Comparison the effects of naproxen, indomethacin and ibuprofen in treatment of spotting due to IUD insertion

Document Type : Original Article


1 PhD student of Health Services Management, Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Karaj, Iran.

2 PhD student of Reproductive Health, Department of midwifery, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran.

3 M.Sc in Psychology, Department of Psychology, Faculty of Psychology, Tarbiat Modarres University, Tehran, Iran.

4 B.Sc of Midwifery, Health Center Region 1, Alborz University of Medical Sciences, Karaj, Iran.

5 Professor, Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran.


Introduction: IUD is one of the most effective and reversible methods of contraception with the widespread use worldwide. Spotting is the most important side effect of this method that due to discontinuing and removal of IUD. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are effective for treatment of spotting, but in previous study have not identified which one of these drugs is most effective. The aim of this study is to comparison the effects of naproxen, indomethacin and ibuprofen in treatment of spotting due to IUD insertion.
Methods: This semi-experimental study was done in 2010. 943 women randomly allocated to naproxen group (250 mg/q 8 hrs), indomethacin group (25 mg/q 12 hrs) or ibuprofen group (200 mg/q 6 hrs). Samples are women with IUD Cu T 380 A insertion during a month ago, referring to health centers of Karaj, Iran. All of samples completed 5 days duration of treatment and then they evaluated for spotting. Data analyzed using SPSS16 software with qui-square test, ANOVA and t-test. Significance level was considered 0.95.
Result:  All of three drugs were effective in treatment of spotting but base on qui-square test naproxen is the most effective one (p<0.0001).
Conclusion: The findings of this study show that naproxen is more effective than indomethacin and ibuprofen in treatment of spotting due to IUD insertion. Therefore we suggest 5 days protocol of naproxen for curing spotting due to IUD insertion.


  1. Wang LY, Li SZ, Wu SY, Zhao YH, Wang Y. A random control study of indomethacin-containing MYCu intrauterine contraceptive device for 60 months. Zhonghua Yi Xue Za Zhi. 2013 Feb 19;93(7):496-9.
  2. Hubacher D, Chen P, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009 May ; 79(5): 356–362. doi:10.1016/j.contraception.2008.11.012.
  3. Hubacher D, Reyes V, Lillo S, Pierre-Louis B, Zepeda A, Chen PL & copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen.Hum Reprod. 2006 Jun;21(6):1467-72.
  4. Sitruk-Ware R, Nath A, Mishell DR. Contraception technology: past, present and future. Contraception 2013; 87(3): 319–30.
  5. Patchen L, Berggren E.K.Use of the Copper T380A Intrauterine Device by Adolescent Mothers: Continuation and Method Failure.J Pediatr Adolesc Gynecol. 2011 April ; 24(2): 71–73. doi:10.1016/j.jpag.2010.07.010.
  6. Hu LX, He J, Hou L, Wang H, Li J, Xie C & Biological evaluation of the copper/low-density polyethylene nanocomposite intrauterine device.PLoS One. 2013 Sep 18;8(9):e74128. doi: 10.1371/journal.pone.0074128. eCollection 2013.
  7. Toppozoda M.Treatment of increased blood loss in IUD users. Contraception 1987; 36(1) : 145-57.
  8. Suvisaari J, Lahteenmaki P. Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system. Contraception 1996;54(4):201–8.
  9. Hubacher D, Reyes V, Lillo S, Zepeda A, Chen PL, Croxatto H. Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen.. Am J Obstet Gynecol. 2006 ;195(5):1272-7.
  10. Li W, Cao L, Chen Z, Li W, Du Q, Chen G. Study on the effects of FCu-IUD and FICu-IUD on matrix metalloproteinases in human uterine flushing and endometrium. J Huazhong Univ Sci Technolog Med Sci. 2002;22(1):9-11, 16.
  11. Chaudhuri G. Inhibition by aspirin and indomethacine of uterine hypertrophy induced by an IUD. J Reprod fertile. 1975 ;43(1):77-81.
  12. Pinkerton JV. Pharmacological therapy for abnormal uterine bleeding. Menopause 2011 Apr;18(4):453-61. doi: 10.1097/gme.0b013e318212499c.
  13. Brthwal M,Srivsta K. Management of IUD- associated menorragia in female rhesus monkeys(Macaca mulatta). Adv contracept. 1991 ;7(1) : 67-76.
  14. Roy S, Shaw ST Jr. Role of prostoglandins in IUD-associated uterine bleeding– effect of a prostaglandin synthetase inhibitor (lbuprofen). Obstet Gynecol 1981; 58(1): 101-6.
  15. Barthwal M.Srivsta K.Histologic studies on endometrium of menstruating monkeys wearing IUDs.comparative evaluation of drugs.Adv contracept. 1990 ;6(2) 113-24.
  16. Toppozada M,EL-Attar A,EL- Ayyat MA,Khamis Y.Management of uterine bleeding by prostoglandins or their synthesis inhibitors Adv prostoglandin thromboxane Res.1980; 8:1459-63.
  17. Jinying L, Ying L, Xuan G, Yanli G, Jianping L. Investigation of the release behavior of cupric ion for three types of Cu-IUDs and indomethacin for medicated Cu-IUD in simulated uterine fluid. Contraception. 2008 ;77(6):468.
  18. Pedron N, Lozano M, Aznar R. Treatment of hypermenorrhea with Mefenamic acid in women using IUDs. Contracept Deliv Syst. 1982 ;3(2):135-9.
  19. Toppozada M , EL-Attar A, EL-Ayyat MA, Khamis Y. Management of uterine bleeding by prostaglandins or their synthesis inhibitors. Adv prostaglandins thromboxane Res 1980; 8:1459-63.
  20. Tang DC,Wu XR , Zhao BR, Liu YQ and Li Y. Influence of Naproxen on uterine PGF2α and the anti infertility effect of IUDs in rats. Eicosanoids. 1989;2(1):47-9.
  21. Grimes DA1, Hubacher D, Lopez LM, Schulz KF.Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006034.
  22. Godfrey EM1, Folger SG, Jeng G, Jamieson DJ, Curtis KM.Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review. Contraception 2013 May;87(5):549-66.
  23. Li Y, Zhang SM, Chen F, Zhang CY, Li YP, Zhou J & A multi-center randomized controlled trial of intrauterine device use in Chinese women. Zhonghua Yi Xue Za Zhi. 2011 Dec 6;91(45):3172-5.