The effect of diclofenac on uterine artery blood flow resistance during menstruation in patients with and without a copper intrauterine device

The aim was to evaluate the effect of diclofenac on uterine artery blood fl ow resistance during the first day of menstruation. A total of 28 regularly menstruating women were examined longitudinally with and without a copper intrauterine contraceptive device (IUD) by transvaginal colour Doppler ultr asonography, The uterine artery pulsatility index (PI) was first measured, after which 50 mg of diclofenac was infused i.v. After 15 min the PI was me asured again. The patients evaluated their menstrual pain with a scoring sy stem before and after the diclofenac infusion. The mean PI (SD) during mens truation was significantly lower with the IUD [2.13 (0.43)] than without [2 .39 (0.62)], P = 0.05. The mean PI in nine patients who experienced advance d menstrual pain was also lower in the presence of the IUD [2.16 (0.42)] th an without it [2.83 (0.78); P < 0.05]. Diclofenac was effective in revealin g menstrual pain both with and without the IUD, and reduced the PI in the a bsence of an IUD [pre-treatment 2.39 (0.62) versus posttreatment 2.12 (0.45 ); P < 0.001], but had no effect when the IUD was present [pre-treatment 2. 13 (0.43) versus post-treatment 2.10 (0.41)]. The results indicate that by inhibiting prostaglandin synthesis one can reduce the resistance to blood h ow in the uterine arteries during menstruation. This does not hold true whe n an IUD is present, however, suggesting that the device might induce the p roduction of vasoactive agents other than prostaglandins in the surrounding tissue.