What is the recommended dose of ibuprofen (Non-Steroidal Anti-Inflammatory Drug) for the treatment of menorrhagia?

Ibuprofen Dosing for Menorrhagia Treatment

The recommended dose of ibuprofen for menorrhagia treatment is 600-800 mg orally every 6 hours (maximum 2400-3200 mg daily) for 3-5 days starting from the first day of menstruation.

Mechanism of Action

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), works by inhibiting prostaglandin synthesis, which plays a key role in excessive menstrual bleeding. By reducing prostaglandin levels, ibuprofen:

• Decreases uterine blood flow
• Reduces inflammation in the endometrium
• Promotes vasoconstriction in the uterus
• Helps reduce menstrual blood loss by approximately 20-35%

Dosing Protocol

1. Starting time: Begin ibuprofen on the first day of menstruation (not before)
2. Dosage: 600-800 mg orally every 6 hours
3. Duration: Continue for 3-5 days during menstruation
4. Maximum daily dose: 2400-3200 mg/day
5. Administration: Take with food to minimize gastrointestinal side effects

Efficacy

Ibuprofen and other NSAIDs have been shown to reduce menstrual blood loss by approximately 20-35% in women with menorrhagia 1. While this reduction is significant, it's important to note that other treatments may provide greater reduction in blood loss:

• NSAIDs (including ibuprofen): 20-35% reduction
• Tranexamic acid: 50-54% reduction 1
• Hormonal treatments: Variable reduction depending on type

Patient Selection and Contraindications

Ibuprofen is most appropriate for:

• Women with mild to moderate menorrhagia
• Those who also experience dysmenorrhea (painful periods)
• Women who prefer non-hormonal treatment options
• Short-term management while investigating underlying causes

Avoid in patients with:

• History of peptic ulcer disease
• Significant alcohol use (≥2 alcoholic beverages per day)
• Renal dysfunction
• Concomitant use of other nephrotoxic drugs
• Age >60 years with compromised fluid status
• History of gastrointestinal bleeding
• Platelet abnormalities
• Concomitant use of anticoagulants

Monitoring and Side Effects

Common side effects include:

• Gastrointestinal upset (nausea, dyspepsia)
• Potential for gastric ulceration with prolonged use
• Fluid retention

For long-term use (>3 months), monitor:

• Blood pressure
• BUN and creatinine
• Liver function tests
• CBC and fecal occult blood

Alternative Treatment Options

If ibuprofen provides inadequate relief or is contraindicated, consider:

1. Tranexamic acid: More effective (50-54% reduction in blood loss) 1, dosage 1g orally every 6 hours for 3-5 days
2. Hormonal options:
   • Combined oral contraceptives
   • Progestins (oral or intrauterine)
3. Surgical options (for refractory cases):
   • Endometrial ablation
   • Hysterectomy

Clinical Pearls

• NSAIDs like ibuprofen are most effective when started at the onset of menstruation
• They provide the dual benefit of reducing both menstrual flow and dysmenorrhea
• For maximum effectiveness, maintain regular dosing throughout the heaviest days of flow
• If one NSAID is ineffective after two cycles, consider switching to another treatment approach rather than trying another NSAID 2
• Combining ibuprofen with non-pharmacological approaches (iron supplementation for anemia, hydration, rest) can improve overall management