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).
Primary/Secondary Keywords