NSAIDs for heavy menstrual bleeding

Abstract

Evidence Evidence was focused on placebo-controlled RCTs. Menorrhagia, when defined, was more than 80 mL per cycle. • Naproxen: In 2 crossover RCTs (N = 4 each), baseline blood loss was about 140 mL. After 2 cycles of each treatment, mean blood loss decreased about 30% over placebo1 and 79% felt naproxen was better than placebo.2 There was no effect on bleeding duration.2 • Ibuprofen: In 1 crossover RCT (N = 13),3 baseline blood loss was not stated. After 1 cycle of each treatment, mean blood loss decreased about 25% over placebo (1200 mg/d) and was not different from placebo (600 mg/d). There was no effect on bleeding duration. • Mefenamic acid: Evidence was 5 RCTs. -The largest RCT (N = 80) followed 3 consecutive cycles.4 — “Relief” of menorrhagia (not defined): 86% versus 20%, number needed to treat (NNT) = 2. — Pads per day: 15 at baseline, 7 with mefenamic acid (placebo not stated). — Bleeding days: 10 at baseline, 4 with mefenamic acid (placebo not stated). In 3 RCTs (2 crossover; N = 49), mefenamic acid was better than placebo. —Mean blood loss was about 10% to 40% lower than placebo.1 —“ Responded” (undefined): 79% versus 18% (placebo), NNT = 2.5,6 In 1 crossover RCT (N = 15), there was no difference in blood loss.7 • Mefenamic acid versus diclofenac: In 1 RCT of 68 women, only 1 completed all study follow-up.8 Median number of pads used (baseline unknown) was 21 versus 10 (diclofenac). Number of bleeding days (baseline unknown) was 6 versus 4 (diclofenac). • Naproxen versus mefenamic acid: In 1 crossover RCT (N = 35),9 both groups improved similarly compared with baseline. Blood loss decreased by about 47%, there were 0.8 fewer days of bleeding, and tampon number decreased from about 31 to 24.