Ginger,Pain,Primary dysmenorrhea,Stretching exercise," /> Ginger,Pain,Primary dysmenorrhea,Stretching exercise,"/> Use of ginger versus stretching exercises for the treatment of primary dysmenorrhea: A randomized controlled trial
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Journal of Integrative Medicine ›› 2017, Vol. 15 ›› Issue (4): 295-301.doi: 10.1016/S2095-4964(17)60348-0

Special Issue: Natural Drug

• Research Article • Previous Articles     Next Articles

Use of ginger versus stretching exercises for the treatment of primary dysmenorrhea: A randomized controlled trial

Marjan Ahmad Shirvania, Narges Motahari-Tabaria, Abbas Alipourb   

  1. a Department of Midwifery, School of Nursing & Midwifery, Mazandaran University of Medical Sciences, Sari 4816715793, Iran 
    b Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari 4847191971, Iran
  • Received:2017-01-12 Accepted:2017-03-31 Online:2017-07-15 Published:2017-07-15
  • Contact: Narges Motahari-Tabari; E-mail:


Dysmenorrhea is a common gynecologic problem. In some cases, non-medical treatments are considered to be more effective, with fewer side effects. Ginger and exercise are alternative treatments for dysmenorrhea, but in the present study they were not combined.


In this study, the effects of ginger and exercise on primary dysmenorrhea were compared.

Design, Setting, Participants and Interventions

This randomized controlled trial was performed in Mazandaran University of Medical Sciences, Iran. Two groups of female students were recruited by simple random allocation. In each group, 61 students with moderate to severe primary dysmenorrhea with regular menstrual cycles and without a history of regular exercise were assessed. The ginger group received 250 mg ginger capsules from the onset of menstruation. In the exercise group, belly and pelvic stretching exercises were performed for 10 min, 3 times per week.

Main Outcome Measures

Intensity of pain was assessed according to a visual analogue scale after the first and the second month.


Exercise was significantly more effective than ginger for pain relief (31.57 ± 16.03 vs 38.19 ± 20.47, P = 0.02), severity of dysmenorrhea (63.9% vs 44.3% mild dysmenorrhea, P = 0.02) and decrease in menstrual duration (6.08 ± 1.22 vs 6.67 ± 1.24, P = 0.006), in the second cycle.


Stretching exercises, as a safe and low-cost treatment, are more effective than ginger for pain relief in primary dysmenorrhea.

Trial registration

The trial was registered in with No. 201203118822N2.

Key words: Ginger, Pain, Primary dysmenorrhea, Stretching exercise

CLC Number: 

  • We thank the vice-Chancellor for Research of Mazandaran University of Medical Sciences for supporting this project (grant number: H-92-24).
1 Dawood MY.Primary dysmenorrhea: advances in pathogenesis and management.Obstet Gynecol. 2006; 108(2): 428-441.
2 Lefebvre G, Pinsonneault O, Antao V, Black A, Burnett M, Feldman K, Lea R, Robert M; SOGC. Primary dysmenorrhea consensus guideline. J Obstet Gynaecol Can.2005; 27(12): 1117-1146. English and French.
3 Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev.2010; (1): CD001751.
4 Abdul-Razzak KK, Ayoub NM, Abu-Taleb AA, Obeidat BA.Influence of dietary intake of dairy products on dysmenorrhea.J Obstet Gynaecol Res. 2010; 36(2): 377-383.
5 5 Banikarim C, Middleman AB, Geffner M, Hoppin AG. Primary dysmenorrhea in adolescents. (2015-11-10) [2017- 01-16]. in-adolescents.
6 Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane Database Syst Rev.2010; (2): CD004142.
7 Collins Sharp BA, Taylor DL, Thomas KK, Killeen MB, Dawood MY.Cyclic perimenstrual pain and discomfort: the scientific basis for practice.J Obstet Gynecol Neonat Nurs. 2002; 31(6): 637-649.
8 Tavallaee M, Joffres MR, Corber SJ, Bayanzadeh M, Rad MM.The prevalence of menstrual pain and associated risk factors among Iranian women.J Obstet Gynaecol Res. 2011; 37(5): 442-451.
9 Gupta R, Kaur S, Singh A.Comparison to assess the effectiveness of active exercises and dietary gingervs. active exercises on primary dysmenorrhea among adolescent girls. Nurs Midwifery Res J. 2013; 9(4): 153.
10 Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev.2001; (3): CD002124.
11 Jenabi E.The effect of ginger for relieving of primary dysmenorrhoea.J Pak Med Assoc. 2013; 63(1): 8-10.
12 Rahnama P, Montazeri A, Huseini HF, Kianbakht S, Naseri M.Effect ofZingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial. BMC Complement Altern Med. 2012; 12(1): 92.
13 Terry R, Posadzki P, Watson LK, Ernst E.The use of ginger (Zingiber officinale) for the treatment of pain: a systematic review of clinical trials. Pain Med. 2011; 12(12): 1808-1818.
14 Blumenthal M, Busse W, Goldberg A.The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council. 1998: 683.
15 Ozgoli G, Goli M, Moattar F.Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea.J Alternat Complement Med. 2009; 15(2): 129-132.
16 Shahr-jerdy S, Hosseini RS, Gh ME. Effects of stretching exercises on primary dysmenorrhea in adolescent girls.Biomed Human Kinetics. 2012; 4: 127-132.
17 Abbaspour Z, Rostami M, Najjar S.The effect of exercise on primary dysmenorrhea.J Res Health Sci. 2006; 6(1): 26-31.
18 Blakey H, Chisholm C, Dear F, Harris B, Hartwell R, Daley AJ, Jolly K.Is exercise associated with primary dysmenorrhoea in young women?BJOG. 2010; 117(2): 222-224.
19 Higuchi K, Umegaki E, Watanabe T, Yoda Y, Morita E, Murano M, Tokioka S, Arakawa T.Present status and strategy of NSAIDs-induced small bowel injury.J Gastroenterol. 2009; 44(9): 879-888.
20 Shi S, Klotz U.Clinical use and pharmacological properties of selective COX-2 inhibitors.Eur J Clin Pharmacol. 2008; 64(3): 233-252.
21 Altman R, Marcussen K.Effects of a ginger extract on knee pain in patients with osteoarthritis.Arthritis Rheum. 2001; 44(11): 2531-2238.
22 Mills S, Bone K.Principles and practice of phytotherapy: modern herbal medicine. London: Churchill Livingstone. 2000.
23 Halder A.Effect of progressive muscle relaxation versus intake of ginger powder on dysmenorrhoea amongst the nursing students in Pune.Nur J India. 2011; 103(4): 152-156.
24 Kashefi F, Khajehei M, Tabatabaeichehr M, Alavinia M, Asili J.Comparison of the effect of ginger and zinc sulfate on primary dysmenorrhea: a placebo-controlled randomized trial.Pain Manag Nurs. 2014; 15(4): 826-833.
25 Daley A.The role of exercise in the treatment of menstrual disorders: the evidence.Br J Gen Pract. 2009; 59(561): 241-242.
26 Chaudhuri A, Singh A, Dhaliwal L.A randomised controlled trial of exercise and hot water bottle in the management of dysmenorrhoea in school girls of Chandigarh, India.Indian J Physiol Pharmacol. 2013; 57(2): 114-122.
27 Rezvani S, Taghian F, Valiani M.The effect of aquatic exercises on primary dysmenorrhoea in nonathlete girls.Iran J Nurs Midwifery Res. 2013; 18(5): 378-383.
28 Izzo A, Labriola D.Dysmenorrhoea and sports activities in adolescents.Clin Exp Obstet Gynecol. 1991; 18(2): 109-116.
29 Maruf FA, Ezenwafor NV, Moroof SO, Adeniyi AF, Okoye EC.Physical activity level and adiposity: are they associated with primary dysmenorrhea in school adolescents?Afr J Reprod Health. 2013; 17(4): 167-174.
30 Mahvash N, Eidy A, Mehdi K, Zahra MT, Mani M, Shahla H.The effect of physical activity on primary dysmenorrhea of female university students.World Appl Sci J. 2012; 17(10): 1246-1252.
31 Shavandi M, Taghian F, Soltani V. The effect of isometric exercise on primary dysmenorrhea. Arak Med Univ J.2010; 13(1): 71-77. Persian.
32 Yang JJ, Sun LH, She YF, Ge JJ, Li XH, Zhang RJ. Influence of ginger-partitioned moxibustion on serum NO and plasma endothelin-1 contents in patients with primary dysmenorrhea of cold-damp stagnation type. Zhen Ci Yan Jiu.2008; 33(6): 409-412. Chinese with abstract in English.
33 Backon J.Mechanism of analgesic effect of clonidine in the treatment of dysmenorrhea.Med Hypotheses. 1991; 36(3): 223-224.
34 Alonso C, Coe CL.Disruptions of social relationships accentuate the association between emotional distress and menstrual pain in young women.Health Psychol. 2001; 20(6): 411-416.
35 Golomb LM, Solidum AA, Warren MP.Primary dysmenorrhea and physical activity.Med Sci Sports Exerc. 1998; 30(6): 906-909.
36 Wang L, Wang X, Wang W, Chen C, Ronnennberg A, Guang W, Huang A, Fang Z, Zang T, Wang L, Xu X.Stress and dysmenorrhoea: a population based prospective study.Occup Environ Med. 2004; 61(12): 1021-1026.
37 Gannon L.The potential role of exercise in the alleviation of menstrual disorders and menopausal symptoms: a theoretical synthesis of recent research.Women Health. 1988; 14(2): 105-127.
38 Locke RJ, Warren MP.Curbside Consult: what is the effect of exercise on primary dysmenorrhea?West J Med. 1999; 171(4): 264-265.
39 Metheny WP, Smith RP.The relationship among exercise, stress, and primary dysmenorrhea.J Behav Med. 1989; 12(6): 569-586.
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