AJOG Reviews
Complementary/alternative therapies for premenstrual syndrome: A systematic review of randomized controlled trials

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Abstract

Complementary/alternative therapies are popular with women who have premenstrual syndrome. This systematic review was designed to determine whether use of such therapies is supported by evidence of effectiveness from rigorous clinical trials. Trials were located through searching 7 databases and checking the reference lists of articles. Randomized controlled trials investigating a complementary/alternative therapy in women with premenstrual syndrome published in the peer-reviewed literature were included in the review. Twenty-seven trials were included investigating herbal medicine (7 trials), homeopathy (1), dietary supplements (13), relaxation (1), massage (1), reflexology (1) chiropractic (1), and biofeedback (2). Despite some positive findings, the evidence was not compelling for any of these therapies, with most trials suffering from various methodological limitations. On the basis of current evidence, no complementary/alternative therapy can be recommended as a treatment for premenstrual syndrome. (Am J Obstet Gynecol 2001;185:227-35.)

Section snippets

Methods

Computerized literature searches were performed on the following databases to locate all articles on PMS and complementary/alternative therapies: MEDLINE, EMBASE, BIOSIS, CINAHL, PsychoINFO, The Cochrane Library (up to October 2000), and CISCOM (up to December 1998, after which it ceased to operate). The reference lists of articles were checked for further relevant publications and experts in complementary medicine, and manufacturers of herbal preparations were asked for any additional trials.

Results

Forty-one controlled clinical trials were located that investigated a complementary/alternative therapy for PMS symptoms. Twenty-seven14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 met the selection criteria for this review and are presented in Table I. The therapies investigated were: herbal medicine (7 trials), homeopathy (1), vitamin, mineral and other dietary supplements (13), relaxation (1), massage (1), reflexology (1), chiropractic (1),

Dietary supplements

Thirteen RCTs investigated treatments of a dietary nature. In 8 trials, individual supplements were studied; the other 5 trials assessed multinutrient products. Calcium supplementation was the subject of 2 RCTs. Although from different research groups, they had the same principal investigator, so they should not be considered truly independent. Both papers reported improvements compared with placebo for most types of symptoms. The first one was a well-designed crossover study, but 45% of the

Comment

Despite their popularity,3, 11 there is no compelling evidence for any complementary/alternative therapy in PMS. No clinical trials were located for many of the therapies advocated by PMS self-help books, including acupuncture, aromatherapy, Chinese herbs, hypnosis, meditation, therapeutic touch, and yoga.8, 9 Although the search strategy for this review was designed to be comprehensive, the possibility that trials were not uncovered because of various forms of publication bias must be

Conclusion

Rigorous research on complementary/alternative therapies for PMS is scarce, and no treatment has been unequivocally shown to be effective. All potential therapies require testing in adequately designed RCTs. Several complementary/alternative therapies (eg, exercise, dietary changes, relaxation) may not be scientifically proven to help PMS, but can be recommended for good general health and are considered to be relatively risk-free. Because complementary/alternative therapies are popular with

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    Reprint requests: Clare Stevinson, MSc, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, United Kingdom. E-mail: [email protected]

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