Cochrane · systematic review · CD006034
Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine‐device use
Christelle, K, Norhayati, MN, Jaafar, SH · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Fertility RegulationAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
53
current version
GRADE rated
28
No studies
16
Included studies
NR
No studies 16 · 30.2%Ungraded 9 · 17%Very low 11 · 20.8%Low 17 · 32.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Interventions (vitamin B1, mefenamic acid, tranexamic acid) compared to placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) for the treatment of heavy menstrual bleeding associated with Cu IUD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Interventions versus comparisons Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | NR | No studies |
Vitamin B1 vs placebo Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 participants | Ungraded |
Menstrual blood loss Number of pads (diary record) Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 110 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Duration of bleeding Number of bleeding days (diary record) Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 110 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events or side effects Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | NR | No studies |
Menstrual blood loss Volume blood loss (pictorial chart in mL) Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 94 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Duration of bleeding Number of bleeding days (menstrual record) Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 2 studies · 152 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Menstrual blood loss Mean reduction of PBAC score Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Menstrual blood loss Volume of blood loss (alkaline hematin method) Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Duration of bleeding Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Side effects: gastrointestinal disturbances (diarrhoea, lower abdominal pain), headache and sweating Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | OR 4.69 [1.2, 18.44] | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Menstrual blood loss PBAC score Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Menstrual blood loss Number of pads per day Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Duration of bleeding Number of bleeding days Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Side effects: headache Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | OR 0.58 [0.18, 1.92] | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Side effects: vomiting Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | OR 0.74 [0.25, 2.18] | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Duration of bleeding Number of bleeding days Interventions (vitamin B1, mefenamic acid, tranexamic acid) vs placebo or active comparators (desmopressin, sodium diclofenac, flavonoids) | no estimate extracted | 4 studies · 290 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ulipristal acetate compared to placebo for the treatment of heavy menstrual bleeding associated with LNG IUD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Interventions vs comparisons Ulipristal acetate vs placebo | no estimate extracted | NR | No studies |
Duration of bleeding Total bleeding in 90 days (bleeding calendar) Ulipristal acetate vs placebo | no estimate extracted | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Mefanamic acid compared to Vitex agnus for the treatment of heavy menstrual bleeding associated with unknown IUD type
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Interventions vs comparisons Mefanamic acid vs Vitex agnus | no estimate extracted | NR | No studies |
Menstrual blood loss PBAC score Mefanamic acid vs Vitex agnus | no estimate extracted | NR | No studies |
Side effects: nausea Mefanamic acid vs Vitex agnus | OR 1 [0.06, 16.53] | 1 participants | Ungraded |
Side effects: abdominal pain Mefanamic acid vs Vitex agnus | OR 0.33 [0.01, 8.22] | 0 participants | Ungraded |
Tranexamic acid compared to sodium diclofenac for the treatment of pain associated with Cu IUD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Tranexamic acid vs sodium diclofenac | OR 1 [0.06, 17.25] | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision |
Naproxen compared to placebo for the treatment of pain associated with unknown IUD type
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Naproxen vs placebo Naproxen vs placebo | no estimate extracted | NR | No studies |
Overall pain relief score (4‐point scale) Naproxen vs placebo | no estimate extracted | 1 study · 33 participants | Low Downgraded: risk of bias, imprecision |
Daily pain relief score (6‐point scale) Naproxen vs placebo | no estimate extracted | 1 study · 33 participants | Low Downgraded: risk of bias, imprecision |
Need for additional analgesia (self‐recorded) Naproxen vs placebo | OR 0.29 [0.05, 1.8] | 1 study · 33 participants | Low Downgraded: risk of bias, imprecision |
Side effects: gastrointestinal symptoms Naproxen vs placebo | OR 2.11 [0.18, 25.17] | 1 study · 33 participants | Low Downgraded: risk of bias, imprecision |
Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) compared to placebo or active comparators (paracetamol, tranexamic acid) for the prevention of heavy menstrual bleeding associated with Cu IUD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ibuprofen vs placebo Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | NR | No studies |
Menstrual blood loss (alkaline hematin method) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | MD 14.11 | NR | Ungraded |
Duration of bleeding (menstrual diary) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | MD 0.2 | NR | Ungraded |
Side effects: eye and mouth swelling, stomach cramps, fatigue, irritability (diary record) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | 2 participants | Ungraded |
Menstrual blood loss Menstruation "more abundant than normal" (questionnaire) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | 0 participants | Ungraded |
Side effects: dyspepsia, diarrhoea, headache, fatigue (questionnaire) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | 0 participants | Ungraded |
Aspirin vs paracetamol Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | NR | No studies |
Menstrual blood loss (alkaline hematin method) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | MD 0.3 | NR | Ungraded |
Adverse events or side effects Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | NR | No studies |
Menstrual blood loss % occurrence of heavy menstrual bleeding (alkaline hematin method) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | NR | No studies |
Menstrual blood loss % occurrence heavy menstrual bleeding (PBAC score) Interventions (ibuprofen, tolfenamic acid, aspirin, tranexamic acid) vs placebo or active comparators (paracetamol, tranexamic acid) | no estimate extracted | NR | No studies |
Interventions (ulipristal acetate, tranexamic acid, mifepristone, naproxen) compared placebo or active comparators (mefenamic acid, vitamin B, estradiol) for the prevention of heavy menstrual bleeding associated with LNG IUD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage days bleeding or spotting (questionnaire) | no estimate extracted | 1 study · 118 participants | Low Downgraded: risk of bias, imprecision |
Adverse events or side effects | no estimate extracted | NR | No studies |
Menstrual blood loss | no estimate extracted | NR | No studies |
Duration of bleeding Median number of bleed days (diary) | no estimate extracted | 1 study · 168 participants | Low Downgraded: risk of bias, imprecision |
Side effects: gastrointestinal disorders, headache, breast tenderness, musculoskeletal disorders | OR 1 [0.49, 2.02] | 1 study · 168 participants | Low Downgraded: risk of bias, imprecision |
Mifepristone vs vitamin B | no estimate extracted | NR | No studies |
Duration of bleeding % spotting and bleeding days | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision |
Naproxen vs estradiol | no estimate extracted | NR | No studies |
Duration of bleeding Median number of bleeding and spotting days (diary) | no estimate extracted | 1 study · 106 participants | Very low Downgraded: risk of bias, imprecision |
Side effects: gastroesophageal reflux | OR 3.22 [0.13, 81.19] | 1 study · 86 participants | Very low Downgraded: risk of bias, imprecision |
Interventions (ibuprofen, tolfenamic acid) compared to placebo for the prevention of pain associated with Cu IUD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ibuprofen vs placebo Interventions (ibuprofen, tolfenamic acid) vs placebo | no estimate extracted | NR | No studies |
Reduction in painful menstruation Interventions (ibuprofen, tolfenamic acid) vs placebo | OR 1 [0.11, 8.95] | 1 study · 20 participants | Low Downgraded: risk of bias, imprecision |
Menstruation "more painful than normal" Interventions (ibuprofen, tolfenamic acid) vs placebo | OR 0.71 [0.44, 1.44] | 1 study · 310 participants | Very low Downgraded: risk of bias, imprecision |