{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:32:51Z","timestamp":1791325971407,"version":"4.3.1"},"reference-count":62,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Primary dysmenorrhea (PD) is a common condition affecting up to 90% of menstruating women, which often results in significant pain without an underlying pathology. Zinc, recognized for its anti-inflammatory and antioxidant effects through inhibiting prostaglandin production and superoxide dismutase 1 (SOD1) upregulation, alleviates menstrual pain by preventing uterine spasms and enhancing microcirculation in the endometrium, suggesting its potential as an alternative treatment for primary dysmenorrhea. The goal of this systematic review and meta-analysis was to assess the efficacy and safety of zinc supplementation in reducing pain severity among women with PD and to explore the influence of dosage and treatment duration. Methods: Following the PRISMA 2020 guidelines, we conducted an extensive search across databases such as PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar, up to May 2024. Randomized controlled trials assessing the effects of zinc supplementation on pain severity in women with PD were included. Pain severity was evaluated with established tools, such as the Visual Analog Scale (VAS). Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool. Two reviewers independently performed the data extraction, and a random-effects model was used for meta-analysis. Meta-regressions were conducted to examine the influence of zinc dosage and treatment duration on pain reduction. Adverse events were also analyzed. Results: Six RCTs involving 739 participants met the inclusion criteria. Zinc supplementation significantly reduced pain severity compared to placebo (Hedges\u2019s g = \u22121.541; 95% CI: \u22122.268 to \u22120.814; p &lt; 0.001), representing a clinically meaningful reduction in pain. Meta-regression indicated that longer treatment durations (\u22658 weeks) were associated with greater pain reduction (p = 0.003). While higher zinc doses provided additional pain relief, the incremental benefit per additional milligram was modest (regression coefficient = \u22120.02 per mg; p = 0.005). Adverse event rates did not differ significantly between the zinc and placebo groups (odds ratio = 2.54; 95% CI: 0.78 to 8.26; p = 0.122), suggesting good tolerability. Conclusions: Zinc supplementation is an effective and well-tolerated option for reducing pain severity in women with primary dysmenorrhea. Doses as low as 7 mg\/day of elemental zinc are sufficient to achieve significant pain relief, with longer durations (\u22658 weeks) enhancing efficacy. The favorable safety profile and ease of use support the consideration of zinc supplementation as a practical approach to managing primary dysmenorrhea.<\/jats:p>","DOI":"10.3390\/nu16234116","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T09:21:23Z","timestamp":1732785683000},"page":"4116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy of Zinc Supplementation in the Management of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4453-9590","authenticated-orcid":false,"given":"Ting-Jui","family":"Hsu","sequence":"first","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong-Hong","family":"Hsieh","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Research Center of Nutritional Medicine, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin-Huan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5785-2373","authenticated-orcid":false,"given":"Chih-Shou","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"School of Medicine, National Cheng Kung University, Tainan City 701401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Ching","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Hui","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Tsai","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Liang","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8382-0017","authenticated-orcid":false,"given":"Hui-Ming","family":"Tsai","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1805-0538","authenticated-orcid":false,"given":"Dong-Ru","family":"Ho","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.12688\/f1000research.11682.1","article-title":"Dysmenorrhea and Related Disorders","volume":"6","author":"Bernardi","year":"2017","journal-title":"F1000Research"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1136\/bmj.332.7550.1134","article-title":"Diagnosis and Management of Dysmenorrhoea","volume":"332","author":"Proctor","year":"2006","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.contraception.2009.09.014","article-title":"Nonsteroidal Anti-Inflammatory Drugs and Hormonal Contraceptives for Pain Relief from Dysmenorrhea: A Review","volume":"81","author":"Zahradnik","year":"2010","journal-title":"Contraception"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1097\/01.AOG.0000230214.26638.0c","article-title":"Primary Dysmenorrhea: Advances in Pathogenesis and Management","volume":"108","author":"Dawood","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1517\/14656566.2012.725045","article-title":"Dysmenorrhea in Adolescents and Young Adults: An Update on Pharmacological Treatments and Management Strategies","volume":"13","author":"Harel","year":"2012","journal-title":"Expert. Opin. Pharmacother."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1093\/humupd\/dmv039","article-title":"What We Know about Primary Dysmenorrhea Today: A Critical Review","volume":"21","author":"Iacovides","year":"2015","journal-title":"Hum. Reprod. Update"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.jogc.2016.12.023","article-title":"No. 345-Primary Dysmenorrhea Consensus Guideline","volume":"39","author":"Burnett","year":"2017","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mendiratta, V., and Lentz, G.M. (2022). Primary and Secondary Dysmenorrhea, Premenstrual Syndrome, and Premenstrual Dysphoric Disorder. Comprehensive Gynecology, Elsevier.","DOI":"10.1016\/B978-0-323-65399-2.00044-9"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nasiadek, M., Stragierowicz, J., Klimczak, M., and Kilanowicz, A. (2020). The Role of Zinc in Selected Female Reproductive System Disorders. Nutrients, 12.","DOI":"10.3390\/nu12082464"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1152\/physrev.1993.73.1.79","article-title":"The Biochemical Basis of Zinc Physiology","volume":"73","author":"Vallee","year":"1993","journal-title":"Physiol. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.mehy.2005.06.013","article-title":"High-Dose Zinc to Terminate Angina Pectoris: A Review and Hypothesis for Action by ICAM Inhibition","volume":"66","author":"Eby","year":"2006","journal-title":"Med. Hypotheses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3000605231171489","DOI":"10.1177\/03000605231171489","article-title":"Efficacy of Zinc Supplementation for the Treatment of Dysmenorrhoea: A Double-Blind Randomised Controlled Trial","volume":"51","author":"Obiagwu","year":"2023","journal-title":"J. Int. Med. Res."},{"key":"ref_13","first-page":"363","article-title":"Comparison of Efficacy and Safety of Zinc Gluconate versus Placebo for Treatment of Primary Dysmenorrhea","volume":"26","author":"Safdar","year":"2022","journal-title":"J. Rawalpindi Med. Coll."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","unstructured":"Hsu, T.-J., and Tsai, H.-M. (2024, October 18). Efficacy of Zinc Supplementation in Management of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. PROSPERO, CRD42024579213, 2024. Available online: https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42024579213."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_17","first-page":"e088","article-title":"Validation of Digital Visual Analog Scale Pain Scoring with a Traditional Paper-Based Visual Analog Scale in Adults","volume":"2","author":"Delgado","year":"2018","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1007\/s00586-005-1044-x","article-title":"Pain Assessment","volume":"15","author":"Haefeli","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3102\/10769986006002107","article-title":"Distribution Theory for Glass\u2019s Estimator of Effect Size and Related Estimators","volume":"6","author":"Hedges","year":"1981","journal-title":"J. Educ. Stat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring Inconsistency in Meta-Analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Borenstein, M., Hedges, L.V., Higgins, J.P.T., and Rothstein, H.R. (2009). Fixed-Effect versus Random-Effects Models. Introduction to Meta-Analysis, John Wiley & Sons, Ltd.","DOI":"10.1002\/9780470743386"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in Meta-Analysis Detected by a Simple, Graphical Test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.pmn.2013.09.001","article-title":"Comparison of the Effect of Ginger and Zinc Sulfate on Primary Dysmenorrhea: A Placebo-Controlled Randomized Trial","volume":"15","author":"Kashefi","year":"2014","journal-title":"Pain. Manag. Nurs."},{"key":"ref_24","first-page":"378","article-title":"The Positive Effects of Zinc Supplements on the Improvement of Primary Dysmenorrhea and Premenstrual Symptoms: A Double-Blind, Randomized, Controlled Trial","volume":"3","author":"Sangestani","year":"2015","journal-title":"J. Midwifery Reprod. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/ajo.12367","article-title":"A Randomised Controlled Trial of Oral Zinc Sulphate for Primary Dysmenorrhoea in Adolescent Females","volume":"55","author":"Zekavat","year":"2015","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"107","DOI":"10.5001\/omj.2016.21","article-title":"The Efficacy of Zinc Administration in the Treatment of Primary Dysmenorrhea","volume":"31","author":"Teimoori","year":"2016","journal-title":"Oman Med. J."},{"key":"ref_27","first-page":"768","article-title":"Zinc: An Essential Micronutrient","volume":"79","author":"Saper","year":"2009","journal-title":"Am. Fam. Physician"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2165\/00148581-200810010-00001","article-title":"Dysmenorrhea in Adolescents: Diagnosis and Treatment","volume":"10","author":"French","year":"2008","journal-title":"Paediatr. Drugs"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Walsh, S.W. (2011). Prostaglandins in Pregnancy. Glob. Libr. Women\u2019s Med.","DOI":"10.3843\/GLOWM.10315"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.mehy.2006.12.009","article-title":"Zinc Treatment Prevents Dysmenorrhea","volume":"69","author":"Eby","year":"2007","journal-title":"Med. Hypotheses"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1095\/biolreprod28.4.883","article-title":"Copper and Zinc Inhibit the Metabolism of Prostaglandin by the Human Uterus","volume":"28","author":"Kelly","year":"1983","journal-title":"Biol. Reprod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/jnci\/dji006","article-title":"Dietary Zinc Modulation of COX-2 Expression and Lingual and Esophageal Carcinogenesis in Rats","volume":"97","author":"Fong","year":"2005","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_33","first-page":"1081","article-title":"Oral Administration of Zinc Capsule for 4 Days before Menstrual Period Decreases Prostaglandin (PGF 2 \u03b1) Level and Pain Intensity in Women with Primary Dysmenorrhea","volume":"6","author":"Sundari","year":"2017","journal-title":"Int. J. Sci. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.taap.2008.04.012","article-title":"Regulation of Cyclooxygenase-2 Expression by CAMP Response Element and MRNA Stability in a Human Airway Epithelial Cell Line Exposed to Zinc","volume":"231","author":"Wu","year":"2008","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.exger.2007.10.013","article-title":"Clinical, Immunological, Anti-Inflammatory and Antioxidant Roles of Zinc","volume":"43","author":"Prasad","year":"2008","journal-title":"Exp. Gerontol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"do Nascimento Marreiro, D., Cruz, K.J.C., Morais, J.B.S., Beserra, J.B., Severo, J.S., and de Oliveira, A.R.S. (2017). Zinc and Oxidative Stress: Current Mechanisms. Antioxidants, 6.","DOI":"10.3390\/antiox6020024"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1093\/humrep\/17.7.1709","article-title":"Different Mechanisms for the Induction of Copper-Zinc Superoxide Dismutase and Manganese Superoxide Dismutase by Progesterone in Human Endometrial Stromal Cells","volume":"17","author":"Sugino","year":"2002","journal-title":"Hum. Reprod."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S0015-0282(16)56884-8","article-title":"Zinc and Copper Levels in Premenstrual Syndrome","volume":"62","author":"Chuong","year":"1994","journal-title":"Fertil. Steril."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s12011-019-01757-9","article-title":"Effect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"194","author":"Jafari","year":"2020","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s12011-022-03175-w","article-title":"The Effect of Zinc Supplementation on the Improvement of Premenstrual Symptoms in Female University Students: A Randomized Clinical Trial Study","volume":"201","author":"Ahmadi","year":"2023","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Oboza, P., Ogarek, N., W\u00f3jtowicz, M., Rhaiem, T.B., Olszanecka-Glinianowicz, M., and Koce\u0142ak, P. (2024). Relationships between Premenstrual Syndrome (PMS) and Diet Composition, Dietary Patterns and Eating Behaviors. Nutrients, 16.","DOI":"10.3390\/nu16121911"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Matsas, A., Sachinidis, A., Lamprinou, M., Stamoula, E., and Christopoulos, P. (2023). Vitamin Effects in Primary Dysmenorrhea. Life, 13.","DOI":"10.3390\/life13061308"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5468\/ogs.20205","article-title":"Role of Vitamin D and Calcium in the Relief of Primary Dysmenorrhea: A Systematic Review","volume":"64","author":"Abdi","year":"2021","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1689S","DOI":"10.1093\/ajcn\/80.6.1689S","article-title":"Overview of General Physiologic Features and Functions of Vitamin D","volume":"80","author":"DeLuca","year":"2004","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2952","DOI":"10.1210\/jc.2006-2726","article-title":"Cyclical Changes in Calcium Metabolism across the Menstrual Cycle in Women with Premenstrual Dysphoric Disorder","volume":"92","author":"McMahon","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/j.1447-0756.2009.01159.x","article-title":"Influence of Dietary Intake of Dairy Products on Dysmenorrhea","volume":"36","author":"Ayoub","year":"2010","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"6847","DOI":"10.1158\/1078-0432.CCR-04-0744","article-title":"Phase I Clinical Trial of Oral Curcumin: Biomarkers of Systemic Activity and Compliance: Biomarkers of Systemic Activity and Compliance","volume":"10","author":"Sharma","year":"2004","journal-title":"Clin. Cancer Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"96","DOI":"10.4082\/kjfm.23.0184","article-title":"Effect of Curcumin on Dysmenorrhea and Symptoms of Premenstrual Syndrome: A Systematic Review and Meta-Analysis","volume":"45","author":"Sharifipour","year":"2024","journal-title":"Korean J. Fam. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"101840","DOI":"10.1016\/j.jogoh.2020.101840","article-title":"Randomized, Double-Blind, Placebo-Controlled Clinical Trial Studying the Effects of Turmeric in Combination with Mefenamic Acid in Patients with Primary Dysmenorrhoea","volume":"50","author":"Hesami","year":"2021","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"6954","DOI":"10.1002\/ptr.7314","article-title":"Effects of Curcumin on Menstrual Pattern, Premenstrual Syndrome, and Dysmenorrhea: A Triple-Blind, Placebo-Controlled Clinical Trial","volume":"35","author":"Bahrami","year":"2021","journal-title":"Phytother. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e15763","DOI":"10.14814\/phy2.15763","article-title":"Effect of Curcumin on Inflammatory Biomarkers and Iron Profile in Patients with Premenstrual Syndrome and Dysmenorrhea: A Randomized Controlled Trial","volume":"11","author":"Talebpour","year":"2023","journal-title":"Physiol. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"502","DOI":"10.3109\/09513590.2015.1136617","article-title":"The Effect of Vitamin D on Primary Dysmenorrhea with Vitamin D Deficiency: A Randomized Double-Blind Controlled Clinical Trial","volume":"32","author":"Moini","year":"2016","journal-title":"Gynecol. Endocrinol."},{"key":"ref_53","first-page":"14","article-title":"Evaluation of the Effects of Oral Vitamin-D for Pelvic Pain Reduction in Primary Dysmenorrhea","volume":"16","author":"Zangene","year":"2014","journal-title":"Iran. J. Obstet. Gynecol. Infertil."},{"key":"ref_54","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2023). Chapter 10: Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions, Version 6.4 (Updated August 2023), Cochrane. Available online: www.training.cochrane.org\/handbook."},{"key":"ref_55","unstructured":"Institute of Medicine (US) (2001). Panel on Micronutrients Zinc. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc, National Academies Press."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/ajcn\/51.2.225","article-title":"Zinc Toxicity","volume":"51","author":"Fosmire","year":"1990","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.3390\/ijerph7041342","article-title":"The Essential Toxin: Impact of Zinc on Human Health","volume":"7","author":"Plum","year":"2010","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/156482650102200201","article-title":"The Importance of Zinc in Human Nutrition and Estimation of the Global Prevalence of Zinc Deficiency","volume":"22","author":"Brown","year":"2001","journal-title":"Food Nutr. Bull."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1111\/j.1471-0528.1996.tb09597.x","article-title":"A Longitudinal Study of Risk Factors for the Occurrence, Duration, and Severity of Menstrual Cramps in a Cohort of College Women","volume":"103","author":"Harlow","year":"1996","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"138","DOI":"10.3109\/03009730903457218","article-title":"Prevalence of Dysmenorrhea and Its Effect on Quality of Life among a Group of Female University Students","volume":"115","author":"Unsal","year":"2010","journal-title":"Ups. J. Med. Sci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"34","DOI":"10.15562\/bmj.v6i1.380","article-title":"Effectiveness of Zinc Supplementation in Treating Dysmenorrhea","volume":"6","author":"Farrah","year":"2017","journal-title":"Bali Med. J."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Rao, R., Nambiar, J., and Pai, M. (2020). A Prospective Interventional Study for the Effect of Zinc Sulphate on Pain Severity and Duration in Primary Dysmenorrhea. Indian Obstet. Gynaecol.","DOI":"10.22541\/au.159285493.39240825"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/23\/4116\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:41:51Z","timestamp":1760114511000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/23\/4116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,28]]},"references-count":62,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["nu16234116"],"URL":"https:\/\/doi.org\/10.3390\/nu16234116","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,28]]}}}