Lavender Aromatherapy on Alleviating Menstrual Pain in Female

Teenagers: A Case Study on Polanharjo Klaten

Sri Sat Titi Hamranani and Devi Permata Sari*

Nursing Departement, College of Health Sciences Muhammadiyah Klaten, Jalan Ir Soekarno Km 1 Buntalan 57419,

Indonesia

Keywords: Aromatherapy, menstrual pain, teenagers, lavender.

Abstract: Menstrual pain is lower abdominal pain originating from uterine cramps and occurs during menstruation.

Menstrual pain occurs due to an increase of progesterone hormone. Menstrual pain is often experienced by

teenagers and is very disturbing daily activities, thus requiring handling to reduce menstrual pain.

Aromatherapy lavender is one of the treatments to reduce menstrual pain. This study aims to determine the

influence of lavender aromatherapy on alleviating of menstrual pain in teenagers in Polanharjo. The method

used in this research was Pre-Experimental with One Group Pre-test Post-test design on the 16 female

teenagers who experience menstrual pain. NRS (Numeric Rating Scale) was utilized to assess the scale of

pain. The results shown that the mean before lavender aromatherapy was given 3.69 and the mean after given

lavender aromatherapy 2.06. Once given lavender aromatherapy there was a decrease in pain 1.63. Result of

data analysis got P = 0,000, α = 0,05. The conclusions of this study indicate that lavender Aromatherapy

affected to alleviate of menstrual pain.

1 INTRODUCTION

Reproductive health is a state of physical, mental and

social well-being as a whole, not merely free from

illness or disability in all matters relating to the

reproductive system, as well as its functions and

processes. The aim of adolescent reproductive health

is to help adolescents to understand and realize such

knowledge, so that it has healthy and responsible

attitudes and behaviors with reproductive life

problems (Widyastuti, 2012).

Adolescent reproductive development takes place

at the age of 11-16 years in men and 10-15 years in

women. In this development rapid physical growth

occurs accompanied by changes and growth of

mature reproductive organs. Changes that occur in the

growth are followed by the appearance of the primary

sign. The primary sex signs in men are wet dreams.

While the primary signs in women are menstruation

(Proverati, 2010).

Menstruation is the release of blood and body

cells from the vagina that come from the uterine wall

of the woman periodically. The average menstrual

period is between 3-8 days with an average menstrual

cycle of 28 days (Wulandari, 2011). Menstrual cycle

involves several stages that are controlled by the

interaction of hormones released by the

hypothalamus. At the beginning of the cycle, the

lining of the uterus will thicken, then the egg will be

released from the ovary to the fallopian tube and

continue to the uterus. If the egg is not fertilized by

the sperm the uterine lining will decay in the form of

menstrual blood. During menstruation many women

experience physical discomfort and discomfort

starting before and during menstrual flow and

continue for 48 hours to 72 hours. Women can have

various problems with menstruation. The problem is

in the form of Pre Menstrual Syndrome (PMS), does

not experience menstruation at all (amenorrhea) to

menorgia or prolonged heavy menstruation, and

menstrual pain (disminorea) (PIlliteri, 2015).

Disminorea is painful during menstruation,

usually with a cramping feeling and is concentrated

in the lower abdomen. The nature and degree of pain

varies. Ranging from mild to severe. Great conditions

can disrupt daily activities, forcing sufferers to rest

and leave work or daily ways of life for several hours

or several days. Almost all women experience a

feeling of discomfort in the lower abdomen during

menstruation. The uterus or uterus consists of

muscles that also contract and relax. Generally,

uterine muscle contractions are not felt, but severe

104

Hamranani, S. and Sari, D.

Lavender Aromatherapy on Alleviating Menstrual Pain in Female Teenagers: A Case Study on Polanharjo Klaten.

DOI: 10.5220/0009123301040109

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 104-109

ISBN: 978-989-758-462-6

contractions and often cause blood flow to the uterus

to be disrupted resulting in pain (Nikjou et al., 2016).

It has been estimated that 7–15% of women suffer

from severe pain which causes disturbances in their

performance for 1–3 days in a month, and 14–52% of

female students miss school because of complaining

dysmenorrhea. This issue is associated with decline

in career and educational function and results in

disturbed quality of life and emerging economic

problems (Nikjou et al., 2016) Whereas in In

Indonesia the numbers of prevalence menstrual pain

or dysmenorrhea by 64.25% were of 54.89% and

9.36% of primary dysmenorrhoea a secondary

dysmenorrhea (Oktri, Hakim, & Juaeriah, 2018) In

2014 PKBI Central Java data, there were 56 young

women who consulted about the highest menstruation

and numbers. They were consultations about

disminorea, the majority of whom lived in Semarang

and the age range consulted was 15 years 19 years

(Central Java Provincial Health Office, 2014). The

research conducted by Haryanti (Haryanti, 2014) in

Karangdowo N 1 High School was 78% experiencing

mild pain, 22% experiencing moderate pain.

Menstrual pain or dysmenorrhea can be overcome

by pharmacological and non-pharmacological

therapy. Pharmacological therapies include analgesic

drugs, hormonal therapy, nonsteroidal prostaglandin

drugs, and dilatation of the cervical canal. (PIlliteri,

2015) Non-pharmacological therapies include warm

compresses, exercise, aromatherapy, Mozart therapy,

and relaxation. Lakhan (Lakhan, Sheafer, & Tepper,

2016) said that aromatherapy directly affects the brain

as an analgesic drug.

Aromatherapy is a complementary therapy in

nursing practice and uses essential oils from the

fragrant smell of plants to reduce health problems and

improve quality of life. Smell directly affects the

brain like an analgesic drug. For example, kissing

lavender will increase alpha waves in the brain and

help to relax (Lakhan et al., 2016) Research results

the aroma of roses has the greatest effect, then

lavender. Lavender as an analgesic, antiseptic,

antidepressant, antispasmodic, antiviral, antideuritic,

and hypotensive (Dwijayanti, 2014).

Research results according (Nikjou et al., 2016)

Lavender Aromatherapy is effective to reduce pain in

dysminore. They were use a lavender on adulthood

who severe from dysminorea. Ou et al. in a research

in 2012 reported aromatherapy with lavender, clary

sage, and marjoram oils in a 2:1:1 ratio reduced pain

intensity of dysmenorrhea, which was statistically

significant (P < 0.001) (Ou, Hsu, Lai, Lin, & Lin,

2012) whereas aromatherapy with lavender did not

decreased the pain of intrauterine device (IUD)

placement in the study of Shahnazi (Shahnazi,

Nikjoo, Yavarikia, & Mohammad-Alizadeh-

Charandabi, 2012). It was a difference finding of

lavender aromatherapy effectiveness. So it could be

interesting to finding the effectiveness of lavender

aromatherapy toward the menstrual pain.

Research of to Dewi (Dewi & Prima, 2013)

Lavender aromatherapy is a therapeutic action that is

beneficial to improve physical and psychological

conditions. Physically both are used to reduce pain,

while psychologically can relax the mind, reduce

tension and anxiety and provide calm. A pleasant

odor will stimulate the thalamus to expel enchefalin

which functions as a natural pain reliever and

produces a feeling of well-being. Enkefalin is similar

to endorphin, an endogenous chemical (produced by

the body) that has a structure similar to opioids.

Enkefalin is thought to cause presynaptic barriers

(neurons that secrete transmitter material) and post

synaptic barriers (where the transmitter works) in

dorsal horn. The process achieves inhibition by

encephalalin, which is the inhibition of substance P

so that reduced pain is transmitted to the brain.

About the prevalence of the menstrual pain and

the side effects of the current treatments and because

of lack of similar studies in this field, we decided to

perform a study on the teenegers in Klaten with the

aim of determining the effect of lavender

aromatherapy on the alleviating the menstrual pain.

2 METHODS

This research is a quantitative research with Pre-

Experiment method with the design of One Group

Pretest-Posttest, that is, the respondents carried out an

intervention, after being given an intervention, then

the second observation (posttest) was conducted

(Sugiyono, 2017). This research was conducted at

SMA N 1 Polanharjo on May 29 to June 15, 2018.

Samples in this study were 16 respondents. The

consideration in selecting samples conducted by

researchers is to determine criteria which consist of

inclusion and exclusion criteria

Lavender aromatherapy is a therapy by using

lavender essential oil given by inhalation by dripping

3-5 drops of aromatherapy into the tissue which is

done for 5 minutes.

Menstrual pain is an uncomfortable feeling felt by

adolescents during the second day of menstruation

due to uterine contractions in the lower abdomen.

Menstrual pain is measured using the NRS (Numeric

Rating Scale).

Lavender Aromatherapy on Alleviating Menstrual Pain in Female Teenagers: A Case Study on Polanharjo Klaten

105

3 RESULTS AND DISCUSSION

Table 1: Average of age, menarche, duration of

menstruation and menstrual cycle.

Variable

Min

Max

Mean

Ages

16,69

0,479

Menarche

ages

13.50

0.966

Duration of

menstruation

6.31

1.014

Cycle

28.88

2.473

Based on table 1 the average age of the youngest

respondents is 16 years, at most 17 years with an

average of 16.69 ± 0.479 years. Based on the average

age of the youngest respondents, they were 12 years

old, at most 16 years with an average of 13.50 ± 0.966

years. Based on the shortest average length of

menstruation for respondents, which is 5 days, the

maximum is 8 days with an average of 6.31 ± 1.014

days. Based on the average respondents' shortest

menstrual cycle, which is 25 days, the longest is 35

days with an average of 28.88 ± 2.473 days.

Table 2: The average of reduction in menstrual pain.

Variable

Min

Max

Mean

Pre test

Post test

3,69

2,06

1,195

1,237

Based on table 2 shows the scale of menstrual pain

before being given lavender aromatherapy has an

average value of 3.69 ± 1.195. After being given

lavender aromatherapy, the average value was 2.06 ±

1.237. After being given lavender aromatherapy there

was a decrease with an average of 1.63.

Table 3: Analysis of the effect of lavender aromatherapy

on respondents.

Median (Min –

Max)

P Value

Pre test

3,00 (2-6)

0.000

Post-test

2,00 (1-5)

Based on Table 3 shows that the results of the

Wilcoxon test analysis obtained p-value = 0,000; α =

0.05 which means lavender aromatherapy has an

effect on decreasing menstrual pain.

Age is one factor in the occurrence of menstrual

pain because menstrual pain usually occurs in

adolescence, and in 2-5 years after menarche.

Menstrual pain often occurs in young women because

it has not reached biological maturity (especially

reproductive organs, which is still imperfect

endometrial growth). So that menstruation at a very

early age can cause menstrual pain (Ali, 2010).

Research of Yulanda (Yulanda, 2013) states that

primary dysmenorrhea generally occurs at the age of

15-30 years and often occurs at the age of 15-25 years

which then disappears in the late 20s or early 30s. The

incidence of primary dysmenorrhea is strongly

influenced by the age of the woman. The pain that is

felt a few days before menstruation and during

menstruation is usually due to an increase in

prostaglandin hormone. The older a person is, the

more frequent menstruation and the wider the cervix,

the secretion of prostaglandin hormones will

decrease. Primary dysmenorrhea will eventually

disappear with the decrease in uterine nerve function

due to aging.

Based on table 1 shows that the duration of

menstruation is at least 5 days, a maximum of 8 days,

with an average of 6.31 ± 1.014. Menstruation is the

release of blood and body cells from the vagina that

come from the uterine wall of the woman

periodically. Menstruation usually begins at the age

of 9-12 years. The average period of menstruation is

between 3-8 days with an average menstrual cycle of

28 days. Duration of menstruation can be influenced

by psychological and physiological factors.

Psychologically it is usually related to the emotional

level of adolescents who are unstable when they

experience menstruation. While physiologically more

than the occurrence of excessive uterine muscle

contractions due to the endometrium in the secretion

phase produce the hormone prostaglandin

(Wulandari, 2011).

Based on table 1 shows that the menstrual cycle is

the shortest 25 days, the longest is 35 days with an

average of 28.88 ± 2.473. Factors that affect the

menstrual cycle include weight, physical activity,

environmental exposure and working conditions,

hormones and psychology. Normal menstrual cycle

22-35 days, irregular menstrual cycles occur due to

abnormalities. Irregular menstrual cycles can be

caused by disturbances in the metabolic system and

hormones or psychological factors, which can affect

the workings of hormones. (Proverati, 2010). Women

can have various problems with menstruation. The

problem is in the form of hypermenorrhoea,

hypomenorrhoea, polymenorrhagia, oligomenorrhea

and dysmenorrhea or menstruation (Mochamad

Anwar, Ali Baziad, 2011).

HSIC 2019 - The Health Science International Conference

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Based on table 4.2 shows menstrual pain before

being given lavender aromatherapy has an average

value of 3.69 ± 1.195. After being given lavender

aromatherapy, the average value was 2.06 ± 1.237.

After being given lavender aromatherapy there was a

decrease with an average of 1.63. Menstrual pain is

pain during menstruation, usually with a feeling of

cramps and is concentrated in the lower abdomen.

Complaints of menstrual pain can vary from mild to

severe (Mochamad Anwar, Ali Baziad, 2011). Until

now menstrual pain has not known the cause, but in

research shows that menstrual pain is influenced by

prostaglandins. Prostaglandin stimulates the uterine

muscles and affects blood vessels which causes a

decrease in blood supply to the uterus through

contraction of the myometrium and narrowing of the

arteries in the endometrium. Increased levels of

prostaglandin occur during the first two days and a

decrease in progesterone at the end of the luteal phase

results in an increase in myometrial tone and

excessive uterine contractions, causing pain in uterine

fibers (Wulandari, 2011).

Factors that affect menstrual pain include age,

nutritional status, work / schoolwork, parity and

constitutional. Menstrual pain can be overcome by

pharmacological and non-pharmacological therapy.

Pharmacological therapy, among others,

administration of analgesic drugs, hormonal therapy,

nonsteroidal prostaglandin drugs, and dilatation of the

cervical canal (PIlliteri, 2015). Non-pharmacological

therapies include warm compresses, exercise,

aromatherapy, Mozart therapy, and relaxation.

Aromatherapy can be used to relieve pain during

menstruation, because aromatherapy is able to

provide a sensation that soothes the self and the brain,

and the stress that is felt. If the mind is calm and

relaxed, it will create a comfortable atmosphere, and

menstrual pain can be reduced (Laila, 2011).

Based on table 4.3 The results of the analysis of

the influence of lavender aromatherapy on decreasing

menstrual pain in adolescents using the Wilcoxon test

obtained a value of p = 0,000 (p <0.05), indicating

that there was a decrease in menstrual pain in

adolescents

Menstruation is periodic and cyclic bleeding from

the uterus, accompanied by desquamation of the

endometrium. In adolescence it is not uncommon to

experience menstrual disorders such as

dysmenorrhea. Dysmenorrhea or menstrual pain is a

symptom that most often causes young women to go

to the doctor for consultation and treatment

(Wiknjosastro., 2009).

Menstrual pain is abdominal pain that comes from

uterine cramps that occur during menstruation. Pain

arises along with the onset of menstruation and lasts

several hours to several days until it reaches peak

pain. Primary dysmenorrhea usually occurs within 6

to 12 months after menarche with a duration of pain

generally 8 to 72 hours. Primary dysmenorrhea is

related to uterine muscle contraction (myometrium)

and prostaglandin secretion. Primary dysmenorrhea

occurs because of an increase in prostaglandin (PG)

F2-alpha which is a cyclooxygenase (COX-2) which

results in hyper tonus and vasoconstriction in the

myometrium resulting in ischemia and pain in the

lower abdomen. The existence of strong and long

contractions in the uterine wall, high prostaglandin

hormone and widening of the uterine wall when

menstruating blood so that pain occurs during

menstruation (Larasati, 2016).

Nutritional problems in adolescents arise because

the habit of eating fast food (junk food) has an

unbalanced nutrient content that is high in calories,

high fat, high sugar, and low in fiber. The fatty acid

content contained in fast food can disrupt

progesterone metabolism in the luteal phase of the

menstrual cycle. As a result, there is an increase in

levels of prostaglandin which will cause pain during

menstruation. Prostaglandin is formed from fatty

acids in the body. After ovulation there is a build-up

of fatty acids in the phospholipid portion of the cell

membrane. When progesterone levels decrease

before menstruation, fatty acids, namely arachidonic

acid are released and experience a chain reaction to

prostaglandins which can cause pain during

menstruation (Larasati, 2016).

Work / school assignments in this factor also

affect the condition of dysmenorrhea, if the work /

schoolwork is very stressful so that it adds to the pain

during menstruation. With its relationship with parity,

it turns out nulliparous women suffer from menstrual

pain more often, then diminish as soon as giving birth,

especially with vaginal delivery. Allegedly this is

because the uterus is still small or the uterus is still

tense and the uterine is still narrow.

Constitutional influences consist of hyperactivity

or excessive responsiveness to pain stimuli and not a

low pain threshold. This relates to a person's

perception or sensitivity to pain itself (Setiabudi,

2012).

Menstrual pain or dysmenorrhea can be overcome

by pharmacological and non-pharmacological

therapy. Pharmacological therapies include analgesic

drugs, hormonal therapy, nonsteroidal prostaglandin

drugs, and dilatation of the cervical canal. Non-

pharmacological therapies include warm compresses,

exercise, aromatherapy, Mozart therapy, and

relaxation (Wiknjosastro., 2009).

Lavender Aromatherapy on Alleviating Menstrual Pain in Female Teenagers: A Case Study on Polanharjo Klaten

107

Aromatherapy is a therapy using essential oils

from plants called essential oils to help improve

health, arouse enthusiasm, arouse, refresh, soothe the

soul, and stimulate the healing process. Lavender

essential oil becomes an adrenocortical stimulant that

stimulates menstrual circulation and 3 has

anticonvulsive properties. Lavender is also useful as

a sedative, relieves pain and changes the perception

of pain (Bangun & Nur’aeni, 2013).

Aromatherapy works by affecting the work of the

brain, olfactory nerves that are directly related to the

hypothalamus, the part of the brain that controls the

gland system that regulates hormones that affect body

activity, and affects the work of the limbic system

associated with blood circulation (Bangun &

Nur’aeni, 2013).

Research results of Dewi (Dewi & Prima, 2013)

Lavender aromatherapy is a therapeutic action that is

useful to improve physical and psychological

conditions. Physically it is well used to reduce pain,

while psychologically can relax the mind, reduce

tension and anxiety and provide calm. A pleasant

odour will stimulate the thalamus to expel encephalin

which functions as a natural pain reliever and

produces a feeling of well-being. Enkephalin is

similar to endorphin, an endogenous chemical

(produced by the body) that has a structure similar to

opioids. Enkephalin is thought to cause presynaptic

barriers (neurons that secrete transmitter material)

and post synaptic barriers (where the transmitter

works) in dorsal horn. The process achieves

inhibition by encephalin, which is the inhibition of

substance P so that reduced pain is transmitted to the

brain.

The results of this study prove that the provision

of lavender aromatherapy given for 5 minutes when

menstrual pain on the second day has significant

results to reduce menstrual pain in adolescents.

Evident from the analysis using the Wilcoxon test

obtained p = 0,000 (α <0.05). This study resulted in a

scale of menstrual pain in adolescents before being

given aromatherapy with an average of 3.69 and after

being given aromatherapy with an average of 2.06.

After being given lavender aromatherapy there was a

decrease with an average of 1.63. The results of the

analysis by Pustikawaty (Pustikawati, 2016) "The

Effect of Lavender Aromatherapy on the Scale of

Menstrual Pain Class X of Senior High School 1 of

Ambawang River in Kubu Raya Regency" showed

that lavender aromatherapy had an effect on

decreasing menstrual pain with (p <0.05).

4 CONCLUSIONS

The average age of the youngest respondents was 16

years, at most 17 years with an average of 16.69 ±

0.479 years. Based on the average age of the youngest

respondents, they were 12 years old, at most 16 years

with an average of 13.50 ± 0.966 years. The scale of

pain before being given aromatherapy with an

average of 3.69 and after being given aromatherapy

with an average of 2.06. After being given lavender

aromatherapy there was a decrease with an average of

1.63. The results showed that lavender aromatherapy

had an effect on reducing menstrual pain with a

significant value of P = 0,000; α = 0.05

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