Effect of Aromatherapy Massage on Dysmenorrhea in Turkish Students

Original Article Effect of Aromatherapy Massage on Dysmenorrhea in Turkish Students Serap Ejder Apay, MSc,* Sevban Arslan, PhD,† Reva Balci Akpinar, PhD,† and Ayda Celebioglu, PhD† ---

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ABSTRACT:

The purpose of this study was to investigate the effect of aromatherapy massage on dysmenorrhea. The study used a quasiexperimental design with the subjects as their own control. Every participant applied both aromatherapy massage with lavender oil and placebo massage with odorless liquid petrolatum [soft paraffin]. The population comprised 438 midwifery and nursing students. The 150 students who had declared that they had suffered from dysmenorrhea used a visual analog scale to indicate their level of pain. Higher scores reflected a greater severity of dysmenorrhea. Forty-four students volunteered to participate in the study. When the lavender massage and the placebo massage were compared, the visual analog scale score of the lavender massage was found to decrease at a statistically significant rate. This study showed that massage was effective in reducing dysmenorrhea.

In addition, this study showed that the effect of aromatherapy massage on pain was higher than that of placebo massage. Ó 2012 by the American Society for Pain Management Nursing From the *Department of Midwifery, Faculty of Health Sciences, Atat€ urk University, Erzurum, Turkey; † Department of Nursing, Faculty of Health Sciences, Atat€ urk University, Erzurum, Turkey.

Address correspondence to Serap Ejder Apay, MSc, Department of Midwifery, Faculty of Health Sciences, Atat€ urk University, Erzurum, Turkey.

E-mail: sejder@hotmail.com Received September 30, 2009; Revised April 21, 2010; Accepted April 22, 2010.

1524-9042/$36.00 Ó 2012 by the American Society for Pain Management Nursing http://dx.doi.org/10.1016/ j.pmn.2010.04.002

Dysmenorrhea is a disorder involving pain that arises in the inguinal region during or just before menstrual bleeding. Dysmenorrhea is associated with lower abdominal cramps and back pain, as well as nausea, vomiting, fatigue, nervousness, appetite loss, diarrhea, and headache (Banikarim, Chacko, & Kelder, 2000; Beckman, Ling, & Laube, 2002; Jun, Chang, Kang, & Kim, 2007; Symonds & Symonds, 2004, p. 253). The pain usually begins just before or as menstrual bleeding begins, and gradually diminishes over 1-3 days. Pain usually occurs intermittently, ranging from being mild to disabling (Roger, Smith, Andrew, & Kaunitz, 2007).

The prevalence of dysmenorrhea is highest in adolescent women, with estimates ranging from 20% to 90%, depending on the measurement method used.

About 15% of adolescent girls report severe dysmenorrhea, and it is the leading cause of recurrent short-term school absenteeism in adolescent girls in the United States (Banikarim, Chacko, & Kelder, 2000; Davis & Westhoff, 2001; French, 2005; French, 2008). Similar results were obtained in a few studies performed in Turkey. In these studies, the ratio of dysmenorrhea was found to be between 70.3% and 83.13% among adolescent women (Aykut et al., 2007; Pain Management Nursing, Vol 13, No 4 (December), 2012: pp 236-240

Aromatherapy Massage and Dysmenorrhea

€ Eryilmaz & Ozdemir, 2009; Vicdan et al., 1993).

Because dysmenorrhea can decrease productivity, creativity, and work performance, leading to serious daily stress and social and economic loss, it is important to treat this disorder (Dawood, 1990).

Different methods have been used to treat dysmenorrhea. Some experimental studies have found alternative methods such as acupuncture, acupressure, transcutaneous electrical nerve stimulation, massage, and aromatherapy to be fairly effective (Han, Hur, Buckle, Choi, & Lee, 2006; Helms, 1987; Jun, Chang, Kang, & Kim, 2007; Lewers, Clelland, Jackson, Varner, & Bergman, 1989).

Through massage, hypoxia regresses and the oxygen level in tissues increases, and thus the severity of the pain decreases. Massage is believed to be an effective way to improve blood and lymph circulation and to reduce stress and ease stiff muscles. An effective massage alleviates pain caused by tight and tense muscles. In addition, after a massage session endorphin release increases, which consequently increases the pain threshold and reduces the level of pain felt (Ay, 2007; Buckle, 1999; Han et al., 2006). Earlier studies have shown that 15 minutes of massage was effective (Han et al., 2006; Seers, Crichton, Martin, Coulson, & Carroll, 2008).

Aromatherapy is the therapeutic use of essential oils from plants and is perceived to be a safe therapy (Buckle, 2001). There are many types of essential oils used for aromatherapy, such as melissa, eucalyptus, and lavender. They have to be used with care, because they are highly concentrated. They are especially effective for relaxing, reducing pain and stress, improving coping mechanisms, and increasing the sense of wellness. Keville and Green (1995) suggested that essential oils should be used for several days before dysmenorrhea or menstrual cramps are expected. The essential oil of lavender is thought to be an adrenocortical stimulant that stimulates menstruation and circulation and has anticonvulsive properties. It has been asserted that lavender oil, which is widely used, has relaxation and sedative effects on the amygdala and it is the least toxic and allergy-inducing essential oil (Buckle, 1998; Buckle, 1999; Buckle, 2001; Dunn, Sleep, & Collett, 1995; Maddocks-Jennings & Wilkinson, 2004).

Lavender is also useful as a sedative, local anesthetic, and analgesic (Ghelardini, Galeotti, & Mazzanti, 1999; Lavabre, 1996).

Aromatherapy massage is the most widely used complementary therapy in nursing practice (Kyle, 2006). In the literature there are studies that have examined the effects of aromatherapy massage on different patient groups (Hur, Oh, Lee, Kim, Choi, & Shin, 2007; Rho, Han, Kım, & Lee, 2006). However, there

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are few studies related to dysmenorrhea (Han et al., 2006). The present study investigated the effect of aromatherapy massage on dysmenorrhea.

METHOD Design and Sample The study was conducted to determine the effect of aromatherapy massage on nursing students’ reports of dysmenorrhea. The study used a quasiexperimental design with the subjects as their own control.

Participants The study population comprised 438 midwifery and nursing students who had attended the Erzurum Health School between January and June 2008. Of the 150 students who had declared that they had suffered from dysmenorrhea, 44 students volunteered to participate in the study. Participants were asked to use a visual analog scale (VAS) on the first day of the menstrual period to record their level of pain. The intensity of dysmenorrhea was measured with a 100point VAS, indicated by marking the appropriate value on a 100-mm horizontal ruled line. Higher scores reflected a greater severity of dysmenorrhea pain, and participants’ VAS scores were >60 on commencement of the study. Participants indicated that they had not suffered from any systemic or genital diseases, they had had regular menstrual cycles, and they had not been using analgesics to overcome dysmenorrhea.

Intervention Every participant was to receive both aromatherapy massage (with lavender oil) and placebo massage (with odorless liquid petrolatum [soft paraffin]). The application order of these massages was determined randomly.

Each participant was monitored during 3 menstrual periods. During the first period participants documented their own pain levels on the VAS without any intervention applied. During the second period, one of the two applications (placebo massage or aromatherapy massage) was applied. In the third menstrual period, those participants who had previously received aromatherapy massage received placebo massage; and those who had received placebo massage received aromatherapy massage through the same means. Following each application, the severity of pain was noted on the VAS. To maintain the study as unbiased, the VAS evaluation was conducted by a researcher who did not know the study groups. On completion of the study, three VAS scores had been obtained for every participant (1 before intervention

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and 2 after intervention [with aromatherapy and with placebo]).

Massage was provided to the participants at a fixed time of the day by the same massager on a bed in a special quiet room where the temperature was between 23 C and 25 C (73.4 F and 77 F). Massage was applied while the participants were lying in a supine position. A cushion was placed under the subject’s knees to keep the abdomen relaxed. Massage was applied on the abdomen, on the region above the pubic symphysis and above the umbilicus. The researcher had washed and dried her hands and waited for them to warm before applying the massage. The first researcher , depending on the type of massage, poured 2 mL of lavender oil or liquid petrolatum into her hands and applied the massage with clockwise circular movements (effleurage). The researcher’s left hand was placed on the right hand and both hands were placed on the abdomen. Overpressure was not applied on the abdominal region during massage. Each massage session lasted 15 minutes. After the massage, the participant’s abdomen was cleaned with a clean and dry paper towel. The second researcher recorded VAS scores.

Data Analysis The data were evaluated using SPSS version 11.0 computer software for analysis using descriptive statistics, and t test p value of .05 was considered to be statistically significant. The significance level was set at .05.

Power analysis was based on a two-sided alpha of .05, with a power of .90 when calculated at the end of the study.

Ethical Approval Legal permission was received from the related institution before the research. Participant students were briefed regarding the purpose of the research and they were told that the intervention had no known side effects. After students were given information on the method of the research they gave their written informed consents. Moreover, students were told that

they could quit the study at any time during the data collection period.

RESULTS The average age of the participants was 20.31 1.09 years, average age of menarche was 13.38 1.38 years, average menstruation period was 6.29 1.09 days, and average period of time between menstruation periods was 26.77 3.16 days.

When the effect of aromatherapy and placebo massage on dysmenorrhea was observed, a statistically significant difference was found between the participants’ preapplication and postapplication VAS scores (p < .001). Likewise, a statistically significant difference (p < .001) was found between the preapplication and postapplication VAS scores for the placebo massage group (Table 1).

When the aromatherapy massage and the placebo massage groups were compared, the participants’ VAS score of the lavender massage group were found to be significantly lower (p < .001) than the placebo group (Table 2).

DISCUSSION Women who experience dysmenorrhea may need to get help from health care professionals when it has negative effects on their lives. In the present study, the effects of aromatherapy were examined in young women who had declared that they suffered from dysmenorrhea and who were studying midwifery and nursing in Turkey.

The participants reported a serious level of dysmenorrhea before the intervention, as shown by the mean rating of dysmenorrhea of 82.38 10.86 on the 100-point VAS. Menstruation periods can be so painful that it can negatively affect women’s daily life activities. Earlier researchers have shown that women had reported intensely painful menstruation periods.

According to a study conducted by Vicdan et al.

(1993), 78.06% of adolescents suffered from pain and

TABLE 1.

Comparison of Impact of Aromatherapy and Placebo Massage Groups on Dysmenorrhea (Visual Analog Scale Scores) Test values Group

Before

After

t

df

p value

Aromatherapy massage Placebo massage

82.38 10.86 82.38 10.86

51.13 24.91 74.31 11.08

8.21 7.63

43 43

<.001 <.001

Aromatherapy Massage and Dysmenorrhea

TABLE 2.

Comparison of Visual Analog Scale Scores After Interventions Test Values

Aromatherapy Massage Group

Placebo Massage Group

t

df

p value

51.13 24.91

74.31 11.08

6.89

43

<.001

20.43% of them did not. Although 74.83% of those reporting pain suffered from mild pain, 25.6% of them were frequently absent from class owing to moderate or severe pain. Only 0.39% of the adolescents with dysmenorrhea had consulted their doctor regarding their pain. Dysmenorrhea was experienced by 83.13% of 18-year-olds and 75% of 13-year-olds. In a study by Aykut et al. (2007), the frequency of dysmenorrhea was 70.3% for the research group. Moreover, in a study € conducted by Eryılmaz and Ozdemir (2009), dysmenorrhea was experienced by 81.7% of subjects.

In the present study, dysmenorrhea decreased from 82.38% to 51.13% after aromatherapy massage; and from 82.38% to 74.31% after placebo massage. It is thought that massage has soothing, relaxing, and tension-reducing effects, because of the lower pain score averages reported by both groups. Massage therapy has been shown to be highly beneficial in relieving pain, tension, and stress. In a study performed by Kim et al. (2005), where they examined the effect of abdominal massage on those suffering from dysmenorrhea, they found that massage had a statistically significant effect on reducing dysmenorrhea and men€ strual cramps. In Eryilmaz and Ozdemir’s (2009) study, applying massage to relieve pain in adolescents who had dysmenorrhea was effective in 11% of the subjects.

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In the present study, it was clear that the aromatherapy massage group’s average pain scores are lower than the placebo massage group’s average pain scores. Thus, the use of both massage and aromatherapy was more effective than only massage.

It is known that both massage therapy and the use of essential oils are beneficial; to combine the two can be even more synergistically beneficial than either therapy separately (Poulton, 2006). In an earlier study that examined the impact of aromatherapy massage on the symptoms of dysmenorrhea, it was found that aromatherapy massage decreased pain (Han et al., 2006).

The present study provides empirical data for evidence-based nursing research. The results of this study have practical implications in nursing practice for adolescents who suffer from dysmenorrhea.

Limitations The present study is limited by its small sample size, and results cannot be generalized to a wider population. Future research should be conducted with a larger sample.

CONCLUSIONS The results of the study have demonstrated that massage was effective in reducing dysmenorrhea. In addition, this study also demonstrated that the effect of aromatherapy massage on pain was higher than that of placebo massage. The results showed that the method could be applied by nurses and patients in a safe manner, because it had no side effects and it was cheap and easily applicable. As the results of the study suggest, nurses should recommend the use of aromatherapy massage to those experiencing dysmenorrhea, informing them of its benefits.

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