What is more effective for managing heavy menstrual bleeding and dysmenorrhea, Naprogesic (naproxen) or Ponstan (mefenamic acid)?

Naproxen vs. Mefenamic Acid for Heavy Menstrual Bleeding and Pain

Mefenamic acid (Ponstan) is more effective than naproxen (Naprogesic) for managing heavy menstrual bleeding, while both medications are similarly effective for menstrual pain. 1

Mechanism of Action

Both medications are non-steroidal anti-inflammatory drugs (NSAIDs) that work by reducing prostaglandin levels, which are elevated in women with heavy menstrual bleeding and dysmenorrhea. They inhibit the cyclooxygenase enzyme, reducing inflammation and pain.

Effectiveness for Heavy Menstrual Bleeding

Mefenamic Acid (Ponstan)

• More effective at reducing blood volume compared to tranexamic acid (MD -64.26,95% CI -105.65 to -22.87) 2
• Provides complete relief of dysmenorrhea symptoms in 88.6% of patients 3
• More effective for reducing menstrual blood loss compared to naproxen 1

Naproxen (Naprogesic)

• Effective for reducing menstrual blood loss compared to placebo, but less effective than mefenamic acid 1
• The evidence is uncertain about naproxen's effect on the volume of menstruation compared to placebo (OR 0.09,95% CI 0.00 to 1.78) 2

Effectiveness for Menstrual Pain

• Both medications are effective for treating menstrual pain
• Naproxen may reduce pain (MD 4.10,95% CI 0.91 to 7.29) 2
• Mefenamic acid produced complete relief of dysmenorrhea symptoms in 88.6% of patients in clinical trials 3
• No significant difference between naproxen and mefenamic acid for pain relief 1

Treatment Considerations

Dosing

• Mefenamic acid: Typically 500 mg every 8 hours for a maximum of 3 days during menstruation 3
• Naproxen: Standard dosing for menstrual symptoms

Medical Management Approach

NSAIDs are considered first-line medical management for heavy menstrual bleeding and pain, along with hormonal options like estrogen-progestin oral contraceptive pills and progestin-containing IUDs 4

Important Caveats

• Individual response to NSAIDs can vary
• The evidence quality ranges from low to moderate, with limitations including risk of bias and imprecision 1
• NSAIDs as a group are more effective than placebo but less effective than tranexamic acid, danazol, or levonorgestrel-releasing intrauterine systems for heavy menstrual bleeding 1
• Consider adding tranexamic acid to hormonal contraception for managing persistent heavy menstrual bleeding 5

When to Consider Alternative Treatments

• If NSAIDs provide inadequate relief after 3 months
• For persistent heavy bleeding, consider:
  • Tranexamic acid (non-hormonal alternative)
  • Hormonal options (if not contraindicated)
  • Levonorgestrel-releasing IUD

In summary, while both medications are effective NSAIDs for menstrual symptoms, mefenamic acid (Ponstan) demonstrates superior efficacy for reducing heavy menstrual bleeding compared to naproxen (Naprogesic), making it the preferred choice when heavy bleeding is the primary concern.