NSAIDs are recommended for patients with heavy menstrual bleeding and dysmenorrhea who do not accept or tolerate hormonal treatment and who do not have a bleeding disorder.
A Cochrane review[Abstract] 1 included 18 studies with a total of 759 subjects. As a group, NDAIDs were more effective than placebo at reducing heavy menstrual bleeding but less effective than either tranexamic acid, danazol or the levonorgestrel releasing intrauterine system. Treatment with danazol caused a shorter duration of menstruation and more adverse events than NSAIDs but this did not appear to affect the acceptability of treatment. There were no statistically significant differences between NSAIDs and the other treatmanets (oral luteal progestogens, ethamsylate, an older progesterone releasing intra-uterine system and oral contraceptive pill), although these results were based on very small studies. There was no evidence of a difference between the individual NSAIDs (naproxen and mefenamic acid).
Another Cocrane review[Abstract]2assessed interventions for heavy menstrual bleeding. For first line treatments, meta-analysis included 26 studies with 1770 participants. LNG-IUS resulted in a large reduction of menstrual blood loss (MBL; mean rank 2.4, MD −105.71 mL/cycle, 95% CI −201.10 to −10.33) and was the best option. Antifibrinolytic agents reduced MBL (mean rank 3.7, MD −80.32 mL/cycle, 95% CI −127.67 to −32.98); long-cycle progestogen reduced MBL (mean rank 4.1, MD −76.93 mL/cycle, 95% CI −153.82 to −0.05), and NSAIDs slightly reduced MBL (mean rank 6.4, MD −40.67 mL/cycle, −84.61 to 3.27). For second line treatments, hysterectomy was the best and endometrial ablation the second best option.
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