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.
Treatment of IUD related menorrhagia by indomethacin.
Indomethacin, prostaglandin synthetase inhibitor was tested in 9 women wearing a lippes loop IUD. These women suffered from excessive bleeding with a mean menstrual blood loss of more than 100 ml. The effect was studied by quantifying menstrual blood loss in a double blind 4 periods crossover study. The mean percentage reduction during treatment was of 57 percent. No significant placebo effect was observed. The effect of indomethacin support the contention that IUD's associated menorrhagia, is connected to an abnormal prostaglandin synthetase in the endometrium.