Mechanism of Action: NSAIDs in Controlling Abnormal Uterine Bleeding

Introduction to NSAID Therapy

NSAIDs reduce abnormal uterine bleeding by 25-50% through inhibition of prostaglandin synthesis in the endometrium, which decreases both menstrual blood flow and associated dysmenorrhea 1, 2

NSAIDs are recommended as first-line therapy for AUB, particularly when hormonal contraception is contraindicated or the patient desires immediate fertility 1
Treatment duration of short-term use for 5-7 days during menstruation is typically sufficient 2
Preferred agents include mefenamic acid, flufenamic acid, and indomethacin, with naproxen and ibuprofen preferred for patients with cardiovascular risk factors 2

NSAIDs should generally be avoided in women with spontaneous coronary artery dissection (SCAD) or significant cardiovascular disease due to their association with myocardial infarction and thrombosis 3
Use with extreme caution in patients with known cardiovascular disease, as NSAIDs carry thrombotic risk 3, 2
Avoid in patients with peptic ulcer disease history, advanced age (>60 years), or concurrent corticosteroid therapy 2
In women on dual antiplatelet therapy, NSAIDs are contraindicated as they compound bleeding risk while paradoxically increasing thrombotic risk 3

Pain control is achieved through the same prostaglandin-blocking mechanism, simultaneously improving dysmenorrhea 2