Efficacy of herbaceous Apiaceae plants in primary dysmenorrhea: A systematic review and meta-analysis of RCTs

Primary dysmenorrhea is a leading cause of job and school absenteeism among young females. Despite its high prevalence, contemporary medicine offers limited treatment options. Herbaceous members of the Apiaceae family, such as Pimpinella anisum L., Anethum sowa L.,Anethum graveolens L.,Cuminum cyminum L., and Foeniculum vulgare Mill., are commonly used in traditional medicine to treat primary dysmenorrhea. Currently, there is no comprehensive assessment of their therapeutic efficacy and safety. This study assessed how effective and safe these herbs are in managing primary dysmenorrhea.

The following electronic databases were thoroughly searched without language restriction from their inception to March 2025 by three independent reviewers: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, AYUSH Research Portal (a database of Ayurveda and other research articles), and Digital Helpline for Ayurveda Research Articles (DHARA), SCOPUS And Google Scholar. All randomized-controlled trials that assessed the efficacy of the herbs belonging to the Apiaceae family on primary dysmenorrhea were considered. The entire review was conducted in strict adherence to PRISMA guidelines. The validity and applicability of the study results were assessed with the help of risk-of-bias assessment tools.

After the data search, screening and full-text review, 14 studies were selected for systematic review. The risk of bias assessment showed low risk in randomization and outcome measurement for studies comparing Pimpinella anisumL. and Foeniculum vulgareMill. against placebos. However, studies using Foeniculum vulgareMill and Anethum graveolensL.against standard treatments revealed concerns related to deviations from interventions and selective reporting, highlighting the need for improved methodological consistency. The meta-analysis included data from seven studies comparing herbaceous Apiaceae family plants against standard treatments for managing primary dysmenorrhea. The pooled results against standard treatments showed a statistically significant effect with low heterogeneity. Further subgroup analysis using fennel seed and dill seed, when compared to standard treatments such as Mefenamic acid or Ibuprofen, also demonstrated a statistically significant positive outcome.

Apiaceae plants are potentially effective adjunct therapies for dysmenorrhea, though further high-quality trials are essential to confirm these findings.

CRD42024538888.