Timing | Medication class | Medication | Oral dose | Frequency | Length of time |
Prophylaxis of postinsertion bleeding* | NSAID | Ibuprofen | 400 mg | 3 times daily | 10 days |
Antifibrinolytic | Tranexamic acid | 650 mg¶ (US available prescription) | 2 times daily | 5 days | |
Tranexamic acid | 500 mg¶ (preparation is not available in US) | 2 times daily | 5 days | ||
Treatment of heavy bleeding >3 months postinsertion | NSAID | Ibuprofen | 400 mg | 4 times daily | 7 days |
Indomethacin | 25 mg | 2 times daily | 7 days | ||
Indomethacin | 25 mg | 4 times daily | 3 days | ||
Mefenamic acid | 100 mg (preparation is not available in US) | 3 times daily | 3 days | ||
Mefenamic acid | 500 mg (US available preparation) | 3 times daily | 5 days | ||
Diclofenac | 50 mg | 3 times daily | 1 day, then | ||
25 mg | 3 times daily | 4 days | |||
Antifibrinolytic | Tranexamic acid | 1300 mg¶ (US available preparation) | 3 times daily | 5 days | |
Tranexamic acid | 1500 mg¶ (preparation is not available in US) | 3 times daily | 5 days | ||
Antidiuretic | Desmopressin | 300 mcg intranasally | Intranasal daily | 5 days |
Treatment is initiated on the first day of menses, or alternatively several days before expected menstruation, to reduce bleeding and cramping. Aspirin is not recommended.
NSAIDs are generally avoided in patients with renal impairment, reduced cardiac output, difficult to control hypertension and some other comorbidities; refer to UpToDate clinical reviews of NSAID safety and individual drug monograph for detail.NSAID: nonsteroidal anti-inflammatory drug; US: United States.
* UpToDate contributors generally do not use prophylactic medication as the abnormal bleeding typically resolves quickly and most women do well with advance education.
¶ Dose adjustment needed in setting of renal impairment.Do you want to add Medilib to your home screen?