From the Guidelines
NSAIDs are effective in managing Abnormal Uterine Bleeding (AUB) by reducing menstrual blood loss through their inhibition of prostaglandin synthesis, and they can be used for short-term treatment (5-7 days) as recommended by the most recent guidelines 1.
Mechanism of Action
NSAIDs work by blocking cyclooxygenase enzymes, which decreases prostaglandin production in the endometrium. Since elevated prostaglandin levels contribute to excessive uterine contractions and increased blood flow, reducing these levels helps normalize the bleeding pattern.
Commonly Used NSAIDs
Common NSAIDs used for AUB management include ibuprofen (400-600mg three times daily), naproxen (500mg twice daily), or mefenamic acid (500mg three times daily), typically started 1-2 days before menstruation begins and continued throughout the period for maximum effectiveness.
Efficacy and Safety
NSAIDs can reduce menstrual blood loss by 20-50% in many women, making them particularly useful for AUB associated with ovulatory cycles or conditions like adenomyosis and fibroids 1. However, side effects may include gastrointestinal discomfort, so taking these medications with food is recommended. NSAIDs should be used cautiously in patients with kidney disease, peptic ulcers, or bleeding disorders, and they may not be sufficient as sole therapy for severe AUB cases.
Key Considerations
- Patient Selection: NSAIDs are suitable for short-term use in patients with AUB who do not have contraindications to their use.
- Dosage and Duration: The recommended duration of NSAID use for AUB is 5-7 days, as indicated in the guidelines 1.
- Alternative Treatments: For patients who do not respond to NSAIDs or have contraindications, other treatment options such as hormonal therapies or antifibrinolytic agents may be considered, depending on the underlying cause of AUB and patient preferences.
From the Research
Mechanism of NSAIDs in AUB
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) help in managing Abnormal Uterine Bleeding (AUB) by reducing prostaglandin levels, which are elevated in women with excessive menstrual bleeding 2, 3, 4, 5.
- Prostaglandin reduction also has a beneficial effect on dysmenorrhea, making NSAIDs a useful treatment option for women experiencing heavy menstrual bleeding and painful periods 3, 4, 5.
Efficacy of NSAIDs in AUB
- NSAIDs have been shown to decrease menstrual bleeding by 25-50% in women with AUB 2, 3, 4, 5.
- While NSAIDs are effective in reducing heavy menstrual bleeding, they are less effective than other treatments such as tranexamic acid, danazol, and the levonorgestrel-releasing intrauterine system (LNG IUS) 3, 5.
- There is no significant difference in efficacy between individual NSAIDs, such as naproxen and mefenamic acid, in reducing heavy menstrual bleeding 3, 5.
Comparison with Other Treatments
- NSAIDs are more effective than placebo in reducing heavy menstrual bleeding, but less effective than danazol, which can cause more adverse events 3, 5.
- There is no significant difference in efficacy between NSAIDs and other medical treatments, such as oral progestogen, ethamsylate, and the oral contraceptive pill, although these results are based on small studies 3, 5.
- NSAIDs may be a useful treatment option for women with AUB who cannot tolerate other treatments or prefer a non-hormonal approach 4.