green coconut water
menstrual pain
β-endorphin levels

How to Cite

Ulya, F. H., Suwandono, A., Ariyanti, I., Suwondo, A., Kumorowulan, S., & Pujiastuti, S. E. (2017). COMPARISON OF EFFECTS OF MASSAGE THERAPY ALONE AND IN COMBINATION WITH GREEN COCONUT WATER THERAPY ON B-ENDORPHIN LEVEL IN TEENAGE GIRLS WITH DYSMENORRHEA. Belitung Nursing Journal, 3(4), 412–419.
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Accepted for publication: 2017-08-31
Peer reviewed: Yes

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Background: Dysmenorrhea is pain during menstruation in lower abdomen, and is not due to other diseases. Effleurage massage and consuming green coconut water are considered able to reduce menstrual pain. However, little is known about the effect of the combination between the two interventions.

Objective: To compare the effectiveness of effleurage massage and in combination with green coconut water on pain, anxiety, and ß-endorphin level in teenage girls with menstrual pain (dysmenorrhea).

Design: A quasi-experiment with pretest-posttest approach design with control group. There were 36 samples recruited in this study by purposive sampling, which were divided into a massage therapy group, the combination therapy group, and a control group. Menstrual pain was measured using Numeric Rating Scale, while anxiety was measured using Zung Self rating Anxiety Scale (ZSAS), and endorphin level using ELISA (Enzyme-Linked Immunosorbent Assay). One-way ANOVA test and repeated ANOVA were performed as a bivariate analysis. MANCOVA and post hoc ANOVA were used for multivariate analysis.

Result: The combination of massage and green coconut water was more effective in reducing pain (p 0.013) and anxiety levels (p 0.000), and in increasing β-endorphin  (p 0.029) with significant value of <0.05 compared to the massage therapy alone.

Conclusion: The combination of effleurage massage and green coconut water had significant effect in decreasing anxiety and pain levels, and increasing β-endorphin levels in teenage girls with painful periods (dysmenorrhea); and more effective than performing effleurage massage only. It is suggested that this combination therapy could be used as an alternative therapy for women with dysmenorrhea.

Supporting Agencies

Magister Applied Midwifery, Poltekkes Kemenkes Semarang, Indonesia


Copyright (c) 2017 Fitria Hikmatul Ulya, Agus Suwandono, Ida Ariyanti, Ari Suwondo, Suryati Kumorowulan, Sri Endang Pujiastuti

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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French L. Dysmenorrhea. American Family Physician. 2005;71(2).

Tangchai K, Titapant V, Boriboonhirunsarn D. Dysmenorrhea in Thai adolescents: Prevalence, impact and knowledge of treatment. Journal-Medical Association of Thailand. 2004;87:S69-S73.

Liliwati I, Verna LKM, Khairani O. Dysmenorrhoea and its effects on school activities among adolescent girls in a rural school in Selangor, Malaysia. Medicine & Health. 2007;2(1):42-47.

Hendrik H. Problema haid: Tinjauan syariat Islam dan medis [Menstruation problem: Islamic and medical review]. Surakarta, Indonesia: Tiga Serangkai; 2006.

Dasuki D. Perilaku pencarian pengobatan keluhan dysmenorrhea pada remaja di Kabupaten Purworejo Propinsi Jawa Tengah [Treatment seeking behavior for dysmenorrhea in adolescents of Purworejo Regency of Central Java Province]. Yogyakarta: Universitas Gadjah Mada; 2006.

Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. American Family Physician. 2014;89(5):341-346.

Proverawati A, Misaroh S. Menarche menstruasi pertama penuh makna [Menarche: Meaningful first menstruation]. Yogyakarta: Nuha Medika; 2009.

Dawood MY. Primary dysmenorrhea: Advances in pathogenesis and management. Obstetrics & Gynecology. 2006;108(2):428-441.

Harel Z. Dysmenorrhea in adolescents and young adults: etiology and management. Journal of Pediatric and Adolescent Gynecology. 2006;19(6):363-371.

Nurkhasanah SS, Fetrisia WW. Pengaruh masase effleurage terhadap penurunan intensitas skala nyeri disminore pada siswi kelas IX MTsN 1 Bukittinggi tahun 2014 [Effect of effleurage massage in lowering pain intensity of dysmenorrhea in students at class IX MTsN 1 Bukittinggi in 2014]. Jurnal Kesehatan STIKes Prima Nusantara Bukittinggi. 2015;5(2).

Lestari F. Pengaruh pemberian air kelapa hijau terhadap tingkat nyeri haid pada mahasiswi Program Studi Ilmu Keperawatan STIKES 'Aisyiyah Yogyakarta [Effect of coconut water on menstrual pain in nursing students of STIKES 'Aisyiyah Yogyakarta]. Yogyakarta: STIKES 'Aisyiyah; 2015.

Bobak IM, Lowdermilk DL, Jensen MD. Buku ajar keperawatan maternitas [Maternity nursing textbook]. Jakarta: EGC; 2005.

Alifa S. Efek teknik masase effleurage pada abdomen terhadap penurunan intensitas nyeri pada disminore primer mahasiswa [Effect of effleurage massage in the abdominal area on pain intensity of primary dysmenorrhea in students]. Malang: PSIK FKUB; 2012.

Purwanti HS. Konsep penerapan ASI eksklusif [Exclusive breastfeeding concept]. Jakarta: EGC; 2004.

Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ. Principles of neural science. Vol 4: New York: McGraw-hill; 2000.

Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of magnesium. American Family Physician. 2009;80(2).

De Souza MC, Walker AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: A randomized, double-blind, crossover study. Journal of Women's Health & Gender-Based Medicine. 2000;9(2): 131-139.

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