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Evidence summaries

Nsaids for Heavy Bleeding or Pain Associated with IUD Use

Non-steroidal anti-inflammatory drugsmay be effective compared with placebo in reducing bleeding and pain associated with IUD use. Level of evidence: "C"

The certainty of evidence is downgraded by imprecise and conflicted evidence.

A Cochrane review [Abstract] 1 included 15 trials involving a total of 2 702 women from both developed and developing countries. NSAIDs (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. No important differences emerged in the one trial comparing the effect of different NSAIDs on bleeding.

Another Cochrane review [Abstract] 3 includes 21 trials involving a total of 3 689 participants. Treatment with mefenamic acid resulted in less volume of blood loss compared to tranexamic acid (MD −64.26, 95% CI −105.65 to −22.87; 1 trial, n=94 women). However, there was no difference in duration of bleeding with treatment of mefenamic acid or tranexamic acid (MD 0.08 days, 95% CI −0.27 to 0.42, 2 trials, n=152). Tolfenamic acid prevented heavy bleeding compared to placebo (OR 0.54, 95% CI 0.34 to 0.85; 1 trial, n=310). Vitamin B1 resulted in fewer pads used per day (mean difference (MD) −7.00, 95% CI −8.50 to −5.50) and fewer bleeding days (MD −2.00, 95% CI -2.38 to −1.62; 1 trial; n=110).

A systematic review 2 evaluated interventons for bleeding irregularities during Cu-IUD use. NSAIDs significantly reduced menstrual blood loss or bleeding duration among Cu-IUD users with heavy or prolonged menstrual bleeding (10 trials).

    References

    • Grimes DA, Hubacher D, Lopez LM, Schulz KF. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev 2006 Oct 18;(4):CD006034. [PubMed]
    • Godfrey EM, Folger SG, Jeng G et al. Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review. Contraception 2013;87(5):549-66. [PubMed]
    • Christelle K, Norhayati MN, Jaafar SH. Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev 2022;(8):CD006034. [PubMed]

Primary/Secondary Keywords