A Cochrane review [Abstract] 1 included 80 RCTs involving a total of 5 820 women. In women with dysmenorrhoea, NSAIDs were found significantly more effective for pain relief than placebo (OR 4.37, 95% CI 3.76 to 5.09; 35 trials, I²=53%) or paracetamol (OR 1.89, 95% CI 1.05 to 3.44; 3 trials, I²=0%), though overall adverse effects were also significantly more common with NSAIDs vs placebo (OR 1.29, 95% CI 1.11 to 1.51; 25 trials). When NSAIDs were compared with each other, there was little evidence of the superiority of any individual NSAID with regard to either efficacy or safety. There was no evidence that COX-2-specific inhibitors were more effective or tolerable for the treatment of dysmenorrhoea than traditional NSAIDs; however data were very scanty (only 2 trials).
A network meta-analysis 2 included 72 RCTs with a total of 5723 patients and 13 NSAIDs. As for pain relief, NSAIDs were superior to aspirin (odds ratio with 95% credible intervals, diclofenac: 0.28 (0.08 to 0.86), flurbiprofen: 0.10 (0.03 to 0.29), ibuprofen: 0.32 (0.14 to 0.73), indomethacin: 0.21 (0.07 to 0.58), ketoprofen: 0.25 (0.10 to 0.64), mefenamic acid: 0.28 (0.09 to 0.87), naproxen: 0.31 (0.15 to 0.64), piroxicam: 0.15 (0.03 to 0.59), and tiaprofenic acid: 0.17 (0.04 to 0.63).
Another network meta-analysis 3 assessing over-the-counter analgesics included 35 trials with a total of 4383 women. NSAIDs except aspirin were more effective than placebo in treating dysmenorrhea: naproxen OR 3.99, 95% CI 2.18 to 7.30, ibuprofen OR 10.08, 95% CI 3.29 to 30.85, diclofenac OR 11.82, 95% CI 2.66 to 52.48, and ketoprofen OR 5.12, 95% CI 1.57 to 16.69. Regarding safety, there was no significant difference between the NSAIDs included and the placebo.
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