Open Access Original

Article DOI: 10.7759/cureus.13743

Efficacy of Ginger in the Treatment of Primary

Dysmenorrhea: A Systematic Review and Meta-
analysis
Rizu Negi 1 , Suresh K. Sharma 2 , Rakhi Gaur 3 , Anupama Bahadur 4 , Prasuna Jelly 4

1. Obstetrics and Gynecology, All India Institute of Medical Sciences, Dehradun, IND 2. College of Nursing, All India
Institute of Medical Sciences, Jodhpur, IND 3. Obstetrics and Gynecology, Akal College of Nursing, Eternal University,
Himachal Pradesh, IND 4. Obstetrics and Gynecology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND

Corresponding author: Rizu Negi, [email protected]

Abstract
It has been evidenced that very few systematic reviews have examined the effectiveness of ginger for pain
duration and its severity among women with primary dysmenorrhea. This meta-analysis was therefore
performed to methodically incorporate and significantly evaluate randomized controlled ginger studies for
the treatment of primary dysmenorrhea. The literature was searched using PubMed, Embase, Ovid,
ClinicalKey, Medline, and electronic database. We have analyzed clinical trials by comparing ginger with
placebo and non-steroidal anti-inflammatory drugs in women with primary dysmenorrhea. The primary
outcomes assessed in our meta-analysis were pain severity and pain duration. Secondary outcomes were
change in bleeding, side effects of the drug, and rate of satisfaction. We have screened a total of 638 studies,
out of which narrative synthesis was formulated for eight studies. We have performed a meta-analysis of five
trials examining ginger with placebo and other two randomized controlled trials comparing ginger with a
non-steroidal anti-inflammatory drug (NSAID); it seems to be more helpful for relieving menstrual pain than
a placebo (mean difference [MD] = 2.67, 95% CI = 3.51-1.84, P = 0.0001, I2 = 86%), although it was found that
ginger and NSAIDs were equally effective in pain severity (risk ratios [RR] = 1.15, 95% CI = 0.53-2.52, P =
0.72, I2 =77%). We have not observed any significant difference between ginger and placebo on pain
duration among primary dysmenorrheic women (MD = -2.22, 95% CI = -7.62-3.18, P = 0.42, I2 =
56%). Accessible information proposes that oral ginger can be a compelling treatment for primary
dysmenorrhea. This meta-analysis strongly supports the requirement for high methodological quality
consistency for upcoming trials.

Categories: Obstetrics/Gynecology, Pain Management, Public Health

Keywords: ginger, primary dysmenorrhea, zingiber, systematic review, menstrual pain

Introduction
Primary dysmenorrhea is a common condition that occurs in the absence of any pelvic disease.
Review began 02/09/2021 It is one of the most familiar gynecology problem, which decreases the performance of women and causes
Review ended 03/04/2021 34%-50% of absentees from education and career;
Published 03/06/2021 dysmenorrhea has many social and economic ramifications, and this impacts the psychological health of
© Copyright 2021 women along with the quality of life [1-3]. Dysmenorrhea results from the withdrawal of progesterone near
Negi et al. This is an open access article the peak of a menstrual cycle; this withdrawal has been shown to extend the synthesis of prostaglandins F2
distributed under the terms of the (PGF2) and E2 (PGE2). Awed et al.'s study suggests that prostaglandins are released during menstruation
Creative Commons Attribution License
because of endometrial cell destruction. PGE2 stimulates uterine contractions and increases vasopressin
CC-BY 4.0., which permits unrestricted
use, distribution, and reproduction in any
release, which ends up in ischemia and pain [4].
medium, provided the original author and
source are credited. Berkley’s study [5] mentioned that dysmenorrhea has been distinguished as primary and secondary. In the
absence of pelvic conditions, primary dysmenorrhea occurs when the pain starts at the beginning of
menstrual bleeding and continues for 12-48 hours. Akhlaghi et al.’s study [6] found that the prevalence of
dysmenorrhea is mentioned in many studies, and it varies between 50% and 90%. Non-steroidal anti-
inflammatory medications are the standard medication for dysmenorrhea and have many side effects, such
as headache, giddiness, dysuria, fatigue, anorexia, vomiting, skin inflammation, and gastric ulcer. Many
studies have shown that herbal medication pain relief is much more practical than chemical drugs, and
Rosenwaks and Seegar-Jones’s study [7] mentions that ginger is known as a complementary remedy to serve
the purpose. Dugasani et al.'s study [8] revealed that herbs and spices are the various treatments used by
women, which are widely accepted safe and known to be effective.

Traditionally, a range of folk medicine has been used to treat every day minor ailments such as menstrual
cramps, headache, vomiting, indigestion, and nausea. Ginger is known to have outweighing benefits among
many conventional remedies. It is useful in minimizing menstrual cramps, and it relaxes the muscular
spasms as well. It is considered as an anti-inflammatory agent in folk remedies. It also contains non-volatile
components like gingerols, shogaols, zingerone, and paradol. Furthermore, it has pleiotropic

How to cite this article

Negi R, Sharma S K, Gaur R, et al. (March 06, 2021) Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and
Meta-analysis. Cureus 13(3): e13743. DOI 10.7759/cureus.13743
 pharmacological activities, like antioxidants, under the prolonged exposure of the desensitized TRPV1
agonists, capsaicin and shogaol, which ends in pain relief [8-10].

Few systematic reviews have investigated the effectiveness of ginger in general pain relief (acute and
chronic pain, including only a few early ginger-specific trials in primary dysmenorrhea) [11,12]. There were
some studies that have compared ginger with placebo and showed beneficial effects in primary
dysmenorrhea [1]. In 2016, Chen et al.’s systematic review [12] of ginger efficacy was reported for primary
dysmenorrhea, but with limited trials, and findings were also restricted by some factors such as the inclusion
of non-randomized controlled trials (RCT) studies. Therefore, an additional thorough and accurate
systematic review and meta-analysis were needed. The objective of this review was to systemically analyze
all randomized clinical studies of the effect of ginger on the treatment of primary dysmenorrhea and to
explain its effectiveness in alleviating the symptoms of primary dysmenorrhea with the well-framed
research question: Is oral ginger (intervention) successful in minimizing menstrual pain (main outcome) in
women with primary dysmenorrhea compared to placebo or non-steroidal anti-inflammatory drug (NSAID)
(comparison) (population)?

Materials And Methods

For this systematic study and meta-analysis, we have followed Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines. To answer the review question with justification, the PICO
(patient/population, intervention, comparison and outcomes) framework was used. The primary outcomes
for this review were pain severity and pain duration. Secondary outcomes were changes in bleeding, side
effects of the drug, and rate of satisfaction.

Data sources and selection criteria

PubMed, Embase, Ovid, ClinicalKey, Medline, and electronic database were searched for data. The Medical
Subject Headings (MeSH) were “Ginger,” (Primary) “Zingiber officinale,” “primary dysmenorrhea,”
“menstruation pain,” “randomized,” “placebo,” “controlled trial,” (dysmenorrhea∗ OR menstruation pain∗
OR “period∗ pain” OR “painful period∗”), “Dysmenorrhea* OR Ginger OR Pharmacological*”, and “pain
modalities.” Also the list of references from the selected studies was examined for the additional trials and
evidence.

Study selection
Studies were searched independently and screened potentially for eligibility by two reviewers who read the
title, abstract, and related references to select literature that requires a detailed examination. Whenever
there is any difference in the opinion of two reviewers, then the third reviewer was approached to take the
last decision. We also contacted the authors whose studies needed further clarity. In this review, RCTs
comparing the effectiveness of oral ginger with placebo or non-steroidal anti-inflammatory medication
(NSAID) in women with primary dysmenorrhea evaluated by a patient-reported outcome measure were
included. RCTs from the year 2008 to 2020 published only in English language were considered for inclusion.
Studies were excluded if they were non-RCTs, case control, cohort, letters, reviews, trials of ginger combined
with other substances, and non-human or in vitro studies. The two reviewers who carried out the search
examined the eligibility of the studies on the basis of the Joanna Briggs Institute (JBI) Critical Appraisal
checklist for RCT, and the data is mentioned in Table 1.

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 2 of 11

 Participant Characteristics Intervention (Ginger Powder) Comparison Outcome (Incidence)
Quality

Study Sample Size Pain Severity (JBI

Age P
Pain Severity Preparation Dosage Preparation Dosage Score)
(Years) value
Dichotomous Continuous

Ginger: 5.12 ± 2.69; Placebo:

Rahnama et al.,
Ginger: 59 Ginger capsule (unknown 500 mg, TID × 500 mg, 6.58 ± 2.02 (Pain duration)*; 0.015 Moderate
2012 [1] (Single- >18 Moderate to severe Placebo
Placebo: 46 origin and constituents) 5 days TID Ginger: 14.7 ± 18.36; Placebo: 0.017 (10/13)
Center Study)
21.36 ± 22.59

Shirvani et al., 2014 Pain intensity over 250 mg, QID Ginger: 27/60
Ginger: 61 Ginger capsule (Zintoma; Mefenamic 250 mg, Low
[14] (Single-Center >18 40 mm based on until the pain Control: >0.05
Control: 61 Iranian brand) acid TID (5/13)
Study) 100 mm VAS subsides 33/60

Ozgoli et al., 2008 Ginger: 18/50

Ginger: 50 Ginger capsule (Zintoma; 250 mg, QID × 400 mg, Moderate
[15] (Multicenter >18 Moderate to severe Ibuprofen Control: NA >0.05
Control: 50 Iranian brand) 3 days QID (8/13)
Study) 10/50

Kashefi et al., 2012

Ginger: 47 Ginger capsule (unknown 250 mg, TID × 250 mg, Ginger: 3.08 ± 1.52; Placebo: High
[16] (Multicenter 15-18 Moderate to severe Placebo <0.001
Placebo: 45 origin and constituents) 4 days TID 6.95 ± 1.67 (11/13)
Study)

Abadi et al., 2020 Ginger: 70

Ginger capsule (unknown 250 mg, QID × 250 mg, (Pain duration)*; Ginger: 1.61 ± Moderate
[17] (Single-Center 20-30 Not mentioned Control: 70 Placebo 0.052
origin and constituents) 3 days QID 0.64; Placebo: 2.12 ± 0.81 (8/13)
Study) Placebo: 70

Pakniat et al., 2019 Ginger: 50 Ginger capsule (Zingiber

250 mg, BD × 250 mg, Ginger: 3.20 ± 1.28; Placebo: 6 ± Moderate
[18] (Single-Center 18-25 Moderate to severe Control: 100 officinale) (Ponstan; Razak Placebo <0.001
3 days BD 0.7 (9/13)
Study) Placebo: 50 Co., Tehran, Iran)

Janebi et al., 2013

Ginger: 35 Ginger capsule (unknown 500 mg, TID × Not Ginger: 4.81± 1.7; Placebo: 7.11 Moderate
[19] (Single-Center >18 Moderate to severe Placebo 0.001
Placebo: 34 origin and constituents) 3 days mentioned ± 1.2 (9/13)
Study)

Rad et al. 2018 [20] Pain severity

Ginger: 78 Ginger capsule (unknown 200 mg, QID × 200 mg Ginger: 3.10 ± 2.69; Control: 2.97 Moderate
(Single-Center 18-26 (grade 2 and grade Novafen >0.05
Control: 90 origin and constituents) 2 days QID ± 2.69 (10/13)
Study) 3)

TABLE 1: Study characteristics

BD, Two times a day; TID, three times a day; QID, four times a day; JBI, Joanna Briggs Institute; VAS, visual analog scale.

Outcome measures
Two authors collected a predefined outcome from the studies, which includes study characteristics and
patients’ profiles. The primary study outcomes were pain severity and pain duration of primary
dysmenorrhea. The secondary outcomes were changes in bleeding, side effects of the drug, and rate of
satisfaction.

Data extraction
Data extraction was carried out by excluding duplicate studies. It has been done independently by three
reviewers. The differences were resolute by the formal discussions and consensus by the senior reviewer.
Data extraction forms were intended to tabulate the characteristics of the included studies. We have
extracted the data of three reviewers and discussed the dataset with the fourth reviewer, who helped us
resolve the discrepancies. Data on the subject of the first author, publication year, country, study type,
population, interventions (ginger), outcomes (primary and secondary), and results were pulled. To get
additional information, corresponding authors of the included studies were contacted through emails. We
tried to contact four authors and only Shirvani et al. and Pakniat et al. reverted (mail) back.

Assessment of risk bias and quality assessment

Bias risks in the studies were evaluated by four authors autonomously. Risk bias evaluation was done by
following the standard guidelines of Cochrane risk bias guidelines by Higgins et al. [13]. In case of any
discrepancy between authors, the consultation from the fifth reviewer was considered to get the final
decision. Risk of bias includes random sequence generation, allocation concealment, blinding, incomplete

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 3 of 11

 outcome data, selective reporting bias, and other bias. Four reviewers reviewed all included studies, and they
used the Cochrane Collaboration approach for the assessment of risk bias. Two primary reviewers assessed
for randomization bias, allocation concealment, blinding of participants and assessor, incomplete outcome
data, and other bias. All studies were reported as low risk, high risk, and unclear risk for its bias toward each
component. If a study reported a low risk for all domains of risk bias, it was considered to be of good quality
and vice versa. If any dissimilar opinion arises between primary reviewers for risk bias, third and fourth
reviewers did a thorough assessment of the study, and conclusions were made with mutual consensus.

The majority of the studies expressed a low to unclear level of risk bias (Figures 1a, 1b). For random
sequence generation, five studies were decided as having a low-risk bias; Shirvani et al. [14] and Rad et
al.'s studies were judged as unknown risk. Ozgoli et al.’s study [15] found a high-risk bias in the random
sequence generation. In allocation concealment, Rahnama et al., Kashefi et al., Abadi et al., and Rad et al.’s
studies were judged as low-risk bias [1,16,17]. Ozgoli et al. and Pakniat et al.’s studies [15,18] were criticized
as having high-risk bias as participants were allocated alternatively into the groups. Two trials were judged
as high-risk bias in blinding of participants and personnel [17,18]. Kashefi et al.’s study shows high-risk bias
in the blinding of outcome assessment, and other remaining studies judged unclear in the bias detection.
Attrition bias was found high in the Rahnama et al.’s study with other two studies [17,18].

FIGURE 1: (a) Risks of bias graph. (b) Risks of bias summary.

In the selective reporting bias, only the Rad et al.’s study has high-risk bias as there was a mention of
assessment of pain severity through pain visual analog scale (PVAS), but as a result, they changed the term
from severity to intensity and have not mentioned it in the results table. All other studies fall in a low-risk
bias in the selecting report. “Other risk bias” was considered high in Rahnama et al.'s study [1]; the result
determined for Protocol 2 was biased by the effects of Protocol 1. For the remaining studies, “other risk of
bias” were found unclear as a result of the restricted report. All the authors were consulted/informed in case

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 4 of 11

 of any missing information from the study findings, and after receiving the response from the corresponding
authors of included studies, further decisions were made with the mutual consensus of all authors of this
analysis.

Data analysis
Narratively, data derived from the included studies were synthesized. Tabulation has been used to bring
together trial features (i.e., author, participants, sample size, intervention, comparison, and outcome
measures), designs across the studies analyzed in requisites of study characteristics, and its results. The
aspect that may have altered the findings was further analyzed. Statistical research was carried out
according to the statistical guidance protocol in the latest edition of the Cochrane Handbook for Systematic
Review of RCT. RevMan Manager 5 (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen) was
used for the production of review and data analysis.

In the present review, dichotomous outcomes (adding the impact of ginger and NSAIDs on pain severity)
were represented as risk ratios (RR) with 95% confidence intervals (CI). Continuous results, such as symptom
scores (e.g., as calculated by VAS), were expressed as mean difference (MD) with 95% CI. Heterogeneity was
tested both by visual examination of forest plots (where non-overlapping CI suggested the probability of
heterogeneity) and by the use of the Chi-squared heterogeneity test (differences at P < 0.05 are considered
statistically significant). Heterogeneity was also represented as I2 figures, with a value of 0% suggesting no
heterogeneity. Subgroup analysis to remove heterogeneity and funnel plots was not possible due to the
small number of studies (<10). Furthermore, due to heterogeneity, we avoided a fixed model and performed
statistical analysis using a random effect model for both continuous and dichotomous results.

Results
Selection and characteristics of the studies
A PRISMA flow diagram depicting the studies that are reported, screened, rejected, and included is shown in
Figure 2. A total of 638 studies were listed in the initial electronic searches, and 396 duplicate studies were
excluded. A total of 15 studies were found to be qualified under the title in which eight of the trials that met
the requirements were comprised in the meta-analysis.

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 5 of 11

 FIGURE 2: PRISMA flow diagram
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.

The comprised studies were conducted between 2008 and 2020. The main characteristics of the included
studies are shown in Table 1. Seven of the eight included studies were of parallel design [1,14-19], and one
study was having a cross-over design by Rad et al. [20]. All eight studies were conducted in Iran. Trial
participants were either high-school or college students. In the included seven studies the outcome variable
was pain severity, and in two studies the outcome variable was the duration of pain [1,18]. The sample size of
the studies ranged from N = 70 to N = 201, and the ginger group lies between n = 35 and n = 78.

Each included trial tested ginger in a variety of dehydrated powder. The number of working components of
ginger was not measured or recorded in any of the trials. Only Abadi et al.’s study mentioned the production
of ginger and placebo capsules in Herbi Daru Pharmaceutical Company, Tabriz, Iran. The dose of ginger
ranges from 700 mg to 1,000 mg per day. The common duration of treatment with ginger was the first to the
third day of menstruation. A continuous numerical scale (visual analog scale) of 10 cm lines was used to
evaluate pain severity in five trials. Only one of the studies measures pain severity by the multidimensional
verbal scoring system (VMS) [15]. In Shirvani et al. [14] and Abadi et al.’s studies [17], “days in pain” data was
collected for pain duration, whereas in Rahnama et al. [1], “hours in pain” data was collected.

Effects of intervention (outcome)

i. Pain severity

Ginger versus placebo and ginger versus NSAID: Four studies observed the effect of ginger and placebo on
pain severity on 245 participants associated with primary dysmenorrhea [1,16,18,19]. On meta-analysis, a

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 6 of 11

 significant reduction was found in the pain severity of participants in the ginger group compared to the
placebo group (MD = 2.67, 95% CI = 3.51-1.84, P = 0.0001, I2 = 86%) (Figure 3).

FIGURE 3: Forest plot for ginger versus placebo (pain severity)

Three trials compared the effect of ginger and NSAID on pain severity; the pooled data of two
trial [14,15] indicated that ginger and NSAID were equally effective in reducing the pain severity among
women with primary dysmenorrhea, and there was no statistical difference between the two (RR = 1.15, 95%
CI = 0.53-2.52, P = 0.72, I2 = 77%) (Figure 4).

FIGURE 4: Forest plot ginger versus NSAID (pain severity)

NSAID, Non-steroidal anti-inflammatory drug.

ii. Pain duration

Ginger versus placebo: A pooled analysis of Rahnama et al. and Abadi et al. showed the effectiveness of
ginger and placebo on pain duration in women with primary dysmenorrhea and revealed no significant
difference between ginger and placebo in pain duration in a three days’ regime (MD = -2.22, 95% CI = -7.62-
3.18, P = 0.42, I2 = 56%) (Figure 5).

FIGURE 5: Forest plot ginger versus placebo (pain duration)

Secondary outcome
We were not able to conduct a meta-analysis of secondary outcomes described in our protocol due to
insufficient data. However, we did a small narrative synthesis on the side effects of ginger.

Side effects of ginger

Regarding side effects, the included studies recommend that ginger is generally safe and can cause minor
ailments in a very few participants (indigestion and headache). This information is reliable in context to the
previous studies on ginger that it has a good safety profile when utilized properly. Rahnama et al. [1], Abadi
et al. [17] and Janebi et al. [19] have reported headache and heartburn as the side effects of ginger [1,16,18].

We also wanted to reveal statistical evaluation on the effect of ginger in the specific cycles of menstruation.
However, due to much fewer studies and excessive heterogeneity, we could not include it in our meta-
analysis.

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 7 of 11

 Discussion
This meta-analysis summarizes the evidence from eight RCT analyzing the effectiveness of ginger on
primary dysmenorrhea. This review provides evidence that ginger can eliminate pain related to primary
dysmenorrhea. It is consistent with the several findings from the observed studies; we can state that ginger
might be considered to treat menstrual pain. Inclusively, ginger was found to be more powerful for relieving
pain than placebo, though we have found ginger and NSAID to be equally effective on pain severity.
However, these results must be viewed with great caution because of a limited number of experiments, low
methodological consistency, and high heterogeneity in the trial.

Various trials have considered ginger for alleviating pain and inflammation. Several reviews support ginger
for its potency in pain relief related to auto-immune disease, rheumatoid arthritis, osteoarthritis, burn
injury, migraine headache, and constant lower back pain [21-26]. Intake of ginger in folk medicine for the
treatment of cold, fever, sore throat, nausea, stomach upset, muscle aches, and arthritis has been
documented in various studies [27]. Ginger is effective for several types of aches. However, it is not
entirely effective for all pain.

This review also revealed the outcome of ginger on pain duration, although we have found only two studies
that assessed pain duration in their trial [1,17]. Abadi et al.’s study [17] found that the length of pain in the
ginger group was substantially shorter relative to the placebo group. The results of another study showed
that taking ginger was significantly better at reducing the severity of the pain two days before the onset of
the menstrual cycle. Yet, in our meta-analysis, we could not find any significant difference between the
ginger and placebo groups in the reduction of pain duration.

Rahnama et al.’s study [1] indicates that ginger is comparatively safe with recorded side effects when
considering safety (heartburn and headache). According to the Lakhan et al.’s reports [28], ginger
encompasses an excellent safety profile when consumed precisely. A systematic analysis indicates that
ginger has a higher safety profile than NSAIDs for pain relief, with a smaller number of gastric side effects
and fewer kidney risks.

The conclusion of this review is somewhat the same as the previous two reviews on the effect of ginger on
primary dysmenorrhea by Daily et al. and Chen et al. [11,12], but our review is different from these two
reviews as we have included only RCTs and one more outcome (pain duration) in our review. Daily et
al. [11] has used two non-RCT studies by Halder et al. and Gupta et al. [29,30]. Chen et al. has also
extensively utilized Halder et al.’s study in their review [12]. Daily et al.’s systematic review [11] reported
more supportive findings regarding the effectiveness of ginger for primary dysmenorrhea than Chen et al.’s
systematic review [12]. The included trials had a "low or moderate" risk of bias according to Daily et al.’s
assessment. Ginger was "highly useful in the reduction of primary dysmenorrhea," according to their review.
In difference, Chen et al.’s review included trials that had “high-risk bias.” Chen et al.’s effect size for ginger
against placebo was lower than Daily et al.’s effect size.

This review has shown that ginger can minimize pain in one or two periods. The present analysis provides
compelling proof of the impact of ginger on relieving menstrual pain. Based on beneficial effects and
minimal side effects, ginger may be a potential adjunct treatment for primary dysmenorrhea. There is a great
requirement to enhance the practical or methodological consistency of upcoming studies. Future studies
have to use efficient methods for generating random sequences, allocation concealment, blinding
participants, blinding outcome assessors, resolving missing data (use of intent-to-treat analysis), and
reporting on pre-specified findings.

The standard of this meta-analysis was an effort to incorporate the existing accessible facts sustaining the
effectiveness of ginger in the treatment of primary dysmenorrhea. To eliminate errors, data extraction,
quality assessment, and study selection were done separately by three authors. However, following are some
of the drawbacks that have been found. First, only RCTs have been included in the study, not observational
studies, which can limit our study's sample size. Second, all the studies were carried out in Iran, which could
have an impact on the generalizability of the findings. Third, the high heterogeneity between the trials and
consequences of our review must be analyzed with caution. Effective design, properly powered, and
prolonged RCTs are required in order to assess the impact of ginger on primary dysmenorrhea. Fourth, this
review was not cataloged on PROSPERO (International Prospective Register of Systematic Reviews);
however, upcoming trials with big sample sizes should use the registration system.

Conclusions
The finding in this study has verified the possibility of ginger efficacy in the treatment of primary
dysmenorrhea, though no/small side effects have been identified and its use is associated with health
benefits. Ginger is easily accessible due to its low cost. It can also be commonly used in the treatment of
primary dysmenorrhea. The use of ginger is very useful and effective as NSAIDs because of the increasing
trend in the use of traditional medicine and herbal medicine, particularly for people who do not want to use
chemical drugs with more side effects. We strongly recommend that further research be performed with a
greater number of patients regarding the effectiveness and protection of various doses of ginger.

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 8 of 11

 Appendices
PubMed search strategies
Filter Applied: 2000-2020, English Language, Full Text Articles, Randomized Controlled Trials

(("ginger"[MeSH Terms] OR "ginger"[All Fields] OR "gingers"[All Fields] OR "ginger s"[All Fields]) AND
("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"[All Fields] OR "dysmenorrheas"[All Fields] OR
"dysmenorrhoea"[All Fields]) AND (("primaries"[All Fields] OR "primary"[All Fields]) AND ("dysmenorrhea"
[MeSH Terms] OR "dysmenorrhea"[All Fields] OR "dysmenorrheas"[All Fields] OR "dysmenorrhoea"[All
Fields] [All Fields] OR "secondaries"[All Fields] OR "secondary"[MeSH Subheading] OR "secondary"[All
Fields]) AND ("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"[All Fields] OR "dysmenorrheas"[All Fields]
OR "dysmenorrhoea"[All Fields]))

("zingiber"[All Fields] OR ("ginger"[MeSH Terms] OR "ginger"[All Fields] OR "gingers"[All Fields] OR "ginger

s"[All Fields]) OR ("ginger"[MeSH Terms] OR "ginger"[All Fields] OR ("zingiber"[All Fields] AND "officinale"
[All Fields]) OR "zingiberofficinale"[All Fields])) AND (("primaries"[All Fields] OR "primary"[All Fields]) AND
("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"[All Fields] OR "dysmenorrheas"[All Fields] OR
"dysmenorrhoea"[All Fields]))

("ginger"[MeSH Terms] OR "ginger"[All Fields] OR "gingers"[All Fields] OR "ginger s"[All Fields]) AND
(("primaries"[All Fields] OR "primary"[All Fields]) AND ("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"
[All Fields] OR "dysmenorrheas"[All Fields] OR "dysmenorrhoea"[All Fields]))

("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"[All Fields] OR ("painful"[All Fields] AND "period"[All

Fields]) OR "painful period"[All Fields]) AND ("ginger"[MeSH Terms] OR "ginger"[All Fields] OR "gingers"[All
Fields] OR "ginger s"[All Fields])

("controlled trial"[All Fields] AND "randomized"[All Fields] AND ("dysmenorrhea"[MeSH Terms] OR

"dysmenorrhea"[All Fields] OR ("menstruation"[All Fields] AND "pain"[All Fields]) OR "menstruation pain"
[All Fields])) OR ("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"[All Fields] OR ("period"[All Fields] AND
"pain"[All Fields]) OR "period pain"[All Fields])

"controlled trial"[All Fields] AND "randomized"[All Fields] AND ("dysmenorrhea"[MeSH Terms] OR

"dysmenorrhea"[All Fields] OR "dysmenorrheas"[All Fields] OR "dysmenorrhoea"[All Fields])

("ginger"[MeSH Terms] OR "ginger"[All Fields] OR "gingers"[All Fields] OR "ginger s"[All Fields]) AND
("ginger"[MeSH Terms] OR "ginger"[All Fields] OR "gingers"[All Fields] OR "ginger s"[All Fields] OR
(("primaries"[All Fields] OR "primary"[All Fields]) AND ("dysmenorrhea"[MeSH Terms] OR "dysmenorrhea"
[All Fields] OR "dysmenorrheas"[All Fields] OR "dysmenorrhoea"[All Fields])))

"ginger"[All Fields]"zingiberofficinale"[All Fields]"primary dysmenorrhea"[All Fields]

(("menstruation pain"[All Fields] AND "randomized"[All Fields]) AND "placebo"[All Fields]) AND "controlled
trial"[All Fields]"menstruation pain"[All Fields]

(("effect"[All Fields] OR "effecting"[All Fields] OR "effective"[All Fields] OR "effectively"[All Fields] OR

"effectiveness"[All Fields] OR "effectivenesses"[All Fields] OR "effectives"[All Fields] OR "effectivities"[All
Fields] OR "effectivity"[All Fields] OR "effects"[All Fields]) AND ("ginger"[MeSH Terms] OR "ginger"[All Fields]
OR "gingers"[All Fields] OR "ginger s"[All Fields]) AND ("officinale"[All Fields] OR "officinales"[All Fields]))
AND "primary dysmenorrhea"[Title ("effect"[All Fields] OR "effecting"[All Fields] OR "effective"[All Fields] OR
"effectively"[All Fields] OR "effectiveness"[All Fields] OR "effectivenesses"[All Fields] OR "effectives"[All
Fields] OR "effectivities"[All Fields] OR "effectivity"[All Fields] OR "effects"[All Fields]) AND "zingiber"[All
Fields] AND ("primaries"[All Fields] OR "primary"[All Fields]) AND ("dysmenorrhea"[MeSH Terms] OR
"dysmenorrhea"[All Fields] OR "dysmenorrheas"[All Fields] OR "dysmenorrhoea"[All Fields])

("effect"[All Fields] OR "effecting"[All Fields] OR "effective"[All Fields] OR "effectively"[All Fields] OR

"effectiveness"[All Fields] OR "effectivenesses"[All Fields] OR "effectives"[All Fields] OR "effectivities"[All
Fields] OR "effectivity"[All Fields] OR "effects"[All Fields]) AND ("ginger"[MeSH Terms] OR "ginger"[All Fields]
OR "gingers"[All Fields] OR "ginger s"[All Fields])) AND "primary dysmenorrhea"[Title]

"randomized"[All Fields] AND "trial"[All Fields] AND "ginger"[All Fields] AND ("mensuration"[All Fields] AND
"pain"[All Fields])

EMBASE search strategies

1. dysmenorrhea AND (pain AND modalities)(randomized trial)) AND (ginger)) AND (mensuration pain) 69

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 9 of 11

 2. (Primary OR dysmenorrhea) AND (ginger OR pharmacological) 652

3. (zingiber AND officinale) AND (dysmenorrhea OR period) AND pain (ginger) AND (dysmenorrhea)) AND
(primary dysmenorrhea)) NOT (secondary dysmenorrhea) 704

4. (zingiber AND officinale) AND dysmenorrhea 14

5. zingiber AND officinale (zingiber) OR (ginger)) OR (zingiberofficinale)) AND (primary dysmenorrhea)

2,030

6. ('ginger' OR zingiber) AND (primary AND dysmenorrhea) 34

7. *ginger OR period pain) 34

Additional Information
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: All authors have declared that there are no
other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements
We are very thankful to Ms. Kalpana Thakur (PhD Scholar) for her valuable suggestions and feedback for the
first draft of this article.

References
1. Rahnama P, Hosseini F, Mohammadi KH, et al.: A study of the ginger effect on girls suffering from primary
dysmenorrhea. J Med Plants. 2011, 4:81-6.
2. Dmitrovic R, Kunselman AR, Legro RS: Continuous compared with cyclic oral contraceptives for the
treatment of primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol. 2012, 119:1143-1150.
10.1097/AOG.0b013e318257217a
3. Shirooye P, Hashem-Dabaghian F, Hamzeloo-Moghadam M, Afrakhteh M, Bioos S, Mokaberinejad R: A
clinical comparative study of oral and topical ginger on severity and duration of primary dysmenorrhea.
Research Journal of Pharmacognosy. 2017, 4:23-32.
4. Awed H, El-saidy T, Amro T: The use of fresh ginger as a home remedy to relieve primary dysmenorrhea .
Journal of Research in Nursing and Midwifery. 2013, 2:104-113.
5. Berkley KJ: Primary dysmenorrhea: an urgent mandate . Pain Clin Updates. 2013, 21:1-8.
6. Akhlaghi F, Zyrak N, Nazemian S: Effect of vitamin E on primary dysmenorrhea . Hayat. 2009, 15:82.
7. Rosenwaks Z, Seegar-Jones G: Menstrual pain: its origin and pathogenesis . J Reprod Med. 1980, 25:207-12.
8. Dugasani S, Pichika MR, Nadarajah VD, Balijepalli MK, Tandra S, Korlakunta JN: Comparative antioxidant
and anti-inflammatory effects of [6]-ginerol, [8]-gingerol, [10]-ginerol and [6]-shogaol. J Ethnopharmacol.
2010, 127:515-20. 10.1016/j.jep.2009.10.004
9. Kavuluru VKSKP: A study to assess the effectiveness of ginger preparation on dysmenorrhea among
adolescent girls. International Journal of Applied Research. 2017, 3:22-25.
10. Iwasaki Y, Morita: A, Iwasawa T, et al.: A nonpungent component of steamed ginger-[10]-shogaol—
increases adrenaline secretion via the activation of TRPV1. Nutr Neurosci. 2006, 9:169-78.
10.1080/110284150600955164
11. Daily JW, Zhang X, Kim DS, Park S: Efficacyof ginger for alleviating the symptoms of primary dysmenorrhea:
a systematic review and meta-analysis of randomized control trials. Pain Med. 2015, 16:2243-2255.
10.1111/pme.12853
12. Chen X, Barrett B, Kwekkeboom K: Efficacy of oral ginger (zingiberofficinale) for dysmenorrhea: a
systematic review and meta-analysis. Evid Based Complement Alternat Med. 2016, 2016:1-10.
10.1155/2016/6295737
13. Higgins JPT, Green S: Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 . Higgins
JPT, Green S (ed): Wiley, Germany; 2011.
14. Shirvani MA, Motahari-Tabari N, Alipour A: The effect of mefenamic acid and ginger on pain relief in
primary dysmenorrhea: a randomized clinical trial. Arch Gynecol Obstet. 2015, 291:1277-81.
10.1007/s00404-014-3548-2
15. Ozgoli G, Goli M, Moattar F: Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in
women with primary dysmenorrhea. J Altern Complement Med. 2009, 15:129-32. 10.1089/acm.2008.0311
16. 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, 15:826-33.
10.1016/j.pmn.2013.09.001
17. Abadi MD, Vakilian K, Aghdam NSZ, Ranjbaran M: The effect of valerian and ginger on dysmenorrhea: a

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 10 of 11

 randomized clinical trial. Int J Women's Health Reprod Sci. 2020, 8:101-105.
18. Pakniat H, Chegini V, Ranjkesh F, Hosseini MA: Comparison of the effect of vitamin E, vitamin D . Obstet
Gynecol Sci. 2019, 62:462-468. 10.5468/ogs.2019.62.6.462
19. Jenabi E: The effect of ginger for relieving of primary dysmenorrhoea . J Pak Med Assoc. 2013, 63:8-10.
20. Rad HA, Basirat Z, Bakouei F, et al.: Effect of ginger and novafen on menstrual pain: a cross-over trial .
Taiwan J Obstet Gynecol. 2018, 57:806-809.
21. Al-Nahain A, Jahan R, Rahmatullah M: Zingiber officinale: a potential plant against rheumatoid arthritis .
Arthritis. 2014, 2014:159089. 10.1155/2014/159089
22. Akhtar N, Haqqi TM: Current nutraceuticals in the management of osteoarthritis: a review . Ther Adv
Musculoskelet Dis. 2012, 4:181-207. 10.1177/1759720X11436238
23. Sepahvand R, Esmaeili-Mahani S, Arzi A, Rasoulian B, Abbasnejad M: Ginger (Zingiber officinale Roscoe)
elicits antinociceptive properties and potentiates morphine-induced analgesia in the rat radiant heat tail-
flick test. J Med Food. 2010, 13:1397-401. 10.1089/jmf.2010.1043
24. Cady RK, Schreiber CP, Beach ME, Hart CC: Gelstat migraine (sublingually administered feverfew and ginger
compound) for acute treatment of migraine when administered during the mild pain phase. Med Sci Monit.
2005, 11:165-9.
25. Young HY, Luo YL, Cheng HY, Hsieh WC, Liao JC, Peng WH: Analgesic and anti-inflammatory activities of
[6]-gingerol. J Ethnopharmacol. 2005, 96:207-10. 10.1016/j.jep.2004.09.009
26. Chrubaski JE, Roufogalis BD, Chrubasik S: Evidence of effectiveness of herbal anti-inflammatory drugs in
the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. 2007, 21:675-83.
27. Baliga MS, Haniadka R, Pererira MM, D'Souza JJ, Pallaty PL, Bhat HP, Popuri S: Update on the
chemopreventive effects of ginger and its phytochemicals. Crit Rev Food Sci Nutr. 2011, 51:499-523.
10.1080/10408391003698669
28. Lakhan SE, Ford CT, Tepper D: Zingiberaceae extracts for pain: a systematic review and meta-analysis . Nutr
J. 2015, 14:10.1186/s12937-015-0038-8
29. Halder A: Effect of progressive muscle relaxation versus intake of ginger powder on dysmenorrhoea
amongst the nursing students in Pune. Nurs J India. 2012, 103:152-6.
30. Gupta R, Kaur S, Singh A: Comparison to assess the effectiveness of active exercises and dietary ginger vs.
active exercises on primary dysmenorrhea among adolescent girls. Nurs Midwifery Res J. 2013, 9:168-77.

2021 Negi et al. Cureus 13(3): e13743. DOI 10.7759/cureus.13743 11 of 11