cimicifugaracemosa Ranunculacea Dried triterpene glycosides premenstrual
Linn e root discomfort and
dysmenorrhoea
11,13,26
15 CichoriumintybusLinn. Compositae Root Flavonoides, Dysmenorrhea,
glucofructosans, Raw amenorrhea
chicory root contains
citric and tartaric
acids.
13,27.
16 Cinnamomumzeylanicu Lauraceae. Bark eugenol, For cramps of the
m cinnamaldehyde, stomach, root bark
tannin consisting of oil acts as a
tetra stimulant in
hydroxyflavandiols; amenorrhoea.
diterpenes,
cinnzeylanin and
cinnzeylanol.
11,13,28
17 CissusquadrangulaLinn Vitaceae Stem phytogenic steroid, Leucorrhea,
ketosteroids, irregular
sitosterol, menstruation,
alphaamyrin,
alpha-ampyrone and
tetracyclic
triterpenoids
11,13,29
18 Crocus sativusLinn. Iridaceae Stigma, urokinase and Dysmenorrhea,
styles of plasmin, crocin, amenorrhea,
flower picrocrocin, crocetin, difficult delivery,
carotenoids and Galactagogue
riboflavin and thiamine
11,13.
19 DaucuscarotaLinn.var. Umbelliferae Seeds apigenin, chypsin, In uterine pain,
luteolin; stimulant to uterus
flavonols including during
kaempferol, quercetin Parturition

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and various
glycosides, the
furanocoumarins,8-
methoxypsoralen and
5-methoxypsoralen
are found in the plant
11,13,30
20 ErythrinavariegataLinn. Papilionaceae Bark, beta-erythroidine Dysmenorrhea
Var. ; Fabaceae leaf hydrochloride and
dihydrobeta-
erythroidine
hydrochloride
13,31
21 Foeniculumvulgare Mill Apiaceae, Seeds Anethole, fenchone emmenagogue,
Umbelliferae and methylchavicol. galactagogue,
amenorrhoea
11,13,32
22 GloriosasuperbaLinn Liliaceae Tuber Alkaloids, colchicines Difficult delivery,
and colchicoside, uterine tonic
gloriosine.
11,13
23 GmelinaarboreaRobx. Verbenaceae Root, The heartwood Threatened
fruit contains lignans, abortion, post
arborone, partum bleeding
7-oxodihydrogmelinol, Leucorrhea
paulownin acetate and
epieudesmin;
metrans-
p-methoxycinnamate
and transp-
hydroxycinnamic acid
11,13
24 Gossypiumherbaceum Malvaceae Root Primary
Linn. bark amenorrhea,
dysmenorrhea,
post partum
bleedinga,
galactagogue
11,33
25 GrewiahirsutaVahl. Tiliaceae Root triacontan-1-ol, α- Leucorrhea,
amyrin, β-amyrin, β- threatened
sitosterol, lupenne, abortion,abortifaci
erythrodiol, betulin and ent,
tetratriacont-21-ol-12- galactagogue,
one, grewinol, emmenogogue
tetratricontane-22-ol-
13-one
13,34
26 Hypericumperforatum Hypericaceae Leaf Flavonoides, Menstrual cramps,
Linn xanthone, hyperfortin, menopausal
hypericin, nervousness
pseudohypericin, rutin,
quercetin, hyperoside,
methylhesperidin,
caffeic, chlorogenic, p-
coumaric, ferulic, p-
hydroxybenzoic and
vanillic acids.
11,13,35
27 Juniperuscommunis Pinaceae; Fruit, α-Thujene, α-Pinene, Leucorrhea
Linn. var Cupressacea volatile α-Fenchene,
e oil Terpinen-4-ol, α-
Terpineol
11,36
28 Leonuruscardiaca Linn Lamiaceae Fresh Flavonoids including used in absent or
/dried rutin and quercitrin, painful
leaves leonurin, betaine, menstruation,
caffeic acid premenstrual
tension,
menopausal
flushes
37
29 Ligusticum striatum Apiaceae Rhizome Ligustilide Menstrual cramps
s.

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11,13
30 MeliaazedarachLinn. Meliaceae Root, Bakayanin, lactone, Dysmenorrhea,
seed bakalactone. Leaves leucorrhea, post
marrow, gave quercitrin and labour pain in
bark rutin and uterus,
tetranortriterpenoids, amenorrhea,
salanin and vilasinin emmenogogue
11,13
31 MimusopselengiLinn. Sapotaceae Bark, a steroidal Leucorrhea,
flower, saponin, spinasterol, menorrhagia,
fruit taraxerol,D-mannitol, increases female
beta-sitosterol and Fertility
beta-sitosterol- D-
glycoside
11,13
32 Mucunaprurita Hook Fabaceae, Root tryptamine, Dysmenorrhea,
Papilionaceae alkylamines, amenorrhea,
steroids, flavonoids, emmenogogue
coumarins and
cardenolides
11,13
33 Nigella sativa Linn. Ranunculacea Seed Essential oil- nigellone Amenorrhea,
e and 2-methyl-4- dysmenorrhea,
isopropyl-pquinone lack of post
partum
lactation,
galactagogue,
abortifacient,
emmenogogue
11,38,39
34 Ocimumbasilicum Linn lamiaceae Leaf Estragole, methyl Stimulant, not use
eugenol, cis-ocimene, in pregnancy due
trans-ocimene,pinene to high amount of
and camphor estragole.
13,40
35 PetroselinumcrispumLi Apiaceae Leaf apiole and myristicin Uterine tonic,
nn emmenagogue,
sedative used for
PMS and
menopausal hot
flushes.
11
36 PhyllanthusemblicaLinn Euphorbiacea Fruit Phyllembin Leucorrhea,
e menorrhagia
11,13
37 PlumbagozeylanicaLin Plumbaginace Root Plumbagin is Concealing
n. ae bark abortifacient amenorrhea,
antiperiodic
11
38 RauwolfiaserpentinaBe Apocyanacea Root Ajmalicine (raubasine) Dysmenorrhea,
nthe ex e and rescinnamine are difficult delivery,
Kurz. also hypotensive and stimulate uterus
tranquilizer. Contraction
Deserpidine is
sedative.
11,13
39 RubiacordifoliaLinn. Rubiaceae Root anthraquinones Dysmenorrhea,
post partum
vaginal pain,
amenorrhea,
uterus and vagina
diseases
11,13
40 RutagraveolensLinn. Rutaceae Whole Flavonoids- quercetin; Dysmenorrhea, in
plant, coumarins include difficult delivery,
leaf bergapten, Amenorrhea,
daphnoretin, emmenogogue
isoimperatorin,
naphthoherniarin,
psoralen, pangelin,
rutamarin, rutarin,
scopoletin and
umbelliferone
11,13
41 SesamumindicumLinn. Pedaliaceae Seed Seed oil-sterols, a Amenorrhea
lignans, sesamin and dysmenorrhea,

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a nitrolactone, galactogogoue,
sesamolin. menorrhagia
emmenogogue
11,13,41
42 SaracaindicaLinn, Caesalpiniace Stem glucoside, n- Uterine tonic,
Saracaasoca(Roxb.) ae bark octacosanol, leucorrhoea,
De. Wilde. tannin, catechin, menstrual pain,
catechol, menorrhagia
epicatechi,epicatechol,
leucocyanidin,
leucopelargonidin,
procyanidin
derivatives, methyl-
and ethylcholesterol
derivatives.
11,13,42
43 Sesbaniagrandiflora(L.) Fabaceae Flower nonacosan-6-one and Leucorrhea
Poir kaempferol-3-
rutinoside
11,43
44 SolanumsurattenseBur Solanaceae Seed Fruits contain Promote
m. solasodine, conception,
campesterol and beta- dysmenorrhea,
sitosterol. amenorrhea
Solamargine,
solasodine, ursolic
acid.
11,13,44
45 SymplocosracemosaR Symplocacea Bark Bark-colloturine, Menorrhagia,
oxb e Harman (loturine) and abortions,
loturidine. Stem bark- aphrodisiac,
proanthocyanidin-3- potent
monoglucofuranosides Remedy for
of 7-O-methyl-and 4’- inflammation and
O-methyl- cleaning uterus,
leucopelargonidin. leucorrhea, for
Betulinic, oleanolic, ulcers in vagina
acetyl oleanolic and
ellagic
acids
45,46
46 Tanacetumparthenium Asteraceae Leaf Flavonoids like 6- Menstrual pain
Linn hydroxykaempferol
3,6-dimethyl ether, 6-
hydroxykaempferol
3,6,4′-trimethyl ether,
quercetagetin 3,6-
dimethyl ether,
quercetagetin 3,6,3′-
trimethyl ether,
quercetin, apigenin
11,13,47
47 TribulusterrestrisLinn. Zygophyllace Fruit and Flavonoids- rutin, Tonic,
ae root quercetin, aphrodisiac,
kaempferol, diseases of
kaempferol-3- genitourinary
glucoside system, uterine
and-rutinoside, and disorder after
tribuloside parturition,
abortion and
vaginal pain
13,48
48 ValerianaofficinalisLinn. Valerianaceae Leaves valepotriates (iridoid Menstrual pain,
molecules) and valeric sedative, intestinal
acid cramps.
13,49,50
49 Viburnum opulus Linn. Caprifoliaceae Bark essential oil, an uterine sedative in
var. amorphous, bitter functional
phenolic uterine disorders,
glucoside, esculetin uterine relaxants
and scopoletin
13,51,52
50 Viburnum Prunifolium Caprifoliaceae Bark Coumarin, scopoletin, Uterine sedative
Linn salicin is an analgesic.

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11,13,53
51 Viburnum foetidumWall Caprifoliaceae Leaf betulin, uvaol, β- Menorrhagia
sitosterol, betulinic
acid, ursolic acid, p-
hydroxy-benzoic acid,
4,4'-dihydroxy-a-
truxillic acid, E-p-
coumaric acid, Z-p-
coumaric acid,
phaseic acid,
protocatechuic acid,
daucosterol, 1-0-( 6-O-
α-L-rhamnopyranosyl-
β-D-glucopyranosyl)-
4-allylbenzene,and
apigenin 7-O-α-
rhamnopyranosy-β-D-
glucopyranoside
11,13,54
52 Vitexnegundo Verbenaceae Root Leaves-iridoid Dysmenorrhea
glycosides, isomeric
flavanones and
flavonoids, besides
casticin and the
glucosides, luteolin-7-
glucoside and alpha-
D-glucoside of a
tetrahydroxymonomet
hoxy flavones.
Dried root-
hentriacontane,
beta-sitosterol and its
aetat and stigmasterol
55,56
53 Zingiberofficinale Zingiberaceae Rhizome zingeberene, Relief from
Roscoe ginger curcumene, menstrual cramps
root farnesene, gingerols,
shogaols, paradols
and zingerone

CONCLUSION avoiding the menstrual cramps Livia is the latest device

For human beings food, cloth and shelter are the three
basics needs of life but now a days health is deemed as
the most important aspect in our lives. In recent years,
for maintaining a happy healthy life, all of us use natural
and traditional medicines which also have the efficacy to
treat the disease or disorders as that of the synthetic
drugs and are considered to be safer for human use.
Generally for treating to menstrual cramps; anti-
inflammatory drugs- naproxen, ibuprofen, ketoprofenetc
are used. Instead of that herbal drugs should be used to
avoid future side effect. There are some Indian
marketed products which are usefulin female health
issues. This includes Arjun Saar, Naari Kalyan Churna,
Pradrantakchurna, Chandra prabha Vati, Shatavari
Capsules, Aloe Vitals capsules, Kumari Saar,
Punarnava Mandur, Kanchnaar Guggul etc. For
introduced by Chen Nachum. It closes the pain gates by
stimulating the nerves & blocking the pain signals from
passing to brain. Thought it is free from any drugs, it is
not affordable to poor and developing countries and not
useful for treating the all menstrual disorders. From this,
it was concluded that herbal drugs are easily available &
affordable to all patients. They had negligible or no side
effects as compare to synthetic drugs. The present
study provides the review of few herbal drugs which are
helpful for different menstrual disorders by screening
through the various literatures available on different
herbal drugs.
CONFLICT OF INTEREST
Conflict of interest declared none.

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