Lethaby A, Augood C, Duckitt K
Department of Obstetrics and Gynaecology, University of Auckland, 2nd Floor, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand.
Cochrane Database Syst Rev. 2002(1):CD000400. doi: 10.1002/14651858.CD000400.
Heavy menstrual bleeding (HMB) is an important cause of ill health in premenopausal women. Although surgery is often used as a treatment, a range of medical therapies are also available. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels which are elevated in women with excessive menstrual bleeding and also may have a beneficial effect on dysmenorrhoea.
The primary objective of this review was to investigate the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in achieving a reduction in menstrual blood loss in women of reproductive years HMB.
Electronic searches for relevant randomised controlled trials of the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, MEDLINE, EMBASE, Current Contents, the Cochrane Library and CINAHL were performed. Attempts were also made to identify trials from citation lists of review articles and drug companies were approached for unpublished data. In most cases, the first author of each included trial was contacted for additional information. An updated search was performed in September and October 2001 but no new eligible trials were identified.
The inclusion criteria were randomised comparisons of individual NSAIDs with either each other, placebo or other medical treatments in women with regular heavy periods measured either objectively or subjectively and with no pathological or iatrogenic (treatment induced) causes for their heavy menstrual blood loss.
Sixteen RCTs were identified that fulfilled the inclusion criteria for this review and data were extracted independently. Odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes were estimated from the data of nine trials. The results of the remaining seven crossover trials with data unsuitable for pooling were described in the Other Data section.
As a group, NSAIDs were more effective than placebo at reducing heavy menstrual bleeding but less effective than either tranexamic acid or danazol. Treatment with danazol caused a shorter duration of menstruation and more adverse events than NSAIDs but this did not appear to affect the acceptability of treatment. There were no statistically significant differences between NSAIDs and the other treatments (oral luteal progestogen, ethamsylate, progesterone releasing intra-uterine system (IUS), oral contraceptive pill (OCC)) but most studies were underpowered. There was no evidence of a difference between the individual NSAIDs (naproxen and mefenamic acid) in reducing HMB.
REVIEWER'S CONCLUSIONS: NSAIDs reduce HMB when compared with placebo but are less effective than either tranexamic acid or danazol. However, adverse events are more severe with danazol therapy. In the limited number of small studies suitable for evaluation, no significant difference in efficacy was demonstrated between NSAIDs and other medical treatments such as oral luteal progestogen, ethamsylate, OCC or IUS.
月经过多是绝经前女性健康不佳的一个重要原因。虽然手术常被用作一种治疗方法，但也有一系列药物疗法可供选择。非甾体抗炎药可降低前列腺素水平，而月经过多的女性体内前列腺素水平会升高，并且非甾体抗炎药对痛经可能也有有益作用。
本综述的主要目的是研究非甾体抗炎药（NSAIDs）在减少生育年龄月经过多女性的月经失血方面的有效性。
对Cochrane月经紊乱与生育力低下组专业对照试验注册库、MEDLINE、EMBASE、《现刊目次》、Cochrane图书馆和护理学与健康领域数据库进行了相关随机对照试验的电子检索。还尝试从综述文章的参考文献列表中识别试验，并与制药公司联系以获取未发表的数据。在大多数情况下，与每项纳入试验的第一作者联系以获取更多信息。于2001年9月和10月进行了更新检索，但未识别出新的符合条件的试验。
纳入标准为将个体NSAIDs相互之间、与安慰剂或其他药物治疗进行随机对照比较，研究对象为月经规律且经客观或主观测量月经过多、且月经失血无病理或医源性（治疗所致）原因的女性。
识别出16项符合本综述纳入标准的随机对照试验，并独立提取数据。从9项试验的数据中估计二分结局的比值比和连续结局的加权均数差。其余7项交叉试验的数据不适合合并，其结果在“其他数据”部分进行了描述。
总体而言，NSAIDs在减少月经过多方面比安慰剂更有效，但比氨甲环酸或达那唑效果差。与NSAIDs相比，达那唑治疗导致月经持续时间更短且不良事件更多，但这似乎并未影响治疗的可接受性。NSAIDs与其他治疗方法（口服黄体期孕激素、酚磺乙胺、左炔诺孕酮宫内缓释系统（IUS）、口服避孕药（OCC））之间无统计学显著差异，但大多数研究的样本量不足。没有证据表明个体NSAIDs（萘普生和甲芬那酸）在减少月经过多方面存在差异。
与安慰剂相比，NSAIDs可减少月经过多，但比氨甲环酸或达那唑效果差。然而，达那唑治疗的不良事件更严重。在适合评估的有限数量的小型研究中，未证明NSAIDs与其他药物治疗（如口服黄体期孕激素、酚磺乙胺、OCC或IUS）在疗效上有显著差异。
