Women’s Health Update

byTori Hudson, ND

Effects of Fish Oil and Vitamin B1 on Primary Dysmenorrhea (Menstrual Cramps)

This double-blind, randomized, placebo-controlled clinical trial was carried out in 240 high school females with dysmenorrhea. They were divided into four groups with 60 in each. The first group received vitamin B1 tablet 100 mg/day starting at the beginning of the menses and taken for two months, the second group a fish oil capsule500 mg/day for the same period of time, the third group a mixture of both and the fourth croup received a placebo, also from the beginning of the menses period for a duration of 2 months.

The inclusion criteria were those who had primary dysmenorrhea (menstrual pain without pelvic pathology), agreed not to take any rescue medication for their cramps, had regular menstrual cycles, had no other health problems, and consumed not more than one serving per week of fish.

The intensity of the pain was significantly reduced in all three treatment groups vs. placebo. Duration of pain also significantly reduced in all three experimental groups compared with placebo. The results were better at the end of the second month than the first month, in all treatment groups. The severity of pain was measured by the Visual Analogue Scale (VAS) and duration was measured by the Cox Menstrual Scale. Participants recorded their points at the beginning of the study, after the first month, and after the second month. They also completed a detailed questionnaire assessing their menstrual pain and duration.

Here are the results in table form:

Pain Intensity ( higher numbers = more painful)

Before study After 1 month of treatment (Tx) After 2 months of Tx

B1 7.49 4.11 2.38

Fish oil 7.59 5.22 3.14

B1/fish oil 7.39 4.01 2.29

Placebo 7.49 7.31 5.02

Duration of Pain (higher numbers = longer duration)

B1 37.98 20.23 22.26

Fish oil 11.00 7.21 9.81

B1/fish oil 38.02 11.36 7.256

Placebo 38.45 25.32 24.38

Comment : This study had some problems, perhaps in the English translation as well as with some of the decimal points. I took the liberty to make the corrections based on other comments in the text. Other studies have shown a reduction in primary dysmenorrhea using fish oils as has vitamin B1. In treating primary dysmenorrhea, it is important to have a strategy that reduces menstrual pain over time, but also treatments that reduce acute pain within 30 to 120 minutes. The current study shows that we can use vitamin B1, fish oil, or a combination and expect improvement over 1 to 2 menstrual cycles.

Hosseinlou A, Alinejad V, Alinejad M, Aghakhani N. The effects of fish oil capsules and vitamin B1 tablets on duration and severity of dysmenorrhea in students of high school in Urmia-Iran. Global J Health Sci. 2014;(7):124–129.

Vulvar Lichen Sclerosus: Treatment with Topical Avocado and Soybean Extracts

Lichen sclerosus is a chronic inflammatory dermatosis condition that has no certain etiology. Treatment options are few, and topical corticosteroid creams are the mainstay of conventional treatment, although not the only treatment. Evidence-based natural treatments are essentially nonexistent, although many an anecdotal and case reports reflect attempts at reducing inflammation with dietary changes, supplements, and topical herbal preparations such as licorice, MSM, and others. None of the natural medicine approaches has a very robust track record. Topical steroids are often needed to reduce itching and/or pain, reduce ulcerations/fissures, and slow or halt the progression of the disease.

The current single-center, prospective cohort, open-label study was designed to assess the efficacy of a topical product containing avocado and soybean extracts (ASE) along with several antioxidant, softening and emollient ingredients. Patients in the study were those with mild to moderate disease related clinical signs of lichen sclerosus, lichen sclerosus relapse, or recurrence after at least one previous treatment with topical steroids, or intolerance to topical corticosteroids. Patients were excluded if they were taking systemic and/or topical lichen sclerosus treatments during the 4 weeks before enrollment, or had active vulvar infections or other vulvar dermatoses or cancer. Women were also excluded if pregnant or breast-feeding.

After screening, 23 women met the eligibility criteria and entered the study, applying ASE cream on the affected vulvar area twice daily for 24 weeks. The ASE cream used was Repasine cream (Pharmaday, Italy). It contains extracts of avocado and soybean, hyaluronic acid, vitamin E, sodium carboxymethyl beta glucan, dimethylmethoxy chromanol, and trimethylglycine. During the first 12 weeks, patients also took two ASE capsules daily between meals, containing 300 mg extracts of avocado, soybean, vitamin E, para-aminobenzoic acid, and phytosterols.

By the end of the 24 weeks of treatment, 12 (70.5%) of symptomatic patients and 13 (72.2%)of asymptomatic patients but those who had objective signs of lichen sclerosus, achieved an improvement of at least 75% in subjective and objective global scores, respectively.

Comment : The authors of this study reported in the discussion that the rates of partial to complete symptom and sign remission is not easily comparable to rates with topical corticosteroids. But, while the ASE-containing products did not achieve as rapid a response of at least 75 % as is seen with topical steroids, after the 24 weeks, the improvement attained was essentially the same as a 12-week course of the potent topical corticosteroids. Of note though is that the patients in this study were those with mild to moderate disease.

It appears that the topical and oral ASE products exerted anti-inflammatory, antifibrotic, emollient, and soothing effects on patients with mild to moderate lichen sclerosus.

Borthi A, Corazza MinghetiG, Toni G, Virgili A. Avocado and soybean extracts as active principles in the treatment of mild-to-moderate vulvar lichen sclerosus: results of efficacy and tolerability. J Eur Acad Dermatol Venereol. 29;2015:1225–1230

Knee Osteoarthritis and Sesame Seeds

Osteoarthritis (OA), also known as degenerative arthritis, is the most common form of arthritis and involves the joint cartilage. The inflammation and degeneration can result in pain, swelling, decreased range of motion and mobility, and even changes in the shape of the joint and abnormal bone growth. The knees are one of the most common joints affected by OA, especially in women.

The current study was conducted in Iran and involved 50 patients (40 women and 10 men) aged 50 to 70 years old who had knee OA with mild to moderate disease severity based on accepted criteria of the American College of Rheumatology (ACR).

The patients were randomly divided into 2 groups: sesame-treated and control. The control group received standard drug therapy of 500 mg acetaminophen twice daily and 500 mg glucosamine once a day. The study intervention group (25) received 40 g of sesame seeds, ground into a powder, per day along with the standard drug therapy, for 2 months. Patients in both groups maintained their usual diet and physical activity during the study.

The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Timed Up and Go (TUG) and the Visual Analog Scale (VAS) tests were used for clinical assessments. VAS measures subjective characteristics or attitudes. In this study, VAS was used to measure the rate and intensity of the pain. 0 represents no pain and 10 represents the maximum pain tolerated. The TUG is used to assess a person’s mobility. It uses the time it takes to rise from a chair, walk 3 meters, turn around, walk back to the chair, and then sit down again. Scores of 10 seconds or less indicated normal mobility, 11–20 seconds are within normal limits for elderly and disabled individuals, and > 20 seconds means that the person needs assistance. A score of 14 seconds or more may indicate that the person is prone to falls. The KOOS is a test specific to the knee and assesses a person’s opinions and problems associated with the knees. It measures pain, swelling, restricted range of motion and mechanical symptoms, activities of daily living, recreation function, and knee-related quality of life. The KOOS scores for each of the areas measured are transformed to a 0–100 scale, with 0 representing extreme knee problems and 100 representing no knee problems.

After treatment, there was significant difference in pain intensity between the two groups. The mean score of KOOS in both treatment and control groups was significantly increased compared with baseline. The mean score of the TUG questionnaire in both treatment and control groups was significantly decreased from baseline. There was no significant differences in pretreatment scores of KOOS and TUG between the two groups. There was significant difference in posttreatment scores of the KOOS and TUG between the two groups.

Comment : This study showed a positive effect of a rather simple dietary addition of 40 g/day of ground sesame seeds in improving clinical signs and symptoms in patients with osteoarthritis of the knee. It should be considered a good adjunct to acetaminophen and glucosamine.

Sesamin, a lignan derived from sesame seeds, has been shown to inhibit pro-inflammatory cytokines involved in inflammatory factors. Oxidative stress also has a role in OA, and sesame oil can increase antioxidant capacity, superoxide dismutase (SOD), and serum antioxidants, including vitamins C and E. Improving antioxidant enzyme activity and improving oxidative status with sesame is a possible mechanism in improving symptoms and signs of OA.

Possible methods of delivery of could be in smoothies, in yogurt, on fruit or vegetable salads, and on top of cooked vegetables. A tablespoon is approximately 9 g, so this would be 4-plus tablespoons per day: simple, safe, tasty, healthful, and hopefully a way to help with mild to moderate osteoarthritis of the knees (and maybe other joints!).

Sadat E, Haghighian K, et al. Effects of sesame seed supplementation on clinical signs and symptoms in patients with knee osteoarthritis. Int J Rheum Dis. 2013;16(5):578–582.

Dr. Tori Hudson graduated from the National College of Naturopathic Medicine (NCNM) in 1984 and has served the college in many capacities over the last 28 years. She is currently a clinical professor at NCNM and Bastyr University; has been in practice for over 30 years; and is the medical director of the clinic A Woman’s Time in Portland, Oregon, and director of research and development for Vitanica, a supplement company for women. She is also a nationally recognized author, speaker, educator, researcher, and clinician.