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Meta-Analysis
. 2006 Oct 18;2006(4):CD006034.
doi: 10.1002/14651858.CD006034.pub2.

Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use

D A Grimes  1 , D Hubacher, L M Lopez, K F Schulz
Affiliations
Meta-Analysis

Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use

D A Grimes et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Heavy bleeding and pain are the most common reasons why women discontinue IUDs. Non-steroidal anti-inflammatory drugs, which inhibit prostaglandin synthesis, have been shown to be effective in reducing menstrual bleeding and pain in women without IUDs.

Objectives: This review summarizes all randomized controlled trials studying use of nonsteroidal anti-inflammatory drugs for treatment of bleeding or pain associated with IUD use. Trials of prophylactic use of these drugs around the time of IUD insertion were also included.

Search strategy: We performed searches of PubMed, CENTRAL, POPLINE, EMBASE, LILACS, and CINAHL for relevant trials. We also wrote to the authors of all trials identified to seek other published or unpublished trials.

Selection criteria: We included all randomized controlled trials in any language that tested one or more nonsteroidal anti-inflammatory drugs for treatment or prevention of bleeding or pain associated with IUD insertion or use.

Data collection and analysis: Two authors independently abstracted data from relevant trials, and we entered data into RevMan for analysis.

Main results: We found 15 trials from 10 countries; the total number of participants was 2702. Nonsteroidal anti-inflammatory drugs (naproxen, suprofen, mefenamic acid, ibuprofen, indomethacin, flufenamic acid, alclofenac, and diclofenac) were effective in reducing menstrual blood loss associated with IUD use. This held true for women with and without complaints of heavy bleeding. Similarly, these drugs were effective in reducing pain associated with IUD use. In contrast, prophylactic use of nonsteroidal anti-inflammatory drugs had mixed results; studies with ibuprofen found no effect on pain after insertion on IUD discontinuation. No important differences emerged in the one trial comparing the effect of different NSAIDs on bleeding.

Authors' conclusions: Nonsteroidal anti-inflammatory drugs reduce bleeding and pain associated with IUD use. NSAIDs should be considered first-line therapy; if NSAIDs are ineffective, tranexamic acid may be considered as second-line therapy. Prophylactic ibuprofen administration with the first six menses after insertion appears unwarranted.

PubMed Disclaimer

Conflict of interest statement

Dr Grimes has consulted with the pharmaceutical companies Bayer Healthcare Pharmaceuticals and Merck & Co, Inc.

Dr Hubacher was the Principal Investigator for one of the trials included.

Figures

1.1
1.1. Analysis
Comparison 1 Naproxen 1250 mg per day versus placebo, Outcome 1 Menstrual blood loss.
2.1
2.1. Analysis
Comparison 2 Naproxen 1000 mg (Day 1) then 750 mg per day versus placebo, Outcome 1 Menstrual blood loss.
3.1
3.1. Analysis
Comparison 3 Naproxen 1250 mg versus naproxen 1000 mg (Day 1) then 750 mg per day, Outcome 1 Menstrual blood loss.
4.1
4.1. Analysis
Comparison 4 Suprofen 800 mg (Day 1) then 600 mg per day versus placebo, Outcome 1 Moderate or "intense" decrease in bleeding.
4.2
4.2. Analysis
Comparison 4 Suprofen 800 mg (Day 1) then 600 mg per day versus placebo, Outcome 2 Moderate or "intense" relief of pain.
5.1
5.1. Analysis
Comparison 5 Aspirin 1500 mg per day versus placebo, Outcome 1 Menstrual blood loss.
7.1
7.1. Analysis
Comparison 7 Aspirin 1500 mg per day versus paracetamol 1500 mg per day, Outcome 1 Menstrual blood loss.
8.1
8.1. Analysis
Comparison 8 Mefenamic acid 1500 mg per day versus desmopressin 300 mcg nasally per day, Outcome 1 Pictorial blood loss assessment chart.
9.1
9.1. Analysis
Comparison 9 Iboprofen 1600 mg per day versus placebo, Outcome 1 Menstrual blood loss.
10.1
10.1. Analysis
Comparison 10 Indomethacin 100 mg daily or flufenamic acid 600 mg daily or alclofenac 1500 mg daily versus placebo, Outcome 1 Menstrual blood loss.
10.2
10.2. Analysis
Comparison 10 Indomethacin 100 mg daily or flufenamic acid 600 mg daily or alclofenac 1500 mg daily versus placebo, Outcome 2 Severe or moderate pain.
11.1
11.1. Analysis
Comparison 11 Indomethacin 50 mg per day versus Baofuxin 16 g per day, Outcome 1 Bleeding/spotting days.
11.2
11.2. Analysis
Comparison 11 Indomethacin 50 mg per day versus Baofuxin 16 g per day, Outcome 2 Bleeding/spotting episodes.
12.1
12.1. Analysis
Comparison 12 Indomethacin 100 mg per day versus placebo, Outcome 1 Menstrual blood loss.
13.1
13.1. Analysis
Comparison 13 Diclofenac sodium 150 mg then 75 mg versus tranexamic acid 4.5 mg per day, Outcome 1 Menstrual blood loss.
14.1
14.1. Analysis
Comparison 14 Diclofenac sodium 150 mg (Day 1) then 75 mg on days 2‐5 versus placebo, Outcome 1 Menstrual blood loss.
15.1
15.1. Analysis
Comparison 15 Tolfenamic acid 600 mg per day versus placebo, Outcome 1 Duration of bleeding after IUD insertion.
15.2
15.2. Analysis
Comparison 15 Tolfenamic acid 600 mg per day versus placebo, Outcome 2 Number of sanitary pads used for bleeding immediately after IUD insertion.
15.3
15.3. Analysis
Comparison 15 Tolfenamic acid 600 mg per day versus placebo, Outcome 3 Next menses more abundant than normal.
15.4
15.4. Analysis
Comparison 15 Tolfenamic acid 600 mg per day versus placebo, Outcome 4 Clots in menstrual blood with subsequent menses.
15.5
15.5. Analysis
Comparison 15 Tolfenamic acid 600 mg per day versus placebo, Outcome 5 Subsequent menses more painful than normal.
16.1
16.1. Analysis
Comparison 16 Naproxen sodium 550 mg then 275 mg every 6 hr as needed versus placebo, Outcome 1 "Good" or "excellent" relief of uterine pain in one or more cycles.
16.2
16.2. Analysis
Comparison 16 Naproxen sodium 550 mg then 275 mg every 6 hr as needed versus placebo, Outcome 2 Mean daily pain relief scores.
17.1
17.1. Analysis
Comparison 17 Naproxen 500 mg initially then additional doses of 250 mg up to 1250 mg per day versus placebo, Outcome 1 Pain relief rated better than alternative treatment.
18.1
18.1. Analysis
Comparison 18 Naproxen 1200 mg per day versus placebo, Outcome 1 Need for additional analgesia after IUD insertion.
19.1
19.1. Analysis
Comparison 19 Ibuprofen 1200 mg per day versus placebo with 6 menses after IUD insertion, Outcome 1 IUD removal by 26 weeks for dysmenorrhea or increased menstrual blood loss.
19.2
19.2. Analysis
Comparison 19 Ibuprofen 1200 mg per day versus placebo with 6 menses after IUD insertion, Outcome 2 IUD removal by 52 weeks.
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Comment in

References

References to studies included in this review

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