Khalesi Zahra Bostani ¹, Beiranvand Soheila Pirdadeh ³, Bokaie Mahshid ^{2 *}

Premenstrual syndrome (PMS) encompasses a vast array of physical and psychological symptoms. Of the herbal supplements mentioned for remedy PMS symptoms, chamomile used as an effective herbal medicine. The overall purpose of this review was to determine the efficacy of chamomile on the treatment PMS. An extensive research review using Web of Science, the Cochrane Controlled Trials Register database, PubMed, Chinese Biomedical Database (CBM), CINAHL, China National Knowledge Infrastructure (CNKI), Psych INFO, Social Science Research Network, SID, Google Scholar, Iran Doc, Magiran and Iran Medex. Eligible studies were identified from English and Persian databases, published between 1990 and 2019. Studies were screened independently by two researchers who performed the data extraction. Of Twenty-seven studies identified, Eight RCTs met our inclusion criteria. Chamomile has been used to treat PMS relief because of therapeutic properties such as anti-inflammatory effects (Chamazulene and α-Bisabolol)&#59; anti-spasmodic effects (Apigenin, Quercetin, and Luteolin, Metoxicomarin, Matrisin, and Phytoestrogens)&#59; anti-anxiety effects (Glycine,Flavonoid). The results of this review show that Chamomile is effective for the treatment of PMS. Based on these results, we believe that Chamomile can be used as good herbal medicine to treat in women with PMS.

chamomile, premenstrual syndrome, herbal medicine

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Premenstrual syndrome (PMS) encompasses a vast array of physical and psychological symptoms. Of the herbal supplements mentioned for remedy PMS symptoms, chamomile used as an effective herbal medicine. The overall purpose of this review was to determine the efficacy of chamomile on the treatment PMS. An extensive research review using Web of Science, the Cochrane Controlled Trials Register database, PubMed, Chinese Biomedical Database (CBM), CINAHL, China National Knowledge Infrastructure (CNKI), Psych INFO, Social Science Research Network, SID, Google Scholar, Iran Doc, Magiran and Iran Medex. Eligible studies were identified from English and Persian databases, published between 1990 and 2019. Studies were screened independently by two researchers who performed the data extraction. Of Twenty-seven studies identified, Eight RCTs met our inclusion criteria. Chamomile has been used to treat PMS relief because of therapeutic properties such as anti-inflammatory effects (Chamazulene and α-Bisabolol); anti-spasmodic effects (Apigenin, Quercetin, and Luteolin, Metoxicomarin, Matrisin, and Phytoestrogens); anti-anxiety effects (Glycine,Flavonoid). The results of this review show that Chamomile is effective for the treatment of PMS. Based on these results, we believe that Chamomile can be used as good herbal medicine to treat in women with PMS.

We conducted a comprehensive review of the literature published between 1990 and 2019 focusing on the efficacy of Chamomile on the treatment PMS. Preferred Reporting Items for Systematic Reviews (PRISMA) principle were used to extend the process explained in this review [<xref ref-type="bibr" rid="B016">16</xref>]. A search of the literature was carried out using Web of Science, the Cochrane Controlled Trials Register database, PubMed, Chinese Biomedical Database (CBM), CINAHL, China National Knowledge Infrastructure (CNKI), Psych INFO, and Social Science Research Network as da-tabases for English papers and SID, Google Scholar, Iran Doc, Magiran and Iran Medex as databases for Persian papers. Gray literature search be conducted by the New York Academy of Medicine, PAIS, and the WHO Global Health Library. Studies were identified using the search terms “Premenstrual Syndrome” , “Premenstrual Tension” , “Premenstrual Dysphoria” , “Chamomile” , “Herbal medicines” , “Alternative Treatment” , “Premenstrual Dysphoric Disorder” according to the medical subject headings (MeSH). Manual reference checks of studies were performed to supplement the electronic search. The finds of the peer-reviewed search were entered into EndNote by Chamomile for PMS subject. In return, because of restrictions on the investigative capacity of the databases for gray literature, results of the gray search were entered into EndNote in relation to use of Chamomile for the treatment PMS more widely. Two authors autonomously assessed every record caption for inclusion in the current review, and a third author adjudicated when disagreement occurred. Detailed records were made about the purpose of each study, participants, methodology, intervention type, data collection, and the outcomes of the study. We included studies meeting the following criteria: RCT that investigated the efficacy of Chamomile for the treatment of PMS, Published in English and Persian language. Published between 1990 to 2019. Studies were excluded that it was irrelevant to the Chamomile for the treatment of PMS or insufficient quantitative data were reported. We assessed the methodology of each trial with a scale developed by Jadad and colleagues [17]. This scale assesses the randomization and double blinding and reports of dropouts and withdrawals. The Consort Statement Checklist [18] used for evaluating ensuring reliability, and for drawing the right conclusions on randomized controlled trial (RCT). Whole duplicates studies were recognized and deleted. Two reviewers autonomously screened the title and abstracts of the article for eligibility. Then, the cause of removing studies was recorded.

A total of Twenty-seven relevant trials were excluded from screening the title and abstract. Finally, Eight RCTs met the inclusion criteria. Reasons for record excluded were no PMS measure (n = 5), conference abstract or letter (n = 5), and unable to obtain full text (n = 2) (Fig. 1) Most studies were conducted in Iran. Chamomile included four different forms (Tea, Capsule, extract, and Oil) in a variety of doses. Chamomile was compared with MA, placebo and no treatment. Full details of the 8 included RTC are exposed in (Table 1)

Although researchers conducted controlled trials aimed to determine the efficacy of Chamomile in the treatment of PMS, various forms and dosage of chamomile were used to did this that makes it difficult to draw conclusions. Clearly, the amount of evidence about the effect of Chamomile is very little, albeit, existing studies have revealed Chamomile in the Menstrual pain reduction were more effective than placebo [19-26]. Presently, the world market has a chamomile drug with a variety of medicinal and therapeutic values [23]. Traditional herbal medicine in England used chamomile as one of the five "opening" herbs for the treatment of irregular menstruation [27]. As efficient methods for determining the drug constituents and effectiveness have been developed, the content of (-)-α Bisabolol and its oxides in the flowers have become a significant index of drug value and quality. Thus, chamomile of particular chemical composition is used as a drug, as it shows specific pharmacological activity [11]. Chamomile has anti-anxiety, antihistamine, anti-inflammatory, antioxidant, and antispasmodic properties. It is considered generally safe, but according to evidence should still take precaution nary measures [15]. Reviewing these studies indicated that most of the result of studies possess antidepressant effects through an anti-anxiety effect can reduce psychological signs of PMS [24, 25]. Laboratory tests on animals show that inhaling the vapors of essential oil of chamomile reduces the body's production of the Adrenocorticotropic hormone, a stress hormone [28, 29]. The therapeutic value of the plant matter was assessed by the substance of essential oil. The quality of essential oil is verified by its color. As the name indicates, bluer the oil better is the quality, because the blue color serves as the chemical indicator for the existence of Flavonoids and Terpenoids, α-Bisabolol and Chamazulene [28]. For manufacturing chamomile extracts of Antiphlogistic effectiveness, only such types of chamomile should be used, which exhibit a high content of (-)-α-Bisabolol and the synthetic Bisabolol [29]. Studies on human have also shown that chamomile tea eases anxiety and irritability that can be caused by PMS [24, 25]. Glycine, Apigenin, Luteolin and also Flavonoid as CNS stimulating molecule is nerve relaxant, which may explain why chamomile is also effective for stress and anxiety relief [30]. Chamomile contains Spiroether, a very strong antispasmodic agent that relaxes aching, tense muscles and alleviates premenstrual pain [12]. A crossover study, Chamomile was compared with MA for treating PMS, that reported that Chamomile was more effective than the MA in reducing menstrual cramps [31]. Relaxing menstrual cramps occur due to an increase in serum Glycine levels following Chamomile tea using [15]. Chamomile seems to suppress pain through the effect of Matrisin, Metoxicomarin, Flavonoids, Phytostrogenic, and Apigenin on the central nervous system [13]. Also, its flowers contain Flavonoids which may responsible for antispasmodic [11]. Another clinical trial supplied the effectiveness of Chamomile at managing abdominal and pelvic pain [23].

In summary, the consequences of the current study propose an efficacy of Chamomile in the treatment PMS. This review has demonstrated that the chemical ingredients of the chamomile drug possess anti-inflammatory, antispasmodic, sedative, and anti-anxiety properties that significantly impact on painful menstruation, anxiety and psychological problems in the women of PMS sufferers. Since the Chamomile as traditional herbal medicine is well known and accessible in Iran, so it could be used easier than other herbs to relieve PMS symptoms. Because the randomized controlled trials could improve our understanding of what Chamomile is efficacious for PMS treatment. Further trials with different forms and doses of Chamomile, larger populations, longer durations, featuring comparisons with safe drugs and accurate descriptions of the involved molecular mechanisms are recommended to confirm the benefits of the procedures described and ensure the absence of complications. One of the major strengths in this research was the extensive review and more than one researcher evaluate each document. Our study's limitations include the Likelihood of removing a number of eligible studies.

MB and ZB contributed to the design of the study, review and summarized the papers, and evaluated the records for quality. MB and SP contributed to the reviewer of papers. ZB drafted the study. The study has been read and approved by all authors.

We have no conflict of interest to declare.

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