***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Dysmenorrhea is a common gynecologic disorder affecting as many as 60 % of menstruating women . In the United States , work absenteeism due to dysmenorrhea is estimated to be 600 million work hours per year , and the economic consequences are estimated at $ 2 billion per year ; therefore , it is a public problem nowadays . Aim : The purpose of this study was to compare the effects of combination of fennel extract/vitamin E with ibuprofen on the intensity of pain in primary dysmenorrhea among the students of Tabriz city in 2007 - 2009 . Material s and Methods : This study was done by using double-blinded quasi-experimental research method . After taking the required licenses from ethics committee , 68 students from Medical and Tabriz universities , who were living in the dormitory , suffering from primary dysmenorrhea , and were eligible for the study , were r and omly divided into two groups of 34 students each ( the two groups used combination of fennel extract/vitamin E and ibuprofen cross-over form in the 2 months ) . We used Visual Analogue Scale ( VAS ) tool for ranking the intensity of the pain . Data analysis was done by using SPSS Ver . 14 . Results : The mean of peak pain intensity in the first , second , third , sixth , and forty-eighth hours in the group that had used combination of fennel extract/vitamin E was lower than the group that had used ibuprofen , and statistical differences were observed between the two groups in the first and second hours ; combination of fennel extract/vitamin E was more effective than ibuprofen in the first hour ( P < 0.03 ) and second hour ( P < 0.04 ) . Conclusion : Combination of fennel extract/vitamin E is effective on decreasing the intensity of pain of primary dysmenorrhea , and it is advised to those who can not use chemical drugs Background Zingiber officinale R. rhizome ( ginger ) is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases . The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea . Method This was a r and omized , controlled trial . The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea . The students were all residents of the dormitories of Shahed University . They were r and omly assigned into two equal groups , one for ginger and the other for placebo in two different treatment protocol s with monthly intervals . The ginger and placebo groups in both protocol s received 500 mg capsules of ginger root powder or placebo three times a day . In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period . In the second protocol ginger and placebo were given only for the first three days of the menstrual period . Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale . Results There was no difference in the baseline characteristics of the two groups ( placebo n = 46 , ginger n = 56 ) . The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one ( P = 0.015 ) and protocol two ( P = 0.029 ) . There was also significant difference in duration of pain between the two groups for protocol one ( P = 0.017 ) but not for protocol two ( P = 0.210 ) . Conclusion Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically significant effect on relieving intensity and duration of pain . Trial registration I RCT OBJECTIVE To evaluate the impact of valerian-a herb with sedative effects and antispasmodic effects on smooth muscles-on the severity of dysmenorrhea .  METHODS In a double-blind , r and omized , placebo-controlled trial , 100 students were r and omly assigned to receive valerian ( n=49 ) or placebo ( n=51 ) . Valerian ( dose 255 mg ) was given 3 times daily for 3 days beginning at the onset of menstruation , for 2 consecutive menstrual cycles . At baseline and during the intervention cycles , the pain severity was evaluated with a visual analog scale and the systemic manifestations were assessed using a multidimensional verbal scale . RESULTS The pain severity at baseline did not differ significantly between the groups . After the intervention , the pain severity was significantly reduced in both groups ( P<0.001 ) , but the extent of the reduction was larger in the valerian group , with the difference between the 2 groups being statistically significant ( P<0.05 ) . The total scores of the systemic manifestations associated with dysmenorrhea decreased after the intervention , but there was no significant difference between the groups , with the exception for syncope ( P<0.05 ) . CONCLUSION Valerian seems to be an effective treatment for dysmenorrhea , probably because of its antispasmodic effects Background : Dysmenorrhea has negative effects on women 's life . Due to side-effects of chemical drugs , there is growing trend toward herbal medicine . The aim of this study was to assess the effect of Dill compared to mefenamic acid on primary dysmenorrhea . Material s and Methods : This double-blind , r and omized , clinical trial study was conducted on 75 single female students between 18 and 28 years old educating in Nursing and Midwifery School and Paramedical Faculty of Qom University of Medical Sciences of Iran in 2011 . They were allocated r and omly into one of the three groups : In Dill group , they took 1000 mg of Dill powder q12h for 5 days from 2 days before the beginning of menstruation for two cycles . Other groups received 250 mg mefenamic acid or 500 mg starch capsule as placebo , respectively . Dysmenorrhea severity was determined by a verbal multidimensional scoring system and a visual analog scale ( VAS ) . Students with mild dysmenorrhea were excluded . Data were analyzed by SPSS using the descriptive statistic , paired- sample s t-test , Wilcoxon signed-rank test , Mann-Whitney test , and Kruskal-Wallis test . Results : There were no significant differences between three groups for demographic or descriptive variables . Comprising the VAS showed that the participants of Dill and mefenamic acid groups had lower significant pain in the 1st and the 2nd months after treatment , whereas in the placebo group this was only significant in the 2nd month ( P < 0.05 ) . Conclusion : Dill was as effective as mefenamic acid in reducing the pain severity in primary dysmenorrhea . Further studies regarding side-effects of Dill and its interactivity are recommended OBJECTIVE Wujijing Oral Liquid ( WJJ ) contained principally the flesh essence of the black-boned chicken . As a kind of food and medicine in China , it was used to treat the menstrual disturbance traditionally , but the exact mechanism of the action was not yet clear . The clinical effects of the WJJ on the symptoms of the menstrual disturbance and the reproductive hormones were studied in this paper . MATERIAL S AND METHODS The 53 women with the menstrual disturbance were selected as the study object , and then they were r and omly divided to receive either WJJ 10mL twice daily ( n=28 ) or the placebo ( n=25 ) from the 1st day after menstrual flow for 2 menstrual cycles . On the 1st day after the discontinuation of the medication but before the treatment , the scores for the menstrual pattern and the related symptoms were obtained and the blood sample s were collected to test the reproductive hormones . The serum levels of the follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LH ) , prolactin ( PRL ) and estradiol ( E2 ) were examined by enzyme-linked immunosorbent assay ( ELISA ) . The levels of progesterone ( P ) and testosterone ( T ) in serum were measured by the radioimmunoassay . RESULTS The score for the primary and related symptoms of the menstruation was increased significantly among patients treated with the WJJ . The differences on the FSH , PRL , and E2 levels of patients were significant before and after the treatment with WJJ . Comparing the WJJ group and the placebo group , the levels of P and T differed significantly after treatment . The oral liquid of WJJ was found to be safe , as it did not cause any change in the hepatic and renal functional parameters . CONCLUSION The oral liquid of Wujijing could improve the menstrual disturbance and were generally safe and well tolerated . The possible mechanism could be associated with its effects in reinforcing the kidney and regulating the hypothalamus-pituitary-ovary axis ( HPOA ) Our objective was to examine the effect of an Iranian herbal drug in the treatment of primary dysmenorrhea . A r and omized , double-blind , placebo-controlled pilot trial among 180 female students at Isfahan University dormitory aged 18 to 27 who suffered from primary dysmenorrhea was undertaken . The participants were r and omly divided into three groups : herbal drug , mefenamic acid , and placebo . The herbal drug group was given 500 mg of highly purified saffron , celery seed , and anise ( SCA ) extracts three times a day for three days , starting from the onset of bleeding or pain . Participants were followed for two to three cycles from the beginning of menstruation through the three days of bleeding . Main outcome measures were the severity and duration of pain at 2 and 3 months . A visual analogue scale was used to record pain . There were statistically significant reductions in pain scores and pain duration scores in the groups that took SCA ( P < . 001 ) and mefenamic acid ( P < . 01 ) . The decrease in pain score was reflected by a significant reduction in other drug use among the treatment groups compared with the women in the placebo group . The magnitude of the reduction was significantly greater in the SCA group than in the mefenamic acid and placebo groups . Both drugs effectively relieved menstrual pain as compared with the placebo . More clinical trials are needed to establish the efficacy of this herbal drug Objective Preliminary evaluation of efficacy and safety of uzara use in treatment of moderate and severe primary dysmenorrhea in comparison to ibuprofen . Material s and Methods This r and omized , comparative two way cross-over study comprised 60 single female students at Faculty of Medicine , Ain Shams University , Egypt , aged 19–28 years with moderate ( n = 46 ) or severe ( n = 14 ) primary dysmenorrhea . Participants were r and omized to take either uzara ( 80 mg/8 hours for two doses , then 40 mg/8 hours ) then ibuprofen ( 400 mg/6 hours ) in two subsequent cycles or vice versa . The pain intensity , using VAS , was recorded immediately before taking the medication ( 0 hour ) and after 4 , 12 , 24 , 48–60 , 96–120 hours . Main outcome measures included effectiveness of pain relief defined as drop of VAS to 3 or less , patient 's global evaluation of the drug , absence from school , the use of a rescue medication , and , in those who continued the treatment , the pain intensity difference ( PID ) at different points after start of medication and its sum ( SPID ) . Results Uzara was comparably effective to ibuprofen ( 78.3 % vs. 86.7 % of cycles ; respectively ) , with comparable rates of effectiveness on global evaluation ( being around 50 % for either drug ) , and rates of school absences ( 11.7 % vs. 13.3 % ; respectively ) . The need for rescue medication was different ( 18.3 % and 10 % ; respectively ) , albeit with no statistical significance . The means of PID at different time points and SPID were comparable , with significantly lower average mean of VAS scores compared to that felt with no medication ( 1.6 vs. 6.8 , p<0.001 ) . Side effects were less with uzara than ibuprofen ( 0 % vs. 8.3 % , p<0.05 ) . Conclusions Uzara might be as effective as ibuprofen in management of primary dysmenorrhea but with less side effects . These findings need to be confirmed by a properly design ed trial with a larger sample size . Trial Registration Current Controlled Trials IS RCT Background : Primary dysmenorrhea refers to the occurrence of painful menstrual cramps of uterus and is considered as a gynecological complaint . The common treatment for this problem is medical therapy such as mefenamic acid [ non-steroidal anti-inflammatory drugs ( NSAIDs ) ] and oral contraceptive pills , both of which work by reducing myometrial activity . Fennel contains an antispasmodic and anethol agents and may be helpful for management of primary dysmenorrhea . Material and Methods : The aim of this study was to evaluate the effects of oral fennel drop for treating primary dysmenorrhea .  Sixty college students suffering from primary dysmenorrhea were r and omly assigned to two groups and followed up for two cycles . Statistical analysis was performed using SPSS version 16 . P < 0.05 was considered to be statistically significant . Parametric and non-parametric tests were adopted . Results : Comparison of pain intensity in the two groups showed that there was no significant difference in pain relief between the two groups . Comparison of bleeding severity in the study group before and after intervention was demonstrated from the first day to the fifth day ( PV on first day , second day , third day , fourth day , and fifth day 0.948 , 0.330 , 0.508 , 0.583 , 0.890 , respectively ) . Conclusion : It seems that fennel can be effective in reducing the severity of dysmenorrhea , but it 
    Output:
    
Effectiveness of supplements for  secondary dysmenorrhoea  There was no strong evidence of benefit for melatonin compared to placebo for dysmenorrhoea secondary to endometriosis ( data were unsuitable for analysis ) .
There was no evidence of a difference between the groups but data were too scanty to reach any conclusions about safety .
There is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhoea , and evidence of safety is lacking .