Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use

 

Abstract

Background

Heavy bleeding and pain are the most common reasons why women discontinue intrauterine devices (IUDs). Non-steroidal anti-inflammatory drugs, which inhibit prostaglandin synthesis, have been shown to be effective in reducing menstrual bleeding and pain in women without IUDs.

Objectives

This review summarizes all randomized controlled trials studying use of nonsteroidal anti-inflammatory drugs for treatment of bleeding or pain associated with IUD use. Trials of prophylactic use of these drugs around the time of IUD insertion were also included.

Search methods

We searched for relevant trials in PubMed, CENTRAL, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We wrote to the authors of trials identified to seek other published or unpublished trials.

Selection criteria

We included all randomized controlled trials in any language that tested one or more nonsteroidal anti-inflammatory drugs for treatment or prevention of bleeding or pain associated with IUD insertion or use.

Data collection and analysis

Two authors independently abstracted data from relevant trials, and we entered data into RevMan for analysis.

Main results

We found 15 trials from 10 countries; the total number of participants was 2702. Nonsteroidal anti-inflammatory drugs (naproxen, suprofen, mefenamic acid, ibuprofen, indomethacin, flufenamic acid, alclofenac, and diclofenac) were effective in reducing menstrual blood loss associated with IUD use. This held true for women with and without complaints of heavy bleeding. Similarly, these drugs were effective in reducing pain associated with IUD use. In contrast, prophylactic use of nonsteroidal anti-inflammatory drugs had mixed results; studies with ibuprofen found no effect on pain after insertion on IUD discontinuation. No important differences emerged in the one trial comparing the effect of different NSAIDs on bleeding.

Authors' conclusions

Nonsteroidal anti-inflammatory drugs reduce bleeding and pain associated with IUD use. NSAIDs should be considered first-line therapy; if NSAIDs are ineffective, tranexamic acid may be considered as second-line therapy. Prophylactic ibuprofen administration with the first six menses after insertion appears unwarranted.

 

Plain language summary

Pain relievers for bleeding and pain related to intrauterine devices used for birth control

Heavy menstrual bleeding and cramping are the most common reasons why women stop using an intrauterine device (IUD) for birth control. A class of drugs (nonsteroidal anti-inflammatory drugs, or NSAIDs) reduces menstrual bleeding and cramping in women who are not using an IUD. These drugs, such as naproxen and ibuprofen, are sold over-the-counter as pain relievers in many countries. Hence, researchers have studied whether these same drugs might reduce bleeding and pain associated with use of intrauterine devices. This might lead to more comfortable use of IUDs for longer periods of time.

We searched for and summarized all the randomized controlled trials that looked at using these drugs to treat bleeding or pain related to an IUD. We also included trials that studied the use of these drugs to prevent these problems.

We found 15 trials from 10 countries, with more than 2700 women studied. These drugs reduced both bleeding and pain with intrauterine device use. Whether one drug is better than another was not clear. Similarly, the best dosing was not clear. Preventive treatment with these drugs around the time of IUD insertion had mixed results. No serious problems were reported, but stomach upset and sleepiness can occur with this class of drugs. Because of their safety, low cost, and wide availability, these drugs are appropriate treatment for women who have troublesome bleeding or pain with IUD use.

 

摘要

背景

使用非類固醇消炎藥來治療子宮內避孕器使用引發的的大量出血或疼痛

大量出血及疼痛是婦女停止使用子宮內避孕器最常見的原因。抑制前列腺素合成的非類固醇消炎藥，已被證明能有效地在無使用子宮避孕器的婦女減低月經出血及疼痛。

目標

本文回顧了所有的隨機對照試驗研究，其使用非類固醇消炎藥治療子宮避孕器相關的出血或疼痛。於置入子宮避孕器的前後期間，預防性給藥的研究也包括在內。

搜尋策略

我們搜尋PubMed、CENTRAL、POPLINE、EMBASE、LILACS、CINAHL。我們還寫信給所有試驗的作者，確定尋求其他已發表或未發表的試驗。

選擇標準

我們納入所有的任何語言的隨機對照試驗，測試一個或多個非類固醇消炎藥治療或預防因子宮避孕器置入或使用相關的出血或疼痛相關。

資料收集與分析

兩位作者獨立地由相關的試驗抽取數據，而我們輸入數據於RevMan進行分析。

主要結論

我們找到來自10個國家的15個試驗;總參與人數共2702人。非類固醇消炎藥(naproxen，suprofen，mefenamic acid，ibuprofen，indomethacin， flufenamic acid，alclofenac與diclofenac)能有效減少因子宮避孕器使用相關的經血流失，而且對於有或是沒有抱怨大量出血的婦女來說都適用。同樣，這些藥物能有效減少與子宮避孕器使用相關的疼痛。相反的，預防性使用非類固醇消炎藥結果好壞參半;Ibuprofen的研究發現在停止子宮避孕器置入後對疼痛沒有任何的影響。在比較不同的非類固醇消炎藥對出血的影響中，並沒有重要的區別出現於任一個試驗。

作者結論

非類固醇消炎藥減少與子宮避孕器使用相關的出血及疼痛。非類固醇消炎藥應被視為第一線治療;如果非類固醇消炎藥是無效的，trannexamic acid可被視為第二線治療。置入後的第一個六個週期的月經使用預防性的ibuprofen是不必要的。

翻譯人

本摘要由臺灣大學附設醫院張致遠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

使用子宮內避孕器所造成的出血及疼痛之緩解。 大量的月經出血及腹部絞痛是造成婦女停止使用子宮避孕器(IUD)控制生育最常見的原因。一種藥物(非類固醇消炎藥，NSAIDs)可減少非使用子宮避孕器婦女的月經出血和絞痛。這些藥物，如naproxen與ibuprofen，在許多國家被當作疼痛解除者而以不用處方箋的方式出售。因此，研究人員曾研究是否這些同樣藥物可能會減少使用子宮避孕器相關的出血及疼痛。這可能導致更舒適且更長期的使用子宮避孕器。我們搜尋並概括所有檢視在使用這些藥物治療子宮避孕器相關的出血或疼痛的隨機對照試驗。我們還函括研究使用這些藥物以防止這些問題的試驗。我們找到了15個試驗，來自10個國家，實驗超過2700個婦女。這些藥物皆減少子宮避孕器使用下的出血及疼痛。是否有一種藥物是優於另一個尚不清楚。同樣地，最佳劑量尚不清楚。這些藥物在子宮避孕器置入前後期間的預防性治療其結果好壞參半。沒有嚴重的問題被報告，但胃不適和嗜睡可能會發生在這一類的藥物。因為他們具有安全性，成本低，以及廣泛的可用性，這些藥物對使用子宮避孕器時有棘手的出血或疼痛的婦女而言是合適的治療。