Efficacy of ginger and fennel in relieving primary dysmenorrhea: A triple-blind crossover controlled trial

Abstract

BACKGROUND:

Primary dysmenorrhea, characterized by painful menstrual cramps without underlying pelvic pathology, is common among young women and affects physical and emotional wellbeing. This study was conducted to evaluate and compare the effectiveness of ginger and fennel in relieving primary dysmenorrhea.

MATERIALS AND METHODS:

A triple-blind crossover clinical trial was conducted from October 2020 to March 2022 at one medical college and two schools in Dehradun, Uttarakhand, India, among 384 young women aged 18–26 years. Participants received ginger (500 mg), fennel (480 mg) or placebo capsules every 8 h during the first three days of menstruation for three cycles, with washout periods between interventions. Pain severity, intensity and duration were assessed using the Visual Analog Scale (VAS), Short Form McGill Pain Questionnaire and self-reported pain duration. Data analysis was performed using repeated measures ANOVA and paired t-tests in SPSS version 27, with a significance level set at P < 0.05.

RESULTS:

A total of 384 participants (mean age: 20.66 ± 1.66 years) completed the study. Ginger showed the greatest reduction in pain severity, with VAS scores decreasing from 6.14 ± 1.45 to 3.28 ± 1.21, followed by fennel (to 4.61 ± 1.26), while the placebo group showed minimal change (6.24 ± 1.51). Ginger also led to the most significant reduction in pain intensity (mean difference: 0.74 ± 0.61; P < 0.001) and duration (from 10.78 ± 5.24 to 5.60 ± 4.61 h/day; P < 0.001), outperforming both fennel and placebo. Statistical analyses confirmed significant between group differences (ANOVA F > 100, P < 0.001).

CONCLUSION:

Both ginger and fennel significantly alleviated menstrual pain in terms of severity, intensity and duration, with ginger demonstrating superior therapeutic benefits. These findings underscore the clinical potential of herbal interventions as effective, safe and culturally acceptable alternatives for managing primary dysmenorrhea, particularly in low-resource settings. Integration of such plant-based therapies into routine menstrual health care may reduce reliance on conventional medications and improve quality of life among affected women.

Introduction

Primary dysmenorrhea, characterized by cramping pelvic pain during menstruation in the absence of pelvic pathology, is one of the most prevalent gynecological complaints among adolescents and young women worldwide.[1] The pain typically originates in the lower abdomen, radiating to the lower back and thighs and is frequently accompanied by systemic symptoms such as nausea, vomiting, fatigue, headache and diarrhea.[2] The condition is predominantly attributed to excessive prostaglandin production, particularly prostaglandin F2α, which induces strong uterine contractions and ischemia.[3] Epidemiological studies indicate that up to 90% of young women experience some form of menstrual pain during their reproductive years.[4] Despite this high prevalence, primary dysmenorrhea is often underrecognized and undertreated, resulting in academic or occupational absenteeism and psychological distress.[5] Conventional pharmacologic therapies namely, nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives, remain the cornerstone of treatment. However, their use may be associated with adverse effects such as gastrointestinal discomfort, hormonal disturbances and poor long-term adherence.[6,7]

In recent years, there has been an increasing shift toward complementary and alternative medicine (CAM) approaches for the management of dysmenorrhea, particularly among populations seeking safer, more holistic and culturally congruent options.[8] Among various CAM modalities, herbal remedies stand out due to their historical significance, accessibility and promising safety profiles.[9] Ginger (Zingiber officinale) and fennel (Foeniculum vulgare) are two herbs traditionally used to alleviate menstrual discomfort due to their anti-inflammatory, analgesic, antispasmodic and antioxidant effects.[10] Ginger contains bioactive compounds such as gingerols, which has been reported to reduce prostaglandin synthesis and alleviate menstrual cramps with efficacy comparable to that of nonsteroidal anti-inflammatory drugs (NSAIDs) and shogaols that inhibit cyclooxygenase and lipoxygenase pathways, thereby reducing prostaglandin synthesis.[11] Fennel (Foeniculum vulgare) has demonstrated significant potential in reducing menstrual pain due to its antispasmodic and estrogenic properties, as shown in several randomized trials involving adolescent females. Fennel, rich in anethole, is known to modulate uterine contractility by acting on calcium channels.[12] Although these mechanisms contribute to their therapeutic potential, they may be more thoroughly explored in the discussion section to maintain clinical focus in the introduction. Furthermore, both herbs have demonstrated antioxidant properties that support hormonal regulation and reproductive health.[13]

While studies from regions such as the Middle East have reported favorable outcomes following the use of these herbs for dysmenorrhea,[14] comparative, high-quality trials specific to Indian populations are limited, despite the deep-rooted acceptance and cultural integration of herbal medicine in India.[15] This underscores a relevant research gap, particularly as India represents a population in which CAM therapies are both accessible and culturally embraced.

The World Health Organization (WHO) has emphasized the importance of validating traditional remedies and integrating them into mainstream healthcare systems, especially in resource-limited settings.[16,17] While this highlights global relevance, such broader perspectives may be more appropriately discussed in the literature review.

Responding to this evidence gap, a triple-blind, randomized crossover clinical trial was conducted to evaluate the clinical efficacy of ginger and fennel in managing symptoms of primary dysmenorrhea Figure 1. This study design was carefully chosen to ensure blinding of participants, investigators and outcome assessors, thus minimizing bias and strengthening internal validity. Each participant received both interventions in a crossover fashion, with a washout period to eliminate carryover effects. Standardized and validated pain assessment tools were used to measure the severity, intensity and duration of dysmenorrhea symptoms both preintervention and postintervention. By streamlining methodological rigor and focusing on a culturally relevant sample, young Indian women of reproductive age, the study enhances both its clinical relevance and applicability. Thus, this study not only contributes to filling the existing research void regarding the use of ginger and fennel in Indian women with primary dysmenorrhea but also aligns with global initiatives promoting evidence-based integration of traditional medicine into modern healthcare frameworks.

Figure 1.

CONSORT flow diagram of the crossover randomized controlled trial (3-arm study)

This study aimed to evaluate and compare the effect of ginger and fennel consumption on pain severity, intensity and duration of primary dysmenorrhea symptoms among young women in India. While studies from regions such as the Middle East have reported favorable outcomes following the use of these herbs for dysmenorrhea,[14] comparative, high-quality trials specific to Indian populations are limited, despite the deep-rooted acceptance and cultural integration of herbal medicine in India.[15] Fennel (Foeniculum vulgare) has demonstrated significant potential in reducing menstrual pain due to its antispasmodic and estrogenic properties, as shown in several randomized trials involving adolescent females.[16] Similarly, ginger (Zingiber officinale), rich in bioactive compounds such as gingerols, has been reported to reduce prostaglandin synthesis and alleviate menstrual cramps with efficacy comparable to that of nonsteroidal anti-inflammatory drugs (NSAIDs).[17] Despite these encouraging outcomes, the Indian context lacks rigorously designed comparative studies evaluating these herbs within a unified framework. This underscores a critical research gap and highlights the novelty of the current study. The aim of this study was to evaluate and compare the effect of ginger and fennel consumption on pain severity, intensity and duration of primary dysmenorrhea symptoms among young women in India.

Materials and Methods

Study design and setting

This study used a rigorous triple-blind, crossover randomized controlled trial (RCT) design to evaluate the “effect of ginger and fennel on primary dysmenorrhea”. This methodological approach was chosen to minimize biases, improve result reliability and enhance the validity of findings. The crossover design ensured that each participant received all three interventions, allowing for direct intra-individual comparisons and reducing confounding variables.

Study participants and sampling

The study was conducted at the College of Nursing, AIIMS, Rishikesh; Fylfot Public School, Dehradun; and Galaxy International School, Dehradun, Uttarakhand, from October 2020 to March 2022. These settings were selected to ensure a diverse sample of young women with varying socioeconomic backgrounds. Participants were aged between 18 and 26 years and reported moderate to severe dysmenorrhea on the Visual Analog Scale (VAS). A consecutive sampling technique was used, wherein all eligible participants meeting the inclusion criteria were selected to ensure adequate representation and generalizability. The inclusion criteria were young women aged between 16 and 30 years, with a regular menstrual cycle (28–35 days), experiencing moderate to severe dysmenorrhea, willing to participate in the study, not taking other herbs or medications for pain in the recent cycle and free from acute or chronic infections such as pelvic inflammatory disease or urinary tract infections. Participants not fulfilling these criteria, those with a history of acute or chronic infection, those currently taking alternative pain-relieving herbs, medications, or those unwilling to participate were excluded from the study.

Sample size calculation

The sample size was calculated based on data from previous studies evaluating the effects of herbal remedies on primary dysmenorrhea. The calculation used a two-tailed test with a significance level of 0.05 (Zₐ/₂ = 1.96) and a power of 90% (Z_β = 1.28). Assuming a standard deviation (σ) of 2.0 and a minimum detectable difference (Δ) of 0.57was calculated using the formula.[18]

To account for possible attrition, the sample size was inflated by 10% for dropout and 2% for withdrawal. Therefore, the final sample included 128 participants per group, totaling 384 participants across all three groups, to ensure adequate statistical power.

Randomization and blinding

A computerized block randomization method (block size = 6) was used to allocate participants into three groups: ginger, fennel, or placebo, in a 1:1:1 ratio. The randomization sequence was generated by a biostatistician unaffiliated with the study to maintain impartiality. This sequence was concealed in opaque, sequentially numbered envelopes by a third party. To ensure double concealment, the treatment assignments were password-secured, preventing researchers, participants and healthcare providers from accessing the randomization list. Identical capsules were prepackaged in similar bottles, maintaining uniformity in appearance and preserving the integrity of blinding throughout the study. The administration of the capsules was carried out by a trained research assistant who was not involved in the study design, data collection, or outcome assessment. This assistant followed the coded sequence without knowledge of group assignments. The participants, primary investigator and data analyst were all blinded to the group allocations, maintaining a rigorous triple-blind design throughout the trial. The participants, Primary investigator and data analyser were blinded in this study.

Data collection tools and techniques

Data collection tools and techniques

A structured demographic questionnaire was used to collect data on participants’ age, BMI, menstrual cycle characteristics (duration, regularity, flow intensity), dietary habits, physical activity levels and pain history. These factors were recorded to control potential confounding variables.

Visual Analog Scale (VAS): The Visual Analog Scale (VAS) was used to assess the severity of menstrual pain. This tool consists of a single 10-point horizontal line, with values ranging from 0 to 10. A score of 0 represents “no pain,” while a score of 10 indicates the “worst pain imaginable”. This score provides a simple and direct measure of pain severity, with higher scores indicating greater pain intensity. VAS is widely recognized for its validity and reliability in pain research. In India, it has been extensively used in clinical studies, including research on dysmenorrhea, where it has demonstrated strong test-retest reliability (r > 0.85) and construct validity.[19]

Short form McGill Pain Questionnaire (SF-MPQ): The Short Form McGill Pain Questionnaire (SF-MPQ) was used to assess the multidimensional experience of menstrual pain. There are 15 descriptions in it: 11 sensory (such throbbing, stabbing, and cramping) and 4 affective (such as weary and nauseating). Each one is graded on a scale from 0 to 3 and the Present Pain Intensity (PPI) index is rated from 0 to 5. The overall score can be anything from 0 to 45, with higher numbers meaning worse conditions. The SF-MPQ has shown high psychometric qualities, such as internal consistency (Cronbach’s α = 0.7) has been tested and found to work for Indian women with dysmenorrhea.[20]

Pain Duration (Self-Structured tool): This tool was designed by the research team to measure the daily duration of menstrual pain (in hours) experienced by participants during the first three days of menstruation, as a part of a triple-blind crossover clinical trial evaluating ginger and fennel for primary dysmenorrhea. Participants recorded pain duration using a numeric chart, with scores ranging from 0 (no pain) to 24 h (maximum daily duration), allowing quantification of cumulative pain burden over the initial menstrual phase. The tool’s content was formulated based on a review of dysmenorrhea literature and consultations with 10 clinical experts (gynaecologists and nursing faculty with ≥5 years of experience in women’s health). To validate the tool, the Lawshe method was applied: experts rated each item for relevance and clarity, achieving a Content Validity Ratio (CVR) >0.80 and Content Validity Index (CVI) >0.80, confirming strong agreement. Internal consistency was assessed via Cronbach’s alpha of 0.7 (higher is considered acceptable)[21] in a pilot study, demonstrating high reliability.

Ethical considerations

“The study was conducted following the ethical principles outlined in the Helsinki Declaration.” “Ethical approval was obtained from the Institutional Ethics Committee (Approval No.: [127/I’EC/Ph.D./2020]) and registered with the CTRI by the (CTRI/2020/03/024407)” “https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=39795&EncHid=81873.50446&modid=1&compid=19”. “Written informed consent was obtained from all participants before enrollment. Participants were informed about their right to withdraw at any stage without any consequences.”

Intervention

This study used a triple-blind, randomized, crossover-controlled trial design to assess the efficacy of ginger and fennel in alleviating symptoms of primary dysmenorrhea among young women. Each participant received all three interventions, ginger, fennel and placebo in a randomly assigned sequence across three consecutive menstrual cycles. A washout period of four weeks was implemented between each cycle to avoid carryover effects and allow for clearance of active herbal constituents.

There were 384 people in the study, and they were randomly split into three groups with 128 people in each group. During menstruation, each group got Thirikadugam capsules (Ginger, 500 mg), Foeniculum vulgare (Fennel, 480 mg) or a placebo (500 mg gramme flour) every eight hours for three days in a row. We used standardized hydro-alcoholic extraction methods to make the herbal extracts and put them in capsules in a GMP-certified setting. To be sure they worked placebo capsules looked, smelt and felt just like the real thing. Randomization codes were made by a computer and a trained pharmacy assistant who was not involved in the study’s design, data collection or analysis prelabeled and distributed the capsules. This kept the study’s triple-blind design.

To make sure they followed the rules, participants kept daily consumption records and noted down any negative effects in a symptom journal. Weekly follow-up calls and pill count at follow-up visits made sure that everyone was following the restrictions. At the start, during treatment and at the end of each cycle, we recorded outcome measures such as pain intensity (VAS), pain duration (custom tool) and multidimensional pain experience (SF-MPQ). To avoid physiological overlaps or carryover effects a four-week washout period was used, which is the same length as one monthly cycle. This is in line with previous herbal intervention research. There were no major side effects reported during the research. Mild side effects were tracked and recorded using both patient-reported outcomes and assessments by investigators.

Safety data reporting

Throughout the study, participants were closely monitored for any adverse reactions to the interventions, ginger and fennel. Regular assessments included patient-reported outcomes and investigator observations to ensure comprehensive safety tracking.

Statistical and data analysis

All statistical analyses were performed using IBM SPSS Statistics version 27.0. Descriptive statistics, including mean, standard deviation and frequencies, were used to summarize baseline characteristics. The normality of the data was assessed using the Kolmogorov-Smirnov (K-S) test, which confirmed that the data were normally distributed. Between-group differences were assessed using one-way Analysis of Variance (ANOVA) (for comparing group means), followed by Tukey’s post hoc test (for pairwise comparisons). Paired t-tests were used to evaluate within-group changes over time (pre-post comparison) and Cohen’s d was calculated to determine the effect size. A P value of less than 0.05 was considered statistically significant (level of significance: P < 0.05).

Results

Sociodemographic

The study included 384 young women with primary dysmenorrhea, divided equally into three groups (ginger, fennel and placebo; n = 128 each). The mean age of participants was 20.66 ± 1.663 years, with a mean age at menarche of 13.49 ± 1.216 years. The average body mass index (BMI) was 23.07 ± 3.629 kg/m², indicating that most participants were within a normal weight range. Many participants were unmarried (99.2%), while only 0.8% were married. Regarding menstrual characteristics, the mean duration of bleeding was 4.40 ± 0.997 days and the mean cycle interval was 27.53 ± 2.412 days [Table 1]. None of the participants reported allergies to ginger or fennel, recent use of medication for menstruation regulation, or unhealthy habits such as smoking or alcohol consumption. The distribution of socio-demographic and menstrual characteristics was comparable across the three groups. One-way ANOVA showed no statistically significant differences in mean age, age at menarche, BMI, duration of bleeding, or cycle interval (P > 0.05). Similarly, marital status did not differ significantly among the groups (χ² (2) = 0.63, P = 0.729). These findings confirm that the randomization process was successful and that the groups were homogenous at baseline, supporting internal validity for the intervention analysis.

Table 1.

Distribution of socio-demographic characteristics by study groups

Variable		Ginger (n=128)		Fennel (n=128)		Placebo (n=128)		Test statistic		P
Age (years)		20.72±1.62		20.55±1.73		20.72 ±1.64		ANOVA F (2, 381)=0.61		0.543
Age at menarche (years)		13.55±1.23		13.50±1.19		13.42±1.23		ANOVA F (2, 381)=0.49		0.612
BMI (kg/m²)		22.88±3.75		23.12±3.54		23.22±3.62		ANOVA F (2, 381)=0.51		0.602
Marital status, n (%)		0.8%		0.8%		0.8%		χ² (2)=0.63		0.729
Duration of bleeding (days)		4.42±1.00		4.37±0.98		4.40±0.97		ANOVA F (2, 381)=0.34		0.714
Cycle interval (days)		27.60±2.39		27.44±2.45		27.55±2.41		ANOVA F (2, 381)=0.27		0.766

Descriptive statistics (mean±SD, frequency and percentage) and interferential statistics (ANOVA (for continues data) and Chi-square (for categorical data) were applied. (n is total sample size)

Pain severity results

The mean post-test pain severity scores showed that the ginger group (3.28 ± 1.21) had a lower pain severity compared with the fennel group (4.61 ± 1.26) and the placebo group (6.24 ± 1.51) [Table 2]. The obtained ‘z’ values for ginger (z = 28.07) and fennel (z = 18.65) were statistically significant at P < 0.001, indicating that the difference between preintervention and postintervention pain scores was not due to chance. The one-way ANOVA showed significant differences among the three groups (F = 475.91, P < 0.001) [Table 3].

Table 2.

Paired t-test based analysis to compare pain severity, intensity and duration before and after intervention

Groups		Pretest (mean±SD)		Post-test (mean±SD)		Mean difference		P
a. Comparison of prepain and postpain severity
Ginger		6.14±1.45		3.28±1.21		−2.86±1.35		<0.001*
Fennel		6.14±1.45		4.44±1.26		−1.70±1.28		<0.001*
Placebo		6.14±1.48		6.24±1.51		+0.10±1.46		0.547
b. Comparison of Prepain and Postpain Intensity Scores
Ginger		2.19±0.56		1.44±0.30		0.75±0.40		<0.001*
Fennel		2.19±0.56		1.49±0.36		0.70±0.42		<0.001*
Placebo		2.19±0.56		2.20±0.60		−0.01±0.30		0.161
c. Comparison of prepain and postpain pain duration
Ginger		10.78±5.24		5.60±4.61		5.18±4.93		<0.001*
Fennel		10.78±5.30		6.18±4.98		4.60±5.01		<0.001*
Placebo		10.78±5.30		10.55±5.33		0.23±5.07		0.161

*P<0.001

Table 3.

Cohens d and F-value for the comparison between groups before and after intervention

Groups		Cohen’s d		F
a. Comparison of Prepain and postpain severity
Ginger		1.43		475.91
Fennel		0.95
Placebo		0.04
b. Comparison of Prepain and Postpain Intensity Scores
Ginger		1.22		359.14
Fennel		1.06
Placebo		0.02
c. Comparison of prepain and postpain pain duration
Ginger		0.74		112.98
Fennel		0.70
Placebo		0.02

Tukey’s HSD post hoc test indicated that the ginger group differed significantly from both the fennel group (P = 0.000, 95% CI: −0.3805 to −0.9268) and the placebo group (P = 0.000, 95% CI: −3.1852 to −2.7315), while the fennel group also showed a significant difference from the placebo group (P = 0.000, 95% CI: −2.0315 to −1.5779).

Pain intensity results

The pretest mean pain intensity was 2.19 ± 0.56. After intervention, pain intensity reduced significantly in the ginger (1.44 ± 0.30) and fennel groups (1.49 ± 0.36) compared with the placebo group (2.20 ± 0.60) [Table 2]. The ginger group had the most substantial reduction (F = 359.14, P < 0.001). Z-values for ginger (z = 23.97) and fennel (z = 20.67) confirmed the significance (P < 0.001).

Tukey’s HSD post hoc analysis revealed no significant difference between the ginger and fennel groups (P = 0.224), while both groups differed significantly from the placebo group (P < 0.001).

Pain duration results

Both ginger and fennel groups showed a significant reduction in pain duration compared with placebo [Table 2]. On Day 1, ginger (7.27 ± 6.4) and fennel (8.19 ± 7.2) groups had a shorter pain duration. On Day 2 and Day 3, the ginger group consistently showed better pain reduction (F = 112.98, P < 0.001).

Tukey’s HSD test showed no significant difference between the ginger and fennel groups (P = 0.284), while both differed significantly from the placebo group (P = < 0.001)

Discussion

This study aimed to assess and compare the effectiveness of ginger and fennel capsules in reducing the severity, intensity and duration of pain in women with primary dysmenorrhea. The most valuable finding was the substantial reduction in pain severity, intensity and duration observed in participants who consumed ginger capsules compared with those who consumed fennel capsules.

The significant analgesic effect of ginger observed in this study can be attributed to the presence of bioactive compounds such as gingerol, shogaol and zingerone, which are known for their anti-inflammatory and analgesic properties.[22,23] These compounds are believed to inhibit the synthesis of prostaglandins and leukotrienes, thus reducing uterine contractions and menstrual pain. Specifically, gingerols and shogaols have been shown to modulate the cyclooxygenase (COX) and lipoxygenase (LOX) pathways, such as nonsteroidal anti-inflammatory drugs (NSAIDs), by inhibiting COX-2 enzyme activity. Furthermore, ginger’s potent antioxidant properties may also contribute to its pain-relieving effects by reducing oxidative stress and inflammation in the uterine tissue. This mechanism aligns with findings from multiple studies, including those by Ozgoli, Rahnama and Kashefi, all of whom found ginger effective in reducing menstrual pain.[18,24,25] However, to avoid redundancy, these findings are now synthesized collectively.

The analgesic action of ginger also appears to be influenced by its pharmacodynamic profile and high bioavailability. Gingerol rapidly enters systemic circulation, exerting effects within a short time span, which may explain the quicker and more pronounced relief seen in ginger users compared with fennel. Comparative studies strengthen the validity of these findings. For instance, Ozgoli reported ginger to be as effective as ibuprofen and mefenamic acid, suggesting it could be a viable natural alternative to NSAIDs. This is particularly significant given the potential gastrointestinal side effects, renal implications and contraindications associated with long-term NSAID use, positioning ginger as a potentially safer option for chronic pain management in dysmenorrhea. The growing patient preference for natural remedies also supports the integration of ginger into clinical practice. Similarly, Rahnama and Kashefi confirmed their effectiveness in lowering pain and medication dependence. These results, while well-supported, have now been consolidated to reduce repetitive citations and enhance coherence.

Regarding fennel, although its effectiveness was lower compared with ginger, it still exhibited significant improvements in symptom relief. The active constituent anethole may account for fennel’s antispasmodic and anti-inflammatory effects, contributing to the reduction of menstrual pain. Anethole is thought to exert its antispasmodic effects by modulating calcium channels and relaxing uterine smooth muscles, thereby alleviating painful contractions. Its anti-inflammatory action may also involve inhibition of pro-inflammatory cytokines. However, the lower efficacy of fennel could be due to differences in pharmacodynamics and bioavailability. Anethole may have a slower onset of action or require higher doses for comparable analgesic effects. In addition, fennel’s bioactive components may be less potent or less efficiently absorbed in the gastrointestinal tract, possibly leading to reduced therapeutic impact compared with ginger. This is consistent with Shobeiri,[26] who observed a significant pain reduction with fennel versus placebo. These data were consistent with results reported by Chen and Negi, further reinforcing the robustness of the findings.[27,28,29]

In addition, Ozgoli found ginger to be comparable to conventional NSAIDs and Kashefi highlighted its synergistic potential when combined with zinc sulfate. These studies are now mentioned succinctly to maintain clarity and avoid overemphasis. Although most literature supports the current results, inconsistencies exist due to differences in study design, sample sizes, formulations and dosage. For instance, variations in the duration of intervention, the timing of administration relative to pain onset, the specific extraction methods of the herbal compounds and the use of different pain assessment scales can significantly impact outcomes. Furthermore, individual variability in absorption, metabolism and response to herbal treatments possibly influenced by genetic or lifestyle factors may also account for the efficacy differences between ginger and fennel.

Future research should explore these variables in depth to tailor effective herbal treatment strategies. This includes investigating specific biomarkers of inflammation (e.g. C-reactive protein, prostaglandin F2α levels) and pain pathways to provide more objective measures of efficacy beyond self-report. The standardization of herbal extracts, ensuring consistent active compound concentrations and quality control, is also crucial for reproducibility and clinical application. In conclusion, ginger demonstrated superior efficacy compared with fennel in alleviating symptoms of primary dysmenorrhea. However, fennel still holds potential, particularly for those seeking milder, more gradual interventions or who may be intolerant to ginger. The combined or sequential use of both herbs could be investigated further. Moreover, examining factors such as optimal dosing, herb-drug interactions and pharmacokinetics may provide valuable insights for clinical practice. Larger, multicentric trials with longer follow-ups will help establish herbal alternatives as mainstream options in menstrual health care.

This study’s primary strength lies in being the first crossover randomized controlled trial comparing ginger and fennel for menstrual pain, with a large sample and evaluation of pain severity, intensity and duration. This robust design enhances the reliability and internal validity of the findings. While the design enhances reliability, limitations include reliance on self-reported pain, which inherently introduces subjectivity and potential recall bias, despite the use of validated scales. The individual variability in herbal response, as discussed, also presents a challenge in generalizing findings to all populations. Furthermore, the potential for unblinding due to the distinct taste and smell of the treatments, even in encapsulated form, could introduce performance bias, although participants were instructed not to guess their treatment. Future studies could explore more sophisticated blinding techniques or objective pain markers to mitigate these issues. Finally, while the sample size was large, the generalizability of these findings might be limited to populations with similar demographic and health profiles to the study participants, suggesting a need for diverse cohorts in future research.

Conclusion

The current study on a triple-blind crossover-controlled trial emphasizes the selection of spices during dysmenorrhea between ginger and fennel. Both significantly reduced pain severity, intensity and duration in women with primary dysmenorrhea, whereas ginger showed greater efficacy across all pain-related parameters, when compared with fennel. The World Health Organization (WHO) says that safe, evidence-based traditional medicine should be a part of healthcare systems ginger can be a cost-effective, accessible intervention.

Primary dysmenorrhea is still a frequent menstrual disorder that many women don’t get enough treatment even though it affects their everyday lives and quality of life. This implies Health practitioners will have simple, safe and effective ways to help women on their most painful days, while policymakers will have that women’s health initiatives can be improved using cheap, culturally appropriate treatments. Unlike conventional analgesics such as NSAIDs, which are often associated with side effects and limited accessibility in low-resource settings So we should Consider herbal options such as ginger and fennel into menstrual health management especially in low-resource settings.

By integrating these interventions into primary care, school health programs and community health education can provide women with safe and effective options for managing dysmenorrhea and could reduce the burden of menstrual pain and minimize reliance on synthetic medications. Their Implementation could not only mitigate the physical burden of menstrual pain but also enhancing women’s daily functioning, reducing absenteeism from school and work and improving overall quality of life among young women.

Future research should investigate prolonged safety and effectiveness of ginger and fennel across diverse demographics and ethnicities. Ultimately, the implementation of these approaches highlights the potential for the integration of traditional medicine with modern healthcare to address an issue that affects a significant proportion of women worldwide.

Informed consent statement

Informed consent was obtained from all participants involved in the study.

Author disclosure statement

No competing financial interests exist.

AI policy statement

The authors declare that no artificial intelligence (AI) tools were used for data analysis or interpretation. AI-assisted language editing was used only to improve grammar and readability. The scientific content, interpretation, and conclusions are entirely those of the authors.

Ethical approval

The study was approved by the Institutional Ethics Committee, AIIMS Rishikesh (Approval No. 127/IEC/Ph.D./2020) and prospectively registered with the Clinical Trials Registry–India (CTRI/2020/03/024407).

Author’s contributions

RN (Rizu Negi): Conceptualization, Project Administration, Data Curation, Formal Analysis, Investigation, Methodology, Writing: Original Draft Preparation, IHM (Inamul Hasan Madar): Conceptualization, Supervision, Data Curation, Formal Analysis, Investigation, Methodology, Writing–Review and Editing, KSC (Khanita Suman Chinannai): Formal Analysis, Investigation, Methodology, Writing–Review and Editing, SKS (Suresh K Sharma): Supervision, Validation, Visualization, Writing–Review and Editing. AB (Anupama Bahadur): Resources, Writing–Review and Editing.

Data availability statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflicts of interest

The authors declare that there is no conflict of interest.

Funding Statement

Self-funded.