Introduction

Primary dysmenorrhea (PD) is a common gynecological complaint among adolescents and young women. Chinese herbal medicines (CHMs) have been widely used for PD treatment in China. However, the relative advantages of different CHM regimens remain uncertain. This systematic review aimed to compare the efficacy and safety of different CHMs for the treatment of PD using network meta-analysis.

Methods

We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical Literature Database (CBM) from their inception to December 17, 2022. Randomized controlled trials (RCTs) comparing CHM or Chinese patent drugs with Prostaglandin Synthetase Inhibitors (PGSIs) were included. Risk of bias was assessed using the Cochrane risk of bias tool. A frequentist framework network meta-analysis was performed using R (4.2.2).

Results

A total of 54 RCTs with 5,345 PD patients were included. Compared with PGSIs, Danggui Sini decoction (mean difference [MD] = -5.92, 95% confidence interval [CI] -8.64 to -3.20) and Xiangfu Siwu Decoction (MD = -4.63, 95%CI -8.37 to -0.89) reduced pain significantly.; Danggui Sini decoction (risk ratio[RR] = 1.31, 95%CI 1.12 to 1.53), Danggui shaoyao san (RR = 1.23, 95%CI 1.05 to 1.44), Siwu decoction (RR = 1.32, 95%CI 1.17 to 1.47), Taohong Siwu Decoction (RR = 1.35, 95%CI 1.14 to 1.61), and Wenjing decoction (RR = 1.33, 95%CI 1.19 to 1.52) showed significantly higher overall response rates, and Wenjing decoction could significantly reduce TCM syndrome scores (MD = -4.14, 95%CI -6.84 to -1.44), compared with PGSIs. No serious adverse events were observed. Siwu decoction and Wenjing decoction ranked as the top treatment options in terms of all outcomes of interest (P-score ranking).

Conclusions

CHMs were associated with improved overall response rate, pain reduction, and alleviation of symptoms compared to conventional treatments for patients with PD, and no serious adverse events were observed. However, the confidence in the conclusions is limited because of the lack of high-quality trials.