1. Introduction
menstrual pain, primary dysmenorrhea, dysmenorrhea, pain, dysmenorrhea pain
VASODILATION, DYSMENORRHEA, MENSTRUAL PAIN, DYSMENORRHEA, PRIMARY DYSMENORRHEA
Dysmenorrhea, the pain experienced by women during menstruation, affects a significant proportion of women worldwide and often leads to decreased productivity. Various pharmacological and non-pharmacological treatments are available for pain relief, but information on their effectiveness, particularly regarding green coconut water, dark chocolate, and Ibuprofen, remains limited. This study aimed to compare the effectiveness of green coconut water, dark chocolate bars, and Ibuprofen in reducing the intensity of primary dysmenorrhea. In this research, a randomized controlled trial with a quantitative design was conducted, involving 45 participants randomly assigned to receive 330 mL of green coconut water, 35 g of 70% dark chocolate, or 400 mg Ibuprofen. The interventions were administered on the first day of menstruation when dysmenorrhea symptoms typically occur in subjects. This study used a single-dose approach to evaluate the immediate impact of each treatment. The subjects were instructed to consume the given interventional product within 15 min. The pain intensity was measured using a Numeric Rating Scale before the intervention and 2 h after the subjects finished consuming the interventional product. The multivariate Kruskal–Wallis test revealed a significant difference in effectiveness among the three interventions (Women have a unique reproductive system because they experience menstruation every month. During menstruation, women usually feel various intensities of pain, ranging from mild to severe, called dysmenorrhea [The incidence of menstrual pain is relatively high; globally, 50–90% of women of reproductive age experience pain, most of which is caused by primary dysmenorrhea [Dysmenorrhea results in a substantial productivity loss [A previous RCT study conducted in Indonesia specifically compared the efficacy of green coconut water in two different doses, 330 mL and 165 mL, and also with 330 mL mineral water as the control group, showing that the 330 mL green coconut water dose was an effective dose compared to the control. In contrast, another dose had a weak effect. This finding proves that green coconut water can be a non-pharmacological alternative in handling dysmenorrhea pain [In recent years, natural remedies for managing dysmenorrhea have gained attention. Furthermore, green coconut water, dark chocolate, and Ibuprofen are known to work through similar mechanisms in reducing the intensity of menstrual pain. Green coconut water and dark chocolate contain high levels of magnesium, which can help reduce smooth muscle tension and potentially cause vasodilation in blood vessels. The flavonoid content in dark chocolate is also known for its natural anti-inflammatory properties by inhibiting the production of prostaglandin hormones, which are responsible for the pain experienced during menstruation. On the other hand, Ibuprofen is one of the most commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) for the pharmacological management of dysmenorrhea. It works similarly to green coconut water and dark chocolate by inhibiting the production of prostaglandin hormones and causing the vasodilation and relaxation of smooth muscles, aiming to decrease the intensity of menstrual pain [Therefore, investigating the comparative effectiveness of these interventions, namely green coconut water, dark chocolate, and Ibuprofen, in reducing the intensity of primary dysmenorrhea is essential in determining their potential as alternative management options. This study aims to address this research gap through a randomized controlled trial and provide valuable insights into the effectiveness of these interventions in the context of dysmenorrhea management.