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Intrauterine device (IUD) is one of the most reliable methods of contraception. Worldwide, over 15% of married women use intrauterine contraception (1). Copper-containing IUDs (Cu-IUDs), introduced in the late 1960s, are available in a variety of types and are mostly categorized based on their shape and their levels of copper. The Copper T380-A is considered the most effective CuIUD (2). Currently, TCu380A IUD is the sole Cu-IUD available in public health clinics in Iran. Abnormal uterine bleeding is one of the most frequent causes for Cu-IUD discontinuation. Menorrhagia is defined as the amount of bleeding more than or equal to 80 mL per menstrual cycle, or menses that lasts longer than 7 days (3). Excessive bleeding accounts for 60% of primary care consultations for menstrual problems and 12% of all gynaecology referrals. This can not only interfere with social activities and day-to-day work of those affected by this condition, but also have a major impact on their quality of life (4). Because of the low failure rate and high efficacy of Cu-IUDs, increasing the satisfaction of users and lowering the discontinuation rate of this method is of utmost importance. Therefore, it is essential to evaluate the effect of inexpensive and widely available medications that could decrease the amount of menstrual blood loss in TCu380A IUD users. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid, act as inhibitors of prostaglandin synthetase and decrease the release of endometrial prostaglandin. Therefore, they potentially result in a reduction in menstrual bleeding, even in the presence of Cu-IUDs (5). Other medications, such as anti-fibrinolytic agents (e.g. tranexamic acid), are recommended by the World Health Organization (WHO) as the treatment for heavy or prolonged menstrual bleeding among Cu-IUD users (6). In a systematic review on treatment of bleeding irregularities in women using Copper-containing IUDs by Godfrey et al, NSAIDs were the most widely studied medications for reduction of blood loss in the presence of a Cu-IUD. Other less widely studied, but possibly effective, medications in reducing bleeding in CuAbstract Objectives: To evaluate and compare the efficacy of mefenamic acid and tranexamic acid in controlling menorrhagia induced by Copper T-380A intrauterine device (IUD). Materials and Methods: Women aged 18-40 years with heavy menstrual bleeding, who were using TCu380A IUD, were randomised to receive tranexamic acid (group 1, n = 120) or mefenamic acid (group 2, n = 90), 500 mg three times daily for 3-5 days of three consecutive menstrual cycles. Changes in menstrual blood loss volume and duration were assessed using the questionnaire form filled out before the treatment and every month for 3 months. Method of calculation of blood loss volume was instructed to all participants at the first visit. Haemoglobin (Hb) concentration level of participants were also assessed before and after the treatment. Data were analysed using t test, paired sample t test, non-parametric Mann-Whitney test, chi-squared test, and analysis of covariance (ANCOVA). Results: After the treatment, mean blood volume decreased significantly, by 42.3% in group 1 and by 44.5% in group 2, but their difference was not significant. Mean menstrual days decreased significantly, by 64% in group 1 and by 62% in group 2; however, their difference was not significant. Hb concentration level before and after the treatment was not significantly different between the 2 groups. The peak effect of both drugs was observed at the end of the second month of treatment. Conclusion: Tranexamic acid and mefenamic acid have the same significant effect in reducing mean blood loss volume and duration of menstruation in TCu380A IUD users.

A Comparative Trial of the Efficacy of Mefenamic Acid and Tranexamic Acid for Treatment of Menorrhagia Induced by Copper T-380A IUD