CHAPTER – II

REVIEW
OF
LITERATURE

22
 CHAPTER – II

REVIEW OF LITERATURE

Review of literature is an important step in the development of the research study

and in broadening the understanding and developing an insight into the problem

area. It further help in developing the broad conceptual context, in which the

problem fits, methodology, instruction of tool, development of evaluative approach

and analysis of data.

The review of literature in this chapter is presented under the following headings,

1. Literature related to dysmenorrhoea

2. Literature related to the use of Mint Leaves.

3. Literature related to non pharmaco-logical measure for dysmenorrhoea

4. Literature related to effectiveness of mint Leaves on dysmenorrhea.

5. Literature related to Knowledge of mint leaves in Dysmenorrhea.

1. Literature Related to Dysmenorrhoea:

Sharefah Al-Matouq,et al,(2019) conducted a cross-sectional study using multistage cluster

sampling with probability proportional to size method was conducted on 763 twelfth grade

female public high-school students (aged 16–21 years). They used face-to-face interview with a

structured questionnaire to collect data on dysmenorrhea and presumed risk factors. Weight and

height of the students were measured using appropriate weight and height scales in a

standardized manner. The association between dysmenorrhea and potential risk factors was

assessed using multiple logistic regression. Results showed that prevalence of dysmenorrhea

was found to be 85.6% (95%CI: 83.1–88.1%). Of the participants with dysmenorrhea, 26%

visited a public or a private clinic for their pain and 4.1% were hospitalized for their menstrual

pain. Furthermore, 58.2% of students with dysmenorrhea missed at least one school day and

13.9% missed at least one exam. Age of menarche (p-value = 0.005), regularity and flow of the

23
 menstrual period (p-value = 0.025, p-value = 0.009; respectively), and drinking coffee (p-value = 

0.004) were significantly associated with dysmenorrhea in multivariable analysis

Hessah Al-Mutairi,et al, (2019) : conducted a cross-sectional study The study aimed to provide

an association between dysmenorrhoea and academic performance among university students in

Ethiopia. Further, the study attempts to determine the prevalence and associated risk factors of

dysmenorrhoea. Design and method Institution-based cross-sectional study was conducted from

1 April to 28 April 2019. A semistructured and pretested self-administered questionnaire was used

to collect data. Binary logistic regression analysis and one-way analysis of variance were

performed to model dysmenorrhoea and academic performance, respectively. Setting and

participants Ethiopia (2019: n=647 female university students). Outcomes of the study was primary

outcome is dysmenorrhoea, which has been defined as painful menses that prevents normal

activity and requires medication. The self-reported cumulative grade point average of students was

used as a proxy measure of academic performance, which is the secondary outcome.

Kwabena Acheampong et al (2019) conducted a cross-sectional study to examine

the predictors of dysmenorrhea, its effect, and coping mechanisms among girls in

selected schools of Shai Osudoku District, Ghana, with the objective of Prevalence

and Predictors of Dysmenorrhea, Its Effect, and Coping Mechanisms among

Adolescents. A self-administered questionnaire was used to collect data from the

sample. Pearson chi-square test and multiple logistic regression analysis were used

to assess the association between exposure variables and the outcome variable. The

prevalence of dysmenorrhea was 68.1% (95% CI, 65.0–72.0) with one-third

recounting their pain as severe. The pain during menstruation negatively influences

the daily physical activities (22.5%), school attendance (6.9%), concentration during

classes‟ hours (27.9%), and academic performance (31.1%) of the respondents.

Finally, a significant association between irregular menstrual cycle (p<0.001), not lived

with their parent (p<0.004), and self-reported dysmenorrhea was found.

24
 A.E. Arafa et al.,(2018) conducted a cross sectional study on prevalence and

patterns of dysmenorrhea and premenstrual syndrome among 4122 girls

(12–25 years) with the objective to investigate the prevalence, and

patterns of dysmenorrhea and premenstrual syndrome (PMS) amongst girls in

Beni- Suef, Egypt. A structured questionnaire was used and a team of data

interviewed collectors the girls. High rates of dysmenorrhea (92%) and PMS

(86.3%) was seeing among girls. A solid association between dysmenorrhea

and PMS was detected. Backaches, generalized aching and nervousness

were the most commonly reported symptoms 63.3%, 62.4%

and 43.5%,respectively. More than half of girls who experienced dysmenorrhea

reported drinking herbal fluids and taking analgesics to alleviate their symptoms

Girls resorted mostly to family members to get information about menstruation.

Vineeta Ghanghoriya et al., (2018)conducted a cross sectional study with

the objective of need to evaluate the, prevalence of dysmenorrhea and its

effect on daily routine activities and quality of life of nursing students. The

sample size of the study was 100 students with mean age of participants was

19-28 year. Prevalence of dysmenorrhea was 79% of these 3% severe, 18%

moderate and 58% were mild grade. Out of 79/100 participants of

dysmenorrhea 63.29% missed individual classes or their study affected,

31.64% had to take leave from work place and 51.89% reported social

withdrawal during menstruation due to dysmenorrhoea.7.59% take medicines

for pain relief.

25
Vineeta Ghanghoriya et al., (2018)conducted a cross sectional study with

the objective of need to evaluate the, prevalence of dysmenorrhea and its

effect on daily routine activities and quality of life of nursing students. The

sample size of the study was 100 students with mean age of participants was

19-28 year. Prevalence of dysmenorrhea was 79% of these 3% severe, 18%

moderate and 58% were mild grade. Out of 79/100 participants of

dysmenorrhea 63.29% missed individual classes or their study affected,

31.64% had to take leave from work place and 51.89% reported social

withdrawal during menstruation due to dysmenorrhoea.7.59% take medicines

for pain relief.

Teshager Aklilu Yesuf et al, (2018) conducted a cross-sectional study

among 246 Mekelle University health science students with the objective to

investigate impacts of dysmenorrhea, factors associated with it and its self-

management used by health science students. Stratified random sampling

technique was used to select the sample and data was collected using self-

administered semi structured questionnaire. The prevalence of dysmenorrhea

was 71.8%. Participants who had long menstrual cycle interval, long menses

flows, and positive family history and who were alcohol users were more likely

to had dysmenorrhea. Participants reported that 28.6% feel depressed, 16.2%

are absent from class, and 22.9% had poor personal relationship due to

dysmenorrhea and 78.2% of them practiced self-medication.

Subasinghe AK et al, (2016) conducted a study with the objective to

evaluate the Prevalence and severity of dysmenorrhea and severity of

dysmenorrhea in women aged 16−25 years in Australia. Participants were

recruited via targeted Facebook advertising and asked to complete an online

questionnaire covering medications, menstruation and lifestyle-related

themes. A follow-up questionnaire on dysmenorrhea was also administered.

The prevalence of dysmenorrhea was 88% (n = 247, mean age 21.5

years, SD 2.6). Only 34% of participants reported consulting a healthcare

provider about their pain, whereas 86% consulted other sources. Pain

medication was used by 58% of the participants. Dysmenorrhea was

associated with interference with daily activities. Dysmenorrhea is highly

prevalent among these women, with most indicating moderate to severe pain

and a significant adverse impact on daily activities. Most women did not

obtain information about dysmenorrhea from healthcare providers, indicating

the need for general practitioners to provide accurate information about

dysmenorrhea to young females.

Nahal Habibi et al. (2014) conducted a cross sectional study with the

objective on Prevalence of Primary Dysmenorrhea to determine the Factors

Associated with its intensity among 311 Undergraduate Students in Iran. In

this study, prevalence of primary dysmenorrhea was 89.1%, with 30.3%,

36.5%, and 33.2% of the respondents reporting mild, moderate, and severe

intensity pain, respectively. There was significant association between age

(r¼ _0.233, p < .01) and mothers‟ years of formal education (r ¼ 0.143, p < .

05) with the intensity of primary dysmenorrhea. Participants who lived at

home with their families reported higher intensity of primary dysmenorrhea

compared to residents of dormitories (chi squared ¼ 16.8, p < .01). More

than
half of the participants (58.8%) reported that they had a history of dysmenorrhea in

their intensity of primary dysmenorrhea, association between length of period and

age of menarche with the intensity of primary dysmenorrhea were not significant (p

> .05). Meanwhile, family history of dysmenorrhea (b ¼ 0.294, p < .05) was the

strongest factor that contributed to the intensity of primary dysmenorrhea; the

weakest factor was the interval between periods (b ¼ 0.168, p < .05)

Unsal A., et. al., (2016) conducted a cross sectional study to evaluate the

prevalence of dysmenorrhea and determine its effect on health-related quality

of life among 623 female university students. The severity of dysmenorrhea

was determined with a 10-point visual analog scale. Chi-square test,

Student’s ‘t’ test, and logistic regression and variance analyses (ANOVA)

were used for statistical analyses. The average age of the study group was

20.8 +/- 1.8 years (range 17-30). Prevalence of dysmenorrhea was found to

be 72.7% and was significantly higher in coffee consumers, females with

menstrual bleeding duration > or =7 days, and those who had a positive

family history of dysmenorrhea when compared to the others. By multivariate

analysis, coffee consumption

Zafettas.N., (2015) mentioned that prostaglandin seems to be intimately involved

in primary dysmenorrhea although it is difficult to understand the underlying cause

for their excessive secretion. Abnormalities in plasma steroid level could account

for the disturbance especially significantly elevated plasma level of estradiol in the

luteal phase. Plasma levels of vasopressin appears to be higher in women with

dysmenorrhea suggesting a possible etiological role in the uterine prostaglandin

synthesis (OR 2.084), menstrual bleeding duration > or =7 days (OR 1.590),
and positive family history of dysmenorrhea (OR 3.043) were important risk

factors for dysmenorrhea. Except for social functioning, role-emotional, and

mental health domains, the SF-36 points received from the other domains

were higher in females with dysmenorrhea (for each one P < 0.05g university

female students.

Polat .A, et al., (2015) conducted a study to determine the prevalence of primary

dysmenorrhea and attitude towards dysmenorrhea. A total of 1,266 female

students were surveyed by doctors. Mean age of the students was 21.02 ± 2.13

years, mean age of menarche was 13.3 ± 1.4 years and frequency of menstruation

was found to be 32.58 ± 19.8 days. The study concluded that 45.35% were found

to suffer from pain in each menstruation, 42.5% in some menstruation and 12.2%

in none, 66.9% were established to take analgesic drugs.

Olabisi M.L., et. al., (2017) conducted a study to assess about 409 students for

dysmenorrhea and to identify the prevalence of dysmenorrhea. The prevalence of

dysmenorrhea was 53.3% and most of them experience pain during the onset of

menses, and about half of them reported that dysmenorrhea interfere the daily

activity. This study suggested the health care providers to screen routinely and

offer treatment for dysmenorrhea. Singh A., et al., (2008) conducted a cross

sectional descriptive study among 107 female medical students to evaluate the

menstrual problem and its severity. The verbal multi dimensional scoring system

was used. The mean age of subjects at menarche was 12.5 (±1.52) years, with a

range of 10-15 years. The prevalence of dysmenorrhea was 73.83 %;

approximately 4.67% of subjects had severe dysmenorrhea. The average duration

between two periods and the duration of menstrual flow were 28.34 (±7.54) days

and 4.5 (±2.45) days respectively. Among female medical students who reported

dysmenorrhea; 31.67 % and 8.68 % were frequently missing college & classes

respectively. Dysmenorrhea is highly prevalent among female medical students, it

is related to college or class absenteeism, Most of the participants do not seek

medical advice and self treat themselves with prostaglandin inhibitors; like

Ibuprofen.

Sharma P. (2018) conducted a study to identify the problem related to

menstruation among adolescent girls and their effect on daily routine. Among 198

adolescent girls (35.9 %) are in the age group of 13-15 years. Dysmenorrhea

(67.2%) was the commonest problem. About 60 % girls daily routine was affected

due to dysmenorrhea, 17.24 % had missed classes and abstain from work.

Rostami M., (2017) estimated that the correlation between the prevalence and

severity of dysmenorrhea and relevant biological and social variables (p < 0.05)

among 660 high school girls and found 14.4 % of participants had dysmenorrhea

and found no improvement after the use of analgesics. There was a significant

correlation between age at menarche and severity of dysmenorrhea and duration

of menstrual flow. It was identified that early age of menarche was related to

severity of dysmenorrhea.

Johnson J., (2005) conducted a study to measure the level of knowledge among

adolescent girls regarding the effectiveness of treatment for dysmenorrhea. A total

of 182 adolescent girls between 14-18 years were selected to assess the

prevalence of dysmenorrhea, the morbidity associated with dysmenorrhea, and the

level of knowledge regarding available treatment. Among the group 72.7%

reported ‘pain or discomfort” during their period, 58.9% reported decreased

activity, and 45.6% reported school or work absenteeism, of the dysmenorrheic

sample, only 15.5% had used medications. The prevalence of school and work

absenteeism provides evidence for the continuing importance of dysmenorrhea as

a public health problem of this age group. Appropriate therapeutic options for

dysmenorrhea should be a part of routine health care visits for adolescent women.

Babi C., et al., (2010) conducted a study to investigate the prevalence of primary

dysmenorrhea and its relationship with menstrual factors and dietary habits by

survey method in educational institute, Italy, among 356 females with the age

group of 10-16 years, through interview method menstrual history, dietary habits

and information about pain were collected. It shows the association of dietary

habits on dysmenorrhea due to dietary changes on dysmenorrhea.

Banikarim., et al, (2010) conducted a study to find the effective treatment

modalities for dysmenorrhea and the result shows that among 85% of adolescents

who had 26 dysmenorrhea treatments taken for dysmenorrhea included rest (58%)

medications (52%) heating pad (26%) tea (20%) exercise (15%) and herbs (7%)

14% consulted physician and 49% saw a school nurse for help. Menstrual pain

was significantly associated with school absenteeism and decreased academic

performance (P<O.01)
Ortiz, (2010) conducted a study to evaluate the prevalence, impact and

treatment of primary dysmenorrhoea among Mexican University students. A

multiple choice questionnaire was administered to 1539 students in six

university programs; medicine, nursing, nutrition, dentistry, pharmacy and

psychology. The data analyzed revealed that the mean  SD age of the

women was 20.4  2.0 years; the mean age of menarche was 12.3  1.5

years. 64% of the women experienced dysmenorrhoea. 36.1% of women had

mild dysmenorrhoea, 43.8% experienced moderate dymenorrhoea and

20.1% experienced severe dysmenorrhoea. Nursing students showed a

significantly higher intensity of pain than that of medicine and dentistry

students (p<0.05). 65% of the women reported that dysmenorrhoea limited

their daily activities, and 42.1% reported school absenteeism of those who

experienced dysmenorrhoea, 25.9% consulted a physician, and 61.7%

practiced self-medications of those women using prescribed medications,

18.4% reported complete remission of their symptoms, while 78.1% reported

little to moderate alleviation, and 3.6% reported no effect on their menstrual

distress.
Okusanya, B.O, (2009) conducted a prospective questionnaire based

study on prevalence of dysmenorrhoea and associated factors among

undergraduates in a Nigerian University. Cluster sampling technique

was used. The prevalence of dysmenorrhoea was 76.3%. The mean

age at menarche was 13.8 years. Having a sister with dysmenorrhoea

had no significant influence on dysmenorrhoea (P=0.76).

Amitha Singh, Dukhukira, et.al, (2008) conducted a cross sectional

descriptive study to evaluate the prevalence and severity of

dysmenorrhea among 107 medical students residing at SS medical

college, Rewa. All participants were given a questionnaire to complete

and a verbal multi dimensional scoring system was used. The mean

age of subjects at menarche was 12.5  1.52 years with a range of

10-15 years.73.83% of them had dysmenorrhoea. Approximately

4.67% of subjects had severe dysmenorrhoea. The average duration

between two periods and the duration of menstrual flow were

28.347.54 days and 4.52.45 days respectively. Prevalence of

other menstrual disorders like inequality, prolonged menstrual

bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%,

23.36% and 3.73% respectively. 31.67% of students were frequently

missing college due to discomfort. Maximum participants do not seek

medical advice and self treat themselves with prostaglandin inhibitors

like ibuprofen.
 Sr. Dr.Chistina John, (2007) conducted a cross sectional study

to assess the common problems related to menstruation faced by

adolescent girls. This study was conducted in Chenganoor among

501 school girls of age group between 10-15 years. Out of 338

students, 237(70.1%) had various menstrual problems, the

commonest being dysmenorrhoea and premenstrual syndromes

(88.8%). School absenteeism due to menstrual problems was

detected up to 23%. The maximum number of dysmenorrhoea is seen

in the age group of 14 yrs, (70.9%) and this is statistically significant

(p = 0.02). fussy eating habits was revealed to have statistically

significant connection with late attainment of menarche as detected

by low BMI.

V.Patel, V.Tanksale, et.al, (2006) conducted a cross sectional study

to describe prevalence of dysmenorrhoea in Goa. 2494 women aged

18-45 years were selected. A Standardized questionairre was used as

a tool for collecting the data. The research finding revealed that755

participants experienced moderate to severe dysmenorrhoea. There

was a significant association between severity of pain, impact and the

onset of pain. (33.4%, 95%, CI 31.4-35.4).

 Connell, (2006) conducted a cross sectional study to describe

both non- pharmacological treatment used by adolescents with

dysmenorrhoea at NewYork. 76 adolescents, aged 19 years or

younger with moderate and severe primary dysmenorrhoea were

selected. All used nonpharmacological remedies such as sleeping

and heat application. Nearly all used atleast one medication, 31%

reported using two and 15% used three medications.42% had

moderate dysmenorrhoea, 58% had severe dysmenorrhoea

associated with nausea is 55% and vomiting is 25%.46% reported

missing schools one or more days monthly . Nearly 80% used at least

one medication.

Romana Dmitrovic, Peter, et.al, (2003) conducted a study on

severity of symptoms in primary dysmenorrhoea at university hospital.

One hundred and fifty four women were examined with colour Doppler

ultrasound. 50 samples were placed in the control group, 60 in the

mild and 44 in the severe dysmenorrhoea sub group. The investigator

calculated resistance index in uterine arteries in these women on the

first day of the cycle, in the follicular (days 9-12) and the luteal (days

20-23) phase of the cycle and used analysis of variance for comparing

results. The rate of visualization was for uterine and arcuate arteries,

radial arteries and spiral arteries was 100%, 44%, and 62%

respectively. A significant difference in Doppler index values among

the mild and severe dysmenorrheic group was observed in the luteal

phase for the arcuate artery and in all the three measurement periods
for the radial and spiral arteries.
 (Strinc.T, et.al., 2003) conducted a study in Croatia to examine the prevalence of

dysmenorrhoea in female adolescents and the influence of anthropological

characteristics and lifestyle factors on menstrual pain. The investigator selected

two hundred and ninety seven girls from several elementary and secondary

schools and interviewed them on the presence of the menstrual pain their age,

height and weight, menarcheal age, menstrual cycles quality, smoking and sexual

activity. 164(55%) subjects complainted of dysmenorrhoea while 133(45%) did

not experience dysmenorrhoea. 22% of the adolescents missed schools while

96% of subjects had the habit of taking pills.

2. LITERATURE RELATED TO USE OF MINT LEAVES

(PEPPER MINT)

Pepper mint is an excellent source of magnesium, vitamin C and vitamin A, the latter notably

through its concentration of carotenoids, including beta-carotene.

Both Vitamin C of carotenoids seems to play a role in decreasing colorectal cancer risk. Vitamin C,

the main water-soluble antioxidant in the body is needed to decrease the levels of free radicals

that can cause damage to cells. Some studies have shown a link between increased vitamin C

intake and decreased risk for Colon cancer, possibly by as much as 40%, while other studies have

shown that vitamin C intake can help to decrease the incidence of colon tumors. Beta-carotene

and carotenoids have been shown in some studies to decrease the risk of developing both colon

cancer and rectal cancer. Carotenoids have also been shown to increase cell differentiation and

protect cells against carcinogenic chemicals that could damage DNA. Vitamin A which is

structurally similar to Beta-carotene may help to decrease risk by preventing excessive colon cell

proliferation and tumor formation.

 In addition to all of the above healing properties, peppermint emerged from our food ranking

system as a very good source of Dietary fiber, Folate, Iron, Magnesium and Calcium, Vitamin B2

(based on its few calories and high nutrient density). This high nutrient density and low calorie

status qualified peppermint as a good source of Omega-3 fatty acids, Vitamins B2, Potassium and

Copper.

Peppermint is recognized for its soothing action on the stomach and intestine. It works on

an antispasmodic, which helps to relieve nausea and other stomach problems. Pepper mint

relaxes the muscles of the digestive tract and stimulates bile flow, which facilitates more

constituent of pepper mint worth as a natural antifungal and antibacterial used for menstrual

cramps, irritable bowel syndrome, and itch.

A study was conducted on pharmacological properties of the menthol extract from menthe

piperita. The study analyses the pharmacological activity in vivo and in vitro models of methanol

extract obtained from the leaves. This extract launched toxiciter, but exhibited an analgesic effect

in, model of chemical and mechanical stimulation suggesting the inclusion of a peripheral

analgesic response.

Peppermint (Mentha piperita L.) is one of the most widely consumed single ingredient

herbal teas, or tisanes. Peppermint tea, brewed from the plant leaves, and the essential oil of

peppermint are used in traditional medicines. Evidence-based research regarding the bioactivity of

this herb is reviewed. The phenolic constituents of the leaves include rosmarinic acid and several

flavonoids, primarily eriocitrin, luteolin and hesperidin. The main volatile components of the

essential oil are menthol and menthone. In vitro, peppermint has significant antimicrobial and

antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential.

Throughout history different species of mint have been used across the globe for their varying

properties, both medicinal and culinary. Today, the commercial sales of mints are expanding each

year--and at the end of a large meal after-dinner mints are frequently served. Peppermint

(Mentha piperita) is usually taken after a meal for its ability to reduce indigestion and colonic

spasms by reducing the gastro colic reflex. It is a naturally occurring hybrid cross between

water mint (M. aquatic) and spearmint (M. spicata) and is best known for its role as a popular
flavoring agent.

Sharmila (2015) A study was conducted to assess the effectiveness of mint leaves paste on

dysmenorrhea among adolescent girls at selected schools kanyakumari district, An experimental

design was adopted and purposive sampling method was used based on the selection criteria 34

adolescent girls in experimental group and 16 adolescent girls in control group. The data were

collected using self administered questionnaire the obtained mean -test and post-test regarding

dysmenorrhea score was 15.3, the obtained t-value t = 9.89 (p < cant.0.01)

wassigni LathaPetal. (2015) A study was conducted to assess the effectiveness of menthe

spicata paste on dysmenorrhea among the adolescent girls in Narayana college of nursing,

Nellore a pre experimental design was adopted and purposive sampling method was adopted on

60 adolescent girls. Pre-test was conducted for60 girls by using study tool. Intervention was given

per each sample for 4 days before menstruation later post-test was conducted by using the same

study tool. The results indicated that the pre-test mean of pain was 0.1198 and standard deviation

7.1749whereas the post-test mean was 0.064 and standard deviation 0.3769.The study revealed

that the menthe spicata to these adolescent girls as itpaste has great benefit reduced these

verity of pain.

Dinesan C., (2010) explained in medicinal uses for mint leaves as, mint leaves has the potentiality

to reduce the post operative nausea. It can be also used to relieve nausea caused by motion

sickness or menstrual cramps by relaxing the smooth muscles of abdominal cavity. Mint can

relieve muscle aches and pain by replicating the same desensitizing action on the nerves which

detect pain. Heartburn can be relieved through its antispasmodic activity and increasing the flow of

digestive fluids and used as remedy for bad breath. It has antispasmodic activity and sedative

properties which can ease tension during pain and muscle aches.
Sonmez G.T., (2010) conducted a study to assess the effect of mint extract on muscle pain and

blood lactate levels among 16 physical education students. The group selected for the intervention

was given the mint extract of 5ml and the effect on the muscle pain and blood lactate levels was

recorded. The findings show a considerable reduction in the muscle pain and blood lactate levels

(P < 0.01) levels.

Brncik C., (2007) evaluated the use of peppermint to relieve irritable bowel syndrome, in Italy.

Peppermint oil capsules were administered to the patients suffered from irritable bowel syndrome.

Seventy five percent of patients who took peppermint oil capsules for four weeks showed a major

reduction in symptoms as compared with only 38% of patients who took a placebo pill. Peppermint

oil’s effect of blocking calcium channels thus relaxing the smooth muscles of the intestinal walls

may be the reason for the efficacy against Irritable bowel syndrome symptoms.

3. Literature Related to Non Pharmacological Measure for Dysmenorrhoea:

Catherine Samba Conney et al, (2019) conducted a cross-sectional study with the

objective of effectiveness of complementary therapies on dysmenorrhea among478

female students attending Archbishop Porter Girl‟s Secondary School and Mporhor

Senior High School. 79.3% of the students used some form of CAM to manage

dysmenorrhea. Of CAM users, 32% were utilizing mind-body medicine such as

endurance and relaxation, 31% used the whole and alternative medicine such as the

hot water therapy, 15% used biological-based medicine such as herbal products, and

22% used the manipulative and body-based systems such as exercises. Various CAM

methods and products were perceived to be effective in relieving the pain and

discomfort associated with dysmenorrhea in about 90% of the participants who used

them. Significant associations were reported for pain severity and quality of life (QoL).
Mike Armour et al, (2019) conducted a study with the objective to determine the
32
effectiveness of participant lead self-care techniques and lifestyle interventions on

menstrual pain intensity, duration, and analgesic usage in women with primary

dysmenorrhea among 2302 women. A Preferred reporting Item for

Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in

selecting samples and data collection by structured questionnaire. All interventions

showed a reduction in menstrual pain symptoms; exercise (g = 2.16, 95% CI 0.97 to

3.35) showed the largest effect size, with heat (g = 0.73, 95% CI 0.06 to 1.40) and

acupressure (g = 0.56, 95% CI 0.10 to 1.03) showing more moderate effect sizes.

Exercise (g = 0.48, 95% CI 0.12 to 0.83) and heat (g = 0.48, 95% CI 0.10 to 0.87),

were more effective than analgesics in reducing pain intensity, whereas acupressure

was significantly less effective (g = − 0.76, 95% CI -1.37 to − 0.15).

Arcury TA (2017) conducted a study with the objective of Conventional and

Complementary Therapy Use among 200 Mexican Farmworkers in North Carolina.

Data collection was done by interview method. Most of the farmworkers had been

treated by a conventional provider (63.0%). One-in-five had been treated by any

traditional healer; 19.5% had been treated by a sobador, 4.5% by a curandero, 2.0%

by an herbalist, and 2.0% by a spiritual healer. Conventional providers (69.8%) and

sobadores (84.6%) most often treated acute conditions; 62.5% had used an herb,

46.0% a vitamin, 57.0% an over-the-counter medicine, and 13.5% a home remedy.

Participants used various self-care practices, including music (36.5%), sleep (18.0%),

prayer for health (15.0%), and social media (14.0%). Education was inversely

associated with the use of a traditional healer and herbs; treatment by a conventional

health care provider was positively associated with using a traditional healer and

vitamins.
Carole Fisher et al, (2016) conducted a cross- sectional survey with the objective to

assess the prevalence of cyclic premenstrual pain and discomfort and to detail the pattern

of complementary and alternative (CAM) use adopted by women for the treatment of

these symptoms. Samples were selected by using random sampling techniques. PMS

was most prevalent at 41.2 % whilst irregular bleeding (22.2 %), heavy periods (29.8 %)

and severe period pain (24.1 %) were reported at lower levels. Women with endometriosis

were more likely than non-sufferers to have consulted with a massage therapist or

acupuncturist and to have used vitamins/minerals, yoga/meditation or Chinese medicines

(p < 0.05). PMS sufferers were more likely to consult with an osteopath, massage

therapist, naturopath/herbalist or alternative health practitioner and to have used all forms

of CAM therapies except Chinese medicines than women who had infrequent PMS (all p 

< 0.05). Women with irregular periods did not have different patterns of CAM use from

non- sufferers and those with heavy periods did not favour any form of CAM but were less

likely to visit a massage therapist or use yoga/meditation than non- sufferers (p < 0.05).

Tyseer M. F. Marzouk et al, (2013) conducted a study with the objective to

investigate the effect of aromatherapy massage on a group of 95 nursing

students who are suffering of primary dysmenorrhea. A randomized blind

clinical trial of crossover design was used and the data was collected by semi-

structured questionnaire and visual analog scale. These results suggest that

aromatherapy is effective in alleviating menstrual pain, its duration and

excessive menstrual bleeding. Aromatherapy can be provided as a non-

pharmacological pain relief measure and as a part of nursing care given to

girls suffering of dysmenorrhea, or excessive menstrual bleeding.

33
 Maryam Kabirian, Zahra Abedian, (2011) conducted a study to

determine the effect of evidence based education on dysmenorrhoea girl’s

self care behaviours and the severity of primary dysmenorrhoea. The

study was conducted at Ferdowsi University among 100 girls. The

samples were divided into two groups, 50 each in experimental and

control group. The experimental group received evidence based

education. The results showed that there was significant reduction in pain

score at the first (- 0.6  1.7 VS 1.1  2.1, p = 0.000) and second ( -1.9 

1.5 VS 0.1  1.6 p=0.000) menstrual period after intervention in the

experimental group compared with the girls in the control group. There was

a significant difference in self care behaviours between the experimental

and control group at the second menstrual period after intervention (105.8

 8.9 VS 80.4  11.3,) at P=0.021 level. The study concluded that health

education system can use evidence based education in order to promote

self management behaviours among primary dysmenorrhoeic girls.

Zhongguo Zhen Jiu, (2010) conducted a study in China to observe the efficacy of

herbal moxibustion on primary dysmenorrhoea. One hundred and two cases were

randomized into isolated herbal moxibustion group and western medication group, 51

cases in each one. The cases in experimental group were treated with isolated herbal

moxibustion on Shenque (CV8) and in western medication group, analgesic was given.

The results showed that in isolated herbal moxibustion group, 17 cases were cured, and

4 cases failed. The total effective rate was 92.2%. In western medication group, 7 cases

were cured and 12 cases failed. The total effective rate was 76.5%. The comparison of

the total effective rates between two groups indicated significant difference in statistics (P

< 0.01), that proves that isolated herbal moxibustion is effective.

Giti Ozgoli (2009) conducted a Comparative study with the objective To compare the

effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary

dysmenorrhea among 180 students. There were not significant differences between

groups in baseline characteristics, p > 0.05. At the end of treatment, severity of

dysmenorrhea decreased in all groups and no differences were found between the

groups in severity of dysmenorrhea, pain relief, or satisfaction with the treatment, p >

0.05. No severe side effects occurred.

Nahid, shahdan, (2009) conducted a double-blind, placebo-controlled study to assess

the effectiveness of Iranian herbal drug on primary dysmenorrhea among 180 students at

Isfahan university. The participants were divided into three groups. Group I received

herbal drug extract three times a day for three days for three cycles. Group II received

mefenamic acid capsules group III received placebo tablets. A visual analogue pain scale

was used to assess the pain. The results showed that after intervention 20(35%) had no

pain in groupI, while in groupII 10(18%) had no pain and in groupIII 2(3.9%) had no

pain.the mean pain score of Group I, II, and III were 0.5, 6, and 6 at the end of 3 months

which shows that herbal medicine was effective in reducing the severity of

dysmennorhoea.

Yang. H, et.al., (2008) conducted a study to assess the effectiveness of acupuncture on

primary dysmenorrhoea at Beijing University. 60 students were selected and were

randomly assigned to experimental and control group.then results showed that

acupuncture was effective in reducing the pain. (Placebo acupuncture WMD = -0.57 and

95% CI = - 0.76 – 0.38; standard control; WMD = - 19 and 95% CI = - 0.37 – 0.01;

visitation control WMD = - 1.04 and 95% CI = - 7.28 – 0.80).

Eun – Mi Jun et al, (2007) conducted a non- randomized controlled trial with the

objective of effectiveness of acupuncture on dysmenorrhea and skin temperature

changes among college students. The experimental group received acupressure

treatment within the first 8 hours of menstruation, and severity of dysmenorrhea and

skin temperature changes was assessed prior to 30 min, 1, 2, and 3 hours following

treatment. There was a significant difference in severity of dysmenorrhea between the

two groups immediately after (F=18.50, p=0.000) and for up to 2 h (F=8.04, p=0.032)

post treatment indicating that SP6 acupressure relieves dysmenorrhea primarily by

temperature elevation in the CV2 pathway.

Lakshmi, (2007) conducted a pre-experimental study on effectiveness of pelvic rocking

exercise upon dysmenorrhea among school girls in Erode District. Thirty one school girls

with dysmenorrhoea were selected by the simple random method. Majority of school girls

(61.3%) had attained menarche between 10-12 years, 83.9% had duration of 4-5 days of

menstrual cycle. 71% did not practice any regular exercise and 83.9% were watching TV

and sleeping as a remedy for dysmenorrhoea. Dysmenorrhoea was measured using

Visual Analog Scale. There was significant reduction in dysmenorrhoea score at the level

of p<0.05 ( t = 8.26).

Sun-Hee Han(2006)conducted an experimental study with the objective to explore the

effect of aromatherapy on menstrual cramps and symptoms of dysmenorrhea among

67 female college students. 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 = – 2.48, 95% CI: –3.68 to –1.29, p < 0.001; second day:

Beta = –1.97, 95% CI: –3.66 to –0.29, p = 0.02) and the severity of
35
dysmenorrhea (first day: Beta =0.31, 95% CI: 0.05 to 0.57, p = 0.02; second day:

Beta = 0.33, 95% CI: 0.10 to 0.56, p = 0.006) than that found in the other two groups.

4. Literature Related to Effectiveness of Mint leaves In Dysmennorhea:

Wijayanthi et al (2020) conducted a quasi-experimental study with a non-

randomized control group pretest posttest design. Bourbaris pain numerical scale to measure the

menstrual pain scale before and after the intervention was carried out in 15 respondents in the

intervention group and 15 respondents in the control group (without treatment). Data

analysis employed the Shapiro Wilk normality test, the effectiveness of the intervention group

before and after treatment with the Wilcoxon test, the difference between the two groups with

the Mann-Whitney Test. Results: There was a difference in the level of menstrual pain before and

after the intervention by giving mint extract with z value = -3,557 and a significance value of 0,000

(p <0.05). Administration of mint leaf extract was more effective in reducing menstrual pain

compared to the control group with z value = -4,472 and significance value 0,000 (p <0.05)

Sana Sultana et al (2020) conducted a study which was aimed to explore the impact of ginger

and peppermint in adolescents suffering with primary dysmenorrhea. For that purpose, 150

adolescents, aged 13-22 years, with regular menstruation suffering with moderate to severe

dysmenorrhea (scoring 3-5 on pain scale) and preferably not taking any medication were enrolled

and randomly divided into three groups i.e. control, ginger and peppermint. Baseline data was

collected with help of self-administered questionnaire. To determine comparative analgesic effect

of ginger and peppermint, capsules were formulated, and each group received total number of 15

capsules in a month (3 capsules/day for consecutive 5 days). Compared with baseline data, ginger

was found more effectual than peppermint in releasing dysmenorrhea i.e. observed scoring in

case of ginger was reduced from mean value of 4.13 ± 0.63 to 2.10 ± 1.52 (p = 0.001). Similarly,

ginger intervention exhibited gradual betterment of 10% in symptoms of dysmenorrhea but also
affected blood pressure positively (p < 0.05). However, blood hemoglobin and serum calcium

levels acted as independent variables in ginger and peppermint groups (p > 0.05), not affected by

any mode of intervention. It was concluded that ginger exhibited superior impact in lowering pain

as compared to peppermint and control groups.

Gurinderpal Kaur et al.(2017) The study is aimed to assess the effectiveness of mint leaves

paste on dysmenorrhea among nursing students A quantitative research approach and pre

experimental one group pre-test post-test design was used and the research setting was Sri Guru

Ram Das College of Nursing, Vallah, Sri Amritsar. Total 60 nursing students were selected with

Simple Random Sampling Technique. Numeric Pain Rating Scale was used to assess the

effectiveness of mint leaves paste on dysmenorrhea. The study revealed that majority 55% of

nursing students had severe pain during dysmenorrhea in Pre-test whereas majority 57% of

nursing students had mild pain during dysmenorrhea in Post-test. Results depicted that pre-test

mean dysmenorrhea score of nursing students was 6.3±2.04 and post-test mean dysmenorrhea

score of nursing students was 2.68±1.71. This difference in the mean scores was statistically

significant at p<0.001 level. The study concluded that, there was a decrease in level of pain during

dysmenorrhea after administration of mint leave paste.

Dinesan.C., (2011) explained that medical uses for mint leaves. It can relieve nausea

caused by morning sickness and menstrual cramps by relaxing the smooth muscles of

abdominal cavity. It has the potentiality to reduce the post operative nausea and muscle

aches. Heartburn can be relieved through its antispasmodic activity and increasing the flow of

digestive fluids and used as remedy for bad breath. It has antispasmodic activity and sedative

properties which can ease tension during pain and muscle aches.
Beulah Queen, (2010) conducted a study to assess the effectiveness of mint leave

paste on dysmenorrhoea among adolescent girls at selected schools at Kanyakumari

district. 34 girls were selected into the experimental group and 16 adolescent girls were

selected into control group. Pretest was done using dysmenorrhoea rating scale. Mint

leaves paste was administered to experimental group for 4 days before menstruation and

3 days after menstruation. The results showed that the mean difference between the

pretest and posttest regarding dysmenorrheal score was 15.3. The obtained‘t’ value

t=9.89(p<0.05) was significant. The study concluded that the adolescent girls who

were taking mint leaves paste had significant reduction in dysmenorrhea.

Sydney .G.T., (2010) conducted a study to assess the effect of mint extract on muscle pain

and blood lactate levels among 16 students. The group selected for the intervention was

given the mint extract of 5ml and the effect on the muscle pain and blood lactate levels was

recorded. The findings shows a considerable reduction in the muscle pain and blood lactate

levels (P<0.01) levels.

Annie joseph., (2010) conducted a study to assess the effectiveness of mint leaves paste

on dysmenorrhea among the adolescent girls. There was a significant reduction in the post

test dysmenorrhea score of experimental group than the post test dysmenorrhea score of

control group t = 4.01 (P<0.01). There was no significant association between the mean

differencein dysmenorrhea score after mint leaves paste administration.

Nazeer .K, et al., (2009) reported the reduction in primary dysmenorrhea among 180 female

students at Isfahan university dormitory aged 18-17 year, who suffered from dysmenorrhea.

The administration of herbal drug, which involves purified saffron, mint leaves, celery seed, and

anise extract obtained a statistically significant reduction in pain scores (P<0.001).

Ramya.M., (2009) conducted study to assess the effectiveness of the mint extract upon

dysmenorrhea .The level of symptoms on dysmenorrhea was assessed before and after mint

extract administration for consecutive days using self administered questionaire. The difference

between the experimental pre test and post test is found to be statistically proven to be

significant (p<0.001). There was no significant association between the selected demographic

variables and pre test post test level of dysmenorrhea score.

Okusanya.B.O., (2008) conducted prospective questionnaire based study on prevalence of

dysmenorrhea and mint tea associated factors among undergraduates in a Nigerian University.

The findings shows that the prevalence of dysmenorrhea 76.3%. Where the Primary

dysmenorrhea was to be more common in the adolescent girls. There is significant pain

reduction by using mint tea (P=0.76).

Spirling, (2001) conducted a study on botanical perspectives on health peppermint.

Peppermint is usually taken after a meal for its ability to reduce indigestion and colonic

spasms by reducing the gastrocolic reflex. Less well recognized is peppermint’s potential

role in the management of numerous other medical conditions including certain

procedures. Eg. colonoscopy. With the growing popularity of herbal remedies among both

the public and medical practitioners, it would seem that now is an opportune time to

consider further what peppermint has to offer the world of medicine

.
5. LITERATURE RELATED TO KNOWLEDGE USE OF MINT IN

DYSMENNORRHEA.

Mentha is also known as mint. Mint is known as pudina in Hindi. It is associated to the

family of lamiaceae. It is aboriginal to Europe and Asia. It is also for its aromatic

properties from the ancient times it is popular for its medical qualities. Mint leaves

consist if nutrient like calcium, phosphorus, Vitamin C Vitamin D, E and B complex.

These, constituents build up the healthy immunity and keeps body free from infection.

A study was conducted to assess the effect of mint extract on muscle pain and blood lactate levels

among 16 physical education students. The group selected for the intervention was given the mint

extract of 5ml and the effect on the muscle pain and blood lactate levels was recorded. The findings

shows a considerable reduction in the muscle pain and blood lactate levels (P<0.01) levels.

Consuming a mixture of dried mint leaves and honey is an excellent cure for menses

problems. It is found to be very effective for relieving painful cramps during menstrual time.

Curing dysmenorrhea is another advantage of using this herbal mixture. Apart from relieving

menstrual problems, use of mint leaves and honey also helps in preventing headaches, curing

acne and reducing free radical mechanism. Drinking vegetable juice is a safe remedial

measure for alleviating the risk of menstrual problems.

Mint was originally used as a medicinal herb to treat stomach ache and chest pains,

and it is commonly used in the form of tea as a home remedy to help alleviate stomach pain.

In Rome, Pliny recommended that a wreath of mint was a good thing for students to wear

since it was thought to "exhilarate their minds". During the middle Ages, powdered mint leaves

were used to whiten teeth. Mint tea is a strong. A common use is as an antipruritic, especially

in insect bite treatments often along with camphor. The strong, sharp flavor and scent of mint

is sometimes used as a mild decongestant for illnesses such as the common cold Mint is also
used in some shampoo products.

Mint tea can be used for curing Dysmenorrhea. Mint tea can be had twice or thrice a

day for best results. The cooling properties of this herb helps to relieve pain and tension

associated with Dysmenorrhea. Mint candy will give for day long relief. Using peppermint,

spearmint or wintergreen can be used for relieving Dysmenorrhea. For preparing mint tea,

take a tablespoon of dried mint leaves and boil it along with a cup of water. Cover it and steep

it for fifteen minutes in order to prevent the oil from evaporating. Drink hot for great results.

Mint is also calming and relaxing which is again good for Dysmenorrhea.

The medicinal uses and pharmacological effects of mint leaves, was found that it is

widely used in the food cosmetics and medicines. It is used in the relief of common cold,

irritable bowel syndrome, dyspepsia, nausea, head ache and as a topical analgesic. This mint

leaves are generally identified as safe herb to consume without side effects.

Masoumi SZ et al, (2016) crossover study and was conducted on 127 girl students

studying in Hamadan University of Medical Sciences who had experienced primary

dysmenorrhea. Each participant was asked to take one of the drugs including

Mefenamic Acid and Mint, starting from the first menstruation for 3 days. At the end of

each period, a questionnaire was used to gather information; through the volunteer

herself, pain intensity was recorded according to visual analog scale (VAS), duration

of pain according to COX questionnaire, and bleeding amount according to pictorial

blood loss assessment chart (PBAC) chart (Hygham) & results, showed Average pain

intensity and duration of pain were significantly lower after intake of Mefenamic Acid

and Mint (P < 0.05). Average bleeding was significantly lower in those taking
Mefenamic Acid capsule than in those taking peppermint extract (P < 0.05). Nausea

and diarrhea were lower in the mint group than in Mefenamic Acid group. But

analgesic usage was lower in Mefenamic Acid group than in peppermint group (P <

0.05).

Priya (2012) conducted a Study To Assess The Effectiveness Of Mint Paste On

Dysmenorrhoea among Adolescent Girls At Selected School, Salem. A Quantitative

evaluative approach with quasi experimental research design was used. 60 samples

were selected by non probability convenience sampling technique 30 adolescents girls

with dysmenorrhoea from Govt. Girls Hr .Sec. School, Kondalampatti as experimental

group and 30 adolescent girls with dysmenorrhoea from Govt. Hr. Sec .School,

Mettupatti, Salem as control group. The data were collected by Dysmenorrhoea

Rating Scale and Structured Interview Schedule. After the pre test 5 grams of mint

paste was given for the period of seven days (4 days prior to menstruation and

continued till 3 days during menstruation) to the 30 samples in experimental group.

Post test was done on 7th day for the both experimental and control group. In

experimental group the pre test score on dysmenorrhoea was 23.67±7.25, post test

mean score was 15.03±4.93, with a difference of 8.63. In control group, the pre test

mean score was 27.93±5.92 and post test mean score was 27.00±5.58 with a

difference of 0.93 which shows that mint paste was effective on reducing

dysmenorrhoea.