What is the recommended dose of ibuprofen (Non-Steroidal Anti-Inflammatory Drug) for a female patient of reproductive age with acute abnormal uterine bleeding?

Ibuprofen Dosing for Acute Abnormal Uterine Bleeding in Reproductive-Age Women

For acute abnormal uterine bleeding in reproductive-age women, ibuprofen should be dosed at 600-800 mg orally every 6-8 hours with food for 5-7 days during the bleeding episode, which reduces menstrual blood loss by 20-60%. 1, 2

Mechanism and Efficacy

• NSAIDs like ibuprofen work by inhibiting prostaglandin synthesis, which reduces menstrual blood flow acutely and can decrease bleeding by 20-60% when used during active bleeding episodes 1, 2
• Ibuprofen is specifically recommended as a first-line adjunctive therapy for persistent bleeding despite hormonal treatment 1
• The medication should be taken with food to minimize gastrointestinal side effects 3

Specific Dosing Regimen

• The recommended dose is 600-800 mg orally every 6-8 hours for the first 24 hours post-procedure or during acute bleeding episodes 3
• Treatment duration should be limited to 5-7 days during the bleeding episode 1, 2, 4
• For ongoing management, ibuprofen can be combined with hormonal therapies (combined oral contraceptives or progestins) for enhanced efficacy 1

Critical Contraindications and Precautions

• Aspirin should be avoided as it can paradoxically increase bleeding 2
• NSAIDs should generally be avoided in women with spontaneous coronary artery dissection (SCAD) given their association with myocardial infarction and thrombosis 3
• Tranexamic acid (which reduces bleeding by 40-60%) is more effective than NSAIDs but is contraindicated in patients with active thromboembolic disease or history/risk of thrombosis 1, 2

When Ibuprofen Alone Is Insufficient

• If bleeding persists beyond 5-7 days of NSAID therapy, hormonal treatment should be initiated with combined oral contraceptives containing 30-35 μg ethinyl estradiol as first-line therapy 1, 4
• For hemodynamically unstable patients (saturating a large pad hourly for ≥4 hours), urgent evaluation and consideration of high-dose hormonal therapy or tranexamic acid is required 2
• Pregnancy must be ruled out with β-hCG testing before initiating any treatment in all reproductive-age women 2

Integration with Hormonal Therapy

• NSAIDs can be added to combined oral contraceptives for breakthrough bleeding during the first 3-6 months of hormonal therapy 1, 4
• The combination of ibuprofen with hormonal methods provides superior bleeding control compared to either therapy alone 1