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Inter. J. of Phytotherapy / Vol 5 / Issue 2 / 2015 / 98-101.

e - ISSN - 2249-7722
Print ISSN - 2249-7730

International Journal of Phytotherapy


www.phytotherapyjournal.com

CITRUS THERAPY CONTROLLING THE MENSTRUAL FLOW


Andrade Priscila M, Passianoto Talita YS, Belsito Izabella PB, Silva Carolina C,
Caneira rika G, Santos Maynara Z, Garcia Gabriela S, Oliveira Letcia C, Farias
Elias, Borra, Ricardo C
1

Medicine Department, Federal University of So Carlos (UFSCar), So Carlos, Brazil.


Genetics and Evolution Department, Federal University of So Carlos (UFSCar), So Carlos, Brazil.

ABSTRACT
The excessive blood loss during the menstrual period might affect quality of life and can lead to medical
problems. There are clinical reports suggesting that it is possible to reduce menstrual flow using lemon juice.
Probably the bioactive components with anti-inflammatory and vasoconstrictor properties such as flavonoids,
diosmin, hesperidin, coumarins and synephrine act on reducing menstrual flow and colics. However, as these
implications were still not confirmed, the objective became the evaluation of the citrus Phytotherapys capacity to
reduce menstrual flow and the collateral effects associated with its use. Then 47 women, between 18 and 40 years
old, were selected to answer two questionnaires. The first questionnaire was administered before using citrus
therapy to evaluate the baseline characteristics of the menstrual cycle. The second questionnaire was administered
after the use of one Tahiti lemon juice per day, during the first three days of menstrual flow and three consecutive
menstrual cycles, to evaluate phytotherapeutic effects in the cycle duration, intensity of menstrual flow, occurrence
of cramps and reduction of the presence of clots. Results showed significant reduction in the duration of the
menstrual flow in 23% of the participants and in the intensity of menstrual flow in 72% of them, reduction of the
presence of clots in 43% of them and complete disappearance of dysmenorrheal, in 21% of the women after citrus
therapy. Therefore, we conclude that the citrus therapy was able to promote the reduction of unfavorable effects
associated with the menstrual cycle.
Key words: Citrus Therapy, Lemon, Menstrual Flow.

INTRODUCTION
Ribeiro [1] emphasizes that the modern woman
experiences more menstrual cycles than her ancestors,
which experienced the menarche later in life, have passed
by multiple pregnancies and long periods of breastfeeding
which suppresses the menstruation. For some women, this
complex menstrual cyclic action, although natural, can
compromise the quality of life, even when the blood flow
is not excessive.
According to Souza [2], the coordination of all
systems which are involved in menstrual cycle, it is
considered one of the most notable. Women experience
an average of 400 menstruations throughout her lives.

This is a periodic event of endometrial desquamation


which manifests approximately every 28 days, starting
with menarche and ending with menopause. The majority
of women present menstrual cycles with an interval
ranging anywhere from 24 to 35 days. We consider a
pattern the interval of 28 days. The duration is between 3
to 7 days on average and, most of blood loss occurs
during the first three days of menstrual flow.
For Kronenberg [3], the composition of the flow
is comprised of blood and flaking fragments of
endometrium liquefied by fibrinolytic activity of the
cellular remains. Gilraldo [4] affirms that progesterone

Corresponding Author:- Prof. Dra. Priscila Maria De Andrade Borra Email: pmborra@gmail.com

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Inter. J. of Phytotherapy / Vol 5 / Issue 2 / 2015 / 98-101.

drop at the end of the ovulatory cycle, fatty acids, omega


6, particularly arachidonic acid, are released and a large
amount of prostaglandins and leukotrienes start to cause a
high production of E2 and F2- prostaglandins in the
uterus which cause vasoconstriction and muscle
contractions. Junqueira [5] emphatizes that the
contraction of the spiral arteries block the blood flow,
causing death of arterial walls by necrosis and
consequently also, the portion of the endometriums
functional layer irrigated by them.
We agree with Petracco [6] when he says that
excessive blood loss during the menstrual period can lead
to medical problems. Thus, 50% of women with
menorrhagia develop a certain degree of anemia. Heavy
menstrual periods may affect women's quality of life
based on their combination with menstrual cramps and the
necessity of frequent changing of menstrual pads. Jain [7]
reports the current use of non-steroid anti-inflammatory
drugs (NSAIDs) in order to overcome problems such as
excessive menstrual flow and the occurrence of menstrual
cramps, due to it reducing bleeding in approximately 30%
to 50% and inhibiting the production of endometrial
prostaglandins and altering the ratio of thromboxan /
prostacyclin.
The Brazilian Ministry of Health [8] reports the
treatment based on medicinal plants with prophylactic,
curative, palliative or diagnostic purposes, became
officially recognized by the WHO in 1978. According to
Spethman [9], in herbal medicine records throughout
history, the lemon from the family Rutaceae and genus
Citrus sp., is a fruit widely used for many different
diseases. There are reports from gynecological clinical
tests, suggesting that the use of lemon juice can alter the
menstrual flow.
S [10] emphasizes that citrus fruits exhibit
potencial properties to reduce menstrual flow with the
containment of bioactive compounds including
flavonoids, diosmin, hesperidin, coumarins and
synephrine. The flavonoids can act as free radical
scavengers, enzyme activities modulators, exerting antiinflammatory activities. The anti-inflammatory properties
presented by diosmin and hesperidin compounds are
justified by inhibiting pro-inflammatory mediators
synthesis, especially arachidonic acid derivatives,
prostaglandins E2 and F2 and thromboxane A2. For
Rossato [11] the synephrine are agonists of the alpha and
beta adrenergic receptors, which during the activation of
alpha 1 receptor promote contraction of the smooth
muscle producing vasoconstrictor effects.
Considering that certain components of lemon
juice exhibit anti-inflammatory and vasoconstrictory
properties with potential for reducing menstrual flow
which is a nuisance for some women, this study aimed to

evaluate feasibility of using the citrus herbal medicine in


the reduction of menstrual flow and associated side
effects.
MATERIALS AND METHODS
We used 47 women during menstruation,
between the ages of 18 to 40. After being informed about
the study, they agreed to sign the term of Free and
Informed Consent (approved project no 224.958, by
Ethics and Research Committee of the Federal University
of So Carlos). Patients with uterine fibroids,
endometriosis, cancer, coagulation disorders or that were
using anti-inflammatory or other medicinal products
during menstruation were excluded.
To prove the effect of citrus therapy in menstrual
flow, the participants answered two questionnaires: one
considered the basal menstrual pattern and other after
using Tahiti lemon juice. In the initial evaluation, the
volunteers informed the characteristics of their menstrual
cycle such as: interval, flow duration, presence of clots,
IUD use or hormonal contraceptives, occurrence of
menstrual cramps, use of medications, physical activity,
alcohol use and smoking.
After answering the first questionnaire, the
participants were instructed to ingest the Tahiti lemon
juice during the day, the time preference of the volunteer,
from the first to the third day of menstrual flow, for three
consecutive menstrual cycles. After three consecutive
periods using lemon, the volunteers answered the second
questionnaire which evaluated the changes in the
menstrual pattern considering: changes in the number of
days, cycle regularity, occurrence of cramps and
elimination of clots. The volunteers were still questioned
about any changes in life habits, such as alcohol
consumption, physical activities and changes in
contraceptive method, since it could influence the results.
Statistical Analysis
The paired Wilcoxon test was used for verifying
the change of categories in the pattern of menstrual flow
of patients before and after application of the treatment.
The binomial test was used for verifying the existence of
a change in the proportion of patients with a decrease in
the occurrence of clots, cramps or menstrual flow,
whereas 0% is the proportion of expected decrease in case
of no intervention. Fisher's exact test was conducted to
eliminate the possibility of interference from the change
in the patterns of medication use, contraceptive use,
physical activity or alcohol use to the results found. All
tests were performed with the program SPSS 17.0 (SPSS
Inc., Chicago, IL, EUA) and with statistical significance
when p<0.05 was considered.
RESULTS
The classification category of the menstrual flow
pattern of each participant (1 to 2, 2 to 3, 3 to 5, more

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than 7 days of menstruation) was being compared before


and after the citrus therapy. There was a significant
improvement which was observed (paired Wilcoxon,
p<0.01) in the menstrual flow pattern of the participants
wherein, 11 (23.4 %) of the women improved one
category or more, 35 (74.5%) did not change category and
only one woman (2.1%) worsened her classification by 1
point. This change was not statistically significant when
correlated with those in the patterns of alcohol use
(p=0.596), physical activity (p=0.196), use of medications
(0.774) or use of contraceptive methods (p=1.000).
Analyzing the proportion of patients with
reduced presence of clots after citrus therapy, there was a
significant difference which was observed (Binomial test,
p<0.01) in the proportion of patients who reported a
decrease (n=20.43%), considering an expected proportion
of 0%. This change was not statistically significant when
correlated with those in the patterns of alcohol use
(p=0.500), physical activity (p=0.915), medication use
(0.164) or use of contraceptive methods (p=0.675).

Comparing the proportion of patients with


reductions of menses after citrus therapy, there was a
significant difference which was observed (Binomial test,
p<0.01) in the proportion of patients who reported a
decrease (n=34.72%), considering an expected proportion
of 0%. This change was not statistically significant when
correlated with those in the patterns of alcohol use
(p=1.000), physical activity (p=0.888), medication use
(1.000) or use of contraceptive methods (p=1.000).
Confronting the proportion of patients with
reductions of colic presence after citrus therapy, there was
a significant difference which was observed (Binomial
test, p<0.01) in the proportion of patients who reported a
decrease (n=10.21%), considering an expected proportion
of 0%. This change was not statistically significant when
correlated (Fisher's exact test) with those in the patterns of
alcohol use (p=0.247), physical activity (p=0.333),
medication use (1.000) or use of contraceptive methods
(p=0.384).

Table 1. Change in menstrual flow pattern after citrus therapy.


Variable
Flow pattern (after) - Flow pattern (before)
<0: Improved a category
= 0: Not changed
Menstrual
Flow Pattern
> 0: Worsened a category
Total
Wilcoxon paired statistical test: p<0.01.

Frequency
11
35
1
47

Table 2. Proportion of patients with decreased presence of clots after citrus therapy.
Decrease in the presence of clots
Frequency
20
Yes
27
No (did not change or increased)
47
Total
Binomial test for expected ratio of 0% of patients with decreased presence of clots: p<0.01.

(%)
23.4
74.5
2.1
100.0

(%)
43%
57%
100.0

Table 3. Proportion of patients with decreased intensity of menstrual flow after citrus therapy.
Decreasing the intensity of the flow
Frequency
(%)
34
72%
Yes
13
28%
No (did not change or increased)
47
100.0
Total
Binomial test for expected ratio of 0% of patients with decreased intensity of flow: p<0.01.
Table 4. Proportion of patients with a reduction in the presence of cramps after citrus therapy.
Decreasing the intensity of the flow
Frequency
10
Yes
37
No (did not change or increased)
47
Total
Binomial test for expected ratio of 0% of patients with reduction in the presence of colic: p<0.01.
DISCUSSION
In the present study, it was observed a reduction
of menstrual flow in 72% of the volunteers, with the use
of citrus therapy. This reduction was observed in the
number of bleeding days, and in reducing the number of

(%)
21%
79%
100.0

spent menstrual pads. Of the 47 women, 23.4% had


decreased to less than 1 day of menses during the study.
Regarding the presence of dysmenorrhea, 21% of
women who reported menstrual cramps did not

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Inter. J. of Phytotherapy / Vol 5 / Issue 2 / 2015 / 98-101.

experience this symptom during supplementation with


lemon. The decrease in the presence of clots was reported
by 43% of respondents. There were also reports of
irregularities in the range of the menstrual cycle in 17% of
the surveyed, while they did supplementation with lemon.
However, there was no significant correlation between the
types of change (increasing or decreasing) reported,
because 5 patients reported an increase and 3 reported a
decrease from the first day of menstrual flow, therefore,
there was an absence of a pattern of change. In the
analysis of changes in menstrual pattern, we were careful
to discard the interference of possible events such as:
medication, changes in the contraceptive method, changes
in the pattern of physical activity and alcohol use in the
routine of these women, so we can infer that menstrual
changes were the result solely and exclusively of the
citrus therapy effect, since none of analysis showed a
significant correlation between the changes in menstrual

characteristics analyzed above and the variables. The


results generated in this study, which were triggered by
the Tahiti lemon juice consumption, shows bioactive
compounds including: flavonoids, diosmin, hesperidin,
coumarins and sinefrinas which have anti-inflammatory
activities. They were able to reproduce the beneficial
effect of reducing and shortening the menstrual flow and
preventing the occurrence of dysmenorrhea.
Thus, citrus phytotherapy can be a candidate to
replace the use of synthetic non-steroidal antiinflammatory pharmaceuticals, to shorten the menstrual
uterine bleeding and to prevent menstrual cramps.
CONCLUSION
Citrus therapy was able to influence the
occurrence of dysmenorrhea and menstrual flow pattern,
decreasing bleeding and duration.

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