A Double-Blind, Randomized, Placebo-Controlled Trial, Evaluating the Efficacy of Commiphora Mukul Cream in Improving Breast Engorgement in Breastfeeding Women

Document Type : Research Paper


1 Students Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iranool of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Biostatics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran



Breast engorgement is a common problem during breastfeeding that can lead to early discontinuation of breastfeeding. Commiphora Mukul (C. Mukul) is a medicinal plant with analgesic and anti-inflammatory compounds. The present study was conducted to determine the effect of C. Mukul on improving breast engorgement in breastfeeding women. This study was a double-blind, randomized, and placebo-controlled trial conducted with 100 breastfeeding women, whose symptoms of breast engorgement were randomly allocated to C. Mukul cream group or placebo. Both groups were to rub one fingertip of cream on each breast after nursing 8 times a day for 2 days. The breast engorgement symptoms) severity index = erythema + tension + pain) were assessed by the validated breast engorgement checklist. The severity of breast engorgement before the intervention was not significantly different between the two drug and placebo groups (breast erythema (P=0.78), tension (P=0.85) and pain (P=0.06)), but two days after the intervention, 60% of women in the drug group and 22% of them in the placebo group scored zero in breast engorgement checklist, though there was a significant difference between the groups (P<0.001). No side effects were observed or reported in either group. According to the findings, Commiphora Mukul cream can improve breast engorgement.


[1] Cunningham F, Leveno K, Bloom S, Spong C, Dashe J, Hoffman B and Casey B. Williams' Obstetrics. 25nd ed. Mc Graw Hill Professional, New York (2018) 781.
[2] World Health Organization. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization. (2009) 6
[3] Trimeloni L and Spencer J. Diagnosis and Management of Breast Milk Oversupply. J. Am. Board Fam. Med. (2016) 29 (1): 139-42.
[4] Chiu JY, Gau ML, Kuo SY, Chang YH, Kuo SC and Tu HD. Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial. J. Nurs. Res. (2010) 18 (1): 1-10.
[5] Alekseev NP, Vladimir I and Nadezhda TE. Pathological postpartum breast engorgement: prediction, prevention, and resolution. Breastfeed Med. (2015) 10 (4): 203-8.
[6] Berens P and Brodrib W. ABM Clinical Protocol #20: Engorgement, Revised 2016. Breastfeed Med. (2016) 11: 159-63.
[7] Mangesi L and Zakarija‚ÄźGrkovic I. Treatments for breast engorgement during lactation. Cochrane Database Syst. Rev. (2010) 6: 16.
[8] Khosravan S, Mohammadzadeh-Moghadam H, Mohammadzadeh F and Ajamkhameset fadafen S. The Effect of Hollyhock (Althaea officinalis L) Leaf Compresses Combined With Warm and Cold Compress on Breast Engorgement in Lactating Women: A Randomized Clinical Trial. eCAM. (2017) 22 (1): 25-30.
[9] Walls D. Herbs and natural therapies for pregnancy, birth and breastfeeding. IJCE. (2009) 24 (2): 29.
[10] Mehreen A, Waheed M, Liaqat I and Arshad N. Phytochemical, antimicrobial, and toxicological evaluation of traditional herbs used to treat sore throat. Biomed. Res. Int. (2016) 2016: 2
[11] Maroon JC, Bost JW and Maroon A. Natural anti-inflammatory agents for pain relief. SNI. (2010) 1: 80.
[12] Sarup P, Bala S and Kamboj S. Pharmacology and Phytochemistry of Oleo-Gum Resin of Commiphora wightii (Guggulu). Scientifica (Cairo). (2015) 2015: 138-39.
[13] Shen T, Huili G, Ningwang X and Xtanglon H. The genus Commiphora: a review of its traditional uses, phytochemistry and pharmacology. JEP. (2012) 142 (2): 319-30.
[14] Jiang G, Xiao X, Zeng Y, Nagabhushanam K, Majeed M and Xia D. Targeting beta-catenin signaling to induce apoptosis in human breast cancer cells by z-guggulsterone and Gugulipid extract of Ayurvedic medicine plant Commiphora mukul. BMC. (2013) 13: 203.
[15] Manjula N, Gayathri B, Vinaykumar KS, Shankernarayanan NP, Vishwakarma RA and Balakrishnan A. Inhibition of MAP kinases by crude extract and pure compound isolated from Commiphora mukul leads to down regulation of TNF-α, IL-1β and IL-2. Int. Immunopharmacol. (2006) 6 (2): 122-132.
[16] Mencarelli A, Renga B, Giuseppe P, Distrutti E and Firucci S. The plant sterol guggulsterone attenuates inflammation and immune dysfunction in murine models of inflammatory bowel disease. BCP. (2009) 78 (9): 1214-23.
[17] Kvist LJ, Hall-Lord ML, Rydhstroem H and Wildelarsson B. A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation. Midwifery. (2007) 23 (2): 184-195.
[18] Kamali Moradzade M, Ahmadi M, Heshmat R and Akbarzadeh Bagheban A. Comparing the effect of acupressure and intermittent compress on the severity of breast hyperemia in lactating women. HMS. (2013) 18 (4): 155-160.
[19] Kim SS, Lim J, Bang Y, Gal J, Uklee S, Changcho Y, Yoon G, Kang BY, Cheon SH and Choi HJ. Licochalcone E activates Nrf2/antioxidant response element signaling pathway in both neuronal and microglial cells: therapeutic relevance to neurodegenerative disease. JNB. (2012) 23 (10): 1314-1323.
[20] Dhippayom T, Kongkeaw CH, Chaiyakunapruk N, Dilokthornsakul P, Sruamsiri R, Saokeaw S and Chuthaputti A. Clinical effects of thai herbal compress: a systematic review and meta-analysis. eCAM. (2015) 2015: 8-10.
[21] Boi B, Koh S and Gail D. The effectiveness of cabbage leaf application (treatment) on pain and hardness in breast engorgement and its effect on the duration of breastfeeding. JBI. Libr Syst. Rev. (2012) 10 (20): 1185-1213.
[22] Thomas A, Chhugani M and Thokchom S. A quasi-experimental study to assess the effectiveness of chilled cabbage leaves on breast engorgement among postnatal mothers admitted in a selected hospital of Delhi. Int. J. Nurs. Midwifery. (2017) 4 (1): 8-13.
[23] Alamhoda H, Aliakbari S, Akbarzadeh Bagheban A and Esmaeeli S. Examined the effect of Aloe vera gel on the improvement of nipple pain. RBMS. (2014) 19 (1): 13-17.
[24] Shahrahmani N, Aliakbari S, Mojab F, Mirzaee M and Shahrahmani H. Investigated the effect of jujube fruit lotion on the improvement of nipple pain. IJOGI. (2016) 19 (35): 13-21.
[25] Ketsuwan S, Baiya N, Paritakul P, Laosooksathit W and Puapornpong P. Effect of herbal compresses for maternal breast engorgement at postpartum: a randomized controlled trial. Breastfeed. Med. (2018) 13 (5): 361-365.
[26] Monazemi M, Yosefzadeh S, Rakhshandeh H, Esmaeeli H and Afiat M. The effect of warm ginger compress on the severity of breast engorgement. IJOGI. (2019) 21 (12): 77-84.
[27] Pustotina O. Management of mastitis and breast engorgement in breastfeeding women. J. Maternal-Fetal Neonatal Med. (2016) 29 (19): 3121-3125.
[28] Alekseev NP. Progesterone-containing gel does not eliminate postpartum breast engorgement? Breastfeed. Med. (2017) 12 (2): 122-123.