Ninety-three trials with a total of 13,997 participants were included.
PMS.
Vitamin B6 was the subject of the most trials in this area and the majority of these demonstrated some benefit. The doses ranged from 50 to 600 mg/day, but no dose-response effects were seen. Due to inadequacies in the methodology of many studies and inconsistencies in the dose or outcome measure, it was not possible to make specific clinical recommendations. Reducing dietary fat or increasing exercise may benefit PMS and there was also some evidence for the benefits of calcium and magnesium supplements. Two studies of chaste-tree berry (Vitex agnus-castus) reported a benefit but only relative to baseline. Evening primrose (Oenethera biennis) oil did not appear to be effective in two of the three trials. Trials of manual therapies and mind-body treatments were few and had small sample sizes, high drop-out rates and a lack of placebo controls, but showed some beneficial outcomes.
Dysmenorrhea.
Consumption of fish oil supplements showed promising results, as did exercise programmes and acupuncture (based on one trial).
Infertility.
There was little evidence that CAM therapies were effective for infertility. In one trial a significantly higher viable pregnancy rate was demonstrated in both the cognitive-behavioural and support group treatment arms. A trial of chaste-tree berry found no significant differences between the groups in terms of spontaneous menstruation, pregnancy, or take-home baby rates during treatment or 6 months later.
Nausea and vomiting in pregnancy.
In 10 of the 14 studies acupuncture point stimulation for nausea and vomiting showed significant benefit on at least one measure. Three trials used needles, nine acupressure bracelets, one self-applied finger pressure and one transcutaneous electric nerve stimulation. Two small studies found significant benefits with ginger at doses of 500 mg/day and 1 g/day. Vitamin B6 lessened nausea in two trials.
Other pregnancy symptoms.
One trial supported acupuncture for back or pelvic pain, while massage improved both back pain and mood in another. Positive benefits were seen for plant-derived rutosides, magnesium and immersion in water.
Labour induction and outcomes.
No major effects were observed for acupuncture point stimulation for inducing labour. One trial of moxibustion for turning breech babies showed promising results. Mind-body therapies and massage might reduce anxiety and pain during labour but more research is needed. The benefits of perineal massage were inconsistent. Neither aromatherapy nor homeopathy reduced perineal discomfort. Listening to a relaxation or imagery tape increased the volume of milk in mothers of premature infants. The application of cabbage leaves or cabbage extract failed to help breast engorgement in four controlled trials.