vv Journal of Gynecological Research and Obstetrics CC By 093 Citation: Ali Mk, Abbas AM, Yosef AH, Abdalmageed OS, Bahloul M (2017) Can the response to three months Ibuprofen for controlling Heavy Menstrual Bleeding with IUD be predicted at baseline visit? J Gynecol Res Obstet 3(4): 093-097. DOI: http://dx.doi.org/10.17352/jgro.000046 Clinical Group http://dx.doi.org/10.17352/jgro.000046 DOI Research Article Can the response to three months Ibuprofen for controlling Heavy Menstrual Bleeding with IUD be predicted at baseline visit? Introduction Copper intrauterine device (Cu-IUD) is a common method of reversible contraception worldwide [1]. Abnormal uterine bleeding and pain are the most common medical indications for the discontinuation of its use [2,3]. Many factors may exert influences on the frequency of bleeding with Cu-IUDs such as the type of device used, the duration of usage, the previous menstrual pattern and the woman’s parity [4]. Moreover; the uterine volumetric measurement and uterine blood flow pattern may be also having a role in development of such bleeding [5]. Excessive prostaglandin release appears to play an important role in provoking both bleeding and pain related to IUDs [6]. There are many types of prostaglandin metabolites that present in the endometrium; one of them is prostacyclin which causes vasodilatation and inhibits platelet aggregation. Another one is thromboxane which induces vasoconstriction and blood clotting [7]. The Cochrane Review states that non-steroidal anti- inflammatory drugs (NSAIDs) are the most effective treatment to reduce the bleeding with IUD use [8]. They are prostaglandin synthetase inhibitors acting by decreasing production of endometrial prostaglandins; thus can improve both uterine bleeding and pain [9]. Mohammed k Ali, Ahmed M Abbas*, Ali H Yosef, Osama S Abdalmageed and Mustafa Bahloul Department of Obstetrics & Gynecology, Faculty of Medicine. Assiut University, Egypt Dates: Received: 17 November, 2017; Accepted: 21 November, 2017; Published: 22 November, 2017 *Corresponding author: Ahmed M. Abbas, Depart- ment of Obstetrics and Gynecology, Assiut Univer- sity, Women Health Hospita 71511, Assiut Egypt, Tel: +20 10033851833, +20 88 2414616; Fax: +20 88 9202503; E-mail: Keywords: Intrauterine device; Heavy menstrual bleeding; Ibuprofen; Doppler https://www.peertechz.com Abstract Objective: The present study examines the hypothesis that the clinical and ultrasonography data reported at baseline visit can predict the responsiveness of ibuprofen in controlling heavy menstrual bleeding with Cu-IUDs at 3 months follow-up visit. Materials and methods: We used data revealed from a single center open label prospective cohort study conducted at Woman’s Health Hospital, Assiut University, Egypt in the period between the 1 st of October 2015 and the 30 th of September 2016. This study included 128 women complaining of heavy/ prolonged menstrual bleeding with Cu-IUD; they received ibuprofen for three consecutive cycles. Seventy patients (54.68%) respond to ibuprofen and while 58 patients (45.31%) did not respond. Logistic regression was done to show the significant predictors of ibuprofen response and a receiver operating characteristic (ROC) curves was used to evaluate the sensitivity and specificity of the potential predictors revealed by logistic regression. Results: The responders had fewer number of bleeding days per month (5.1 ± 1.7 vs. 7.41 ± 1.7 days in the non-responders, p<0.001). Additionally, the uterine volume was significantly smaller in the responders than the non-responders with statistically significant difference (47.01 ± 6.5 mL vs. 60.9 ± 25.5 mL, p=0.001; respectively). Women reporting higher number of bleeding days per month (OR 3.26, 95% CI 1.06-10.03, p<0.001), larger uterine volume (OR 1.26, 95% CI 1.00-1.59, p=0.03) and lower uterine PI (OR 0.15, 95% CI 0.23-0.95, p=0.005 were likely to not succeed to be controlled by ibuprofen. Our predictive model can predict the failure of ibuprofen when utilize the 3 prior predictors with 93.5% sensitivity, 57.5%specificity, 67.4% PPV, 90.5% NPV and 75.0%accuracy. Conclusion: Women reporting a lot of bleeding days per month, high uterine volume and low uterine artery PI during baseline visit may not respond to ibuprofen in controlling of heavy menstrual bleeding with Cu-IUD.