Can pre-insertion uterine artery Doppler indices predict intrauterine contraceptive device-related heavy menstrual bleeding?

Abstract

Background: The intrauterine contraceptive device (IUCD) is a frequently used method of contraception all-over the world. The most common side effect of IUCD is menorrhagia which is accountable for increased removal rate in the first year of its use. Objective: To test the hypothesis that initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of Tcu 380A IUCD could predict IUCD-related heavy menstrual bleeding or not. Methodology: A cohort study was performed on 300 women who demanded copper IUCD insertion as a method of contraception. Full history, detailed examination and investigations were done. Hemoglobin (Hb) concentration and PI and RI of uterine artery were measured using voluson B6 equipment before IUCD insertion and 3 and 6 months after insertion. Results: 162 participants who suffered from heavy menstrual bleeding (group II) had significantly lower uterine artery PI and RI than 138 participants who did not suffer from heavy menstrual bleeding (group I) before IUCD insertion and 3 and 6 months after insertion (p-value 0.05). 64 participants in group II with severe heavy menstrual bleeding required removal of the IUCD at the 3 months follow up visit. A cut-off levels for Doppler indices of uterine artery were PI ≤1.52 and RI ≤0.66. Conclusion: PI and RI of uterine artery are lower in patients with IUCD-induced heavy menstrual bleeding before IUCD insertion. Initial measurement of Doppler indices of uterine artery could predict IUCD-related heavy bleeding.