NSAIDs and menstrual blood loss

Should NSAIDs be first-line treatment for heavy menstrual bleeding?

Nonsteroidal anti-inflammatory drugs (NSAIDs) may not be the best choice for reducing heavy menstrual bleeding (HMB), according to the results of a new Cochrane review. Although better than placebo and commonly used, NSAIDs are less effective than tranexamic acid, Danazol, or the levonorgestrel-releasing intrauterine system (LNG-IUS).

For the systematic analysis, researchers from the University of Auckland selected 18 trials, based on a search of Cochrane Collaboration databases and contacts with other scientists and manufacturers. All the studies were randomized comparisons of individual NSAIDs or of NSAIDs combined with other medical therapy with each other, placebo, or other medical treatments in women with regular HMB. The bleeding was measured either objectively or subjectively and it had no pathological or iatrogenic causes.

The authors’ conclusions are drawn mainly from data from 9 trials and based on estimation of odds ratios (ORs) for dichotomous outcomes and weighted mean differences for continuous outcomes. Information from 7 cross-over trials had data that could not be pooled, data in another trial were skewed, and the final trial had missing variances in data tables.

Overall, treatment with danazol was associated with a shorter duration of menstruation and more adverse events than NSAIDs, but that did not appear to affect the acceptability of treatment. No statistically significant differences were found between NSAIDS and oral luteal progestogen, ethamsylate, the Progestasert intrauterine device, and oral contraceptives. No difference was found between naproxen and mefenamic acid in reducing HMB. The authors did find, however, that most of the studies were underpowered.

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