IUD use and endometrial bleeding

Abstract

Bleeding disturbances account for 41-52% of all IUD discontinuations. These bleeding disturbances include an increase in menstrual blood loss (MBL) intermenstrual bleedings (IMBs) and prolonged duration of menstruation. IUD users experience an increase of MBL of 50-75% which continues throughout the duration of IUD use. MBL decreases after insertion of a progestin-releasing IUD. A progestin-releasing IUD can treat women suffering from excessive bleeding during menstruation. MBL of at least 60-80 ml causes iron deficiency and anemia. Since due to infections and malnutrition iron balance is especially important in women from developing countries copper T IUD use threatens their health. IMBs are most frequent during the first months following IUD insertion. IMBs differ with the IUD type. IMB generally results in minimal blood loss (4-5 ml) which has no negative health effects in IUD users. IUD-induced IMB may keep many women from using the IUD in cultures where irregular bleeding is unacceptable. The copper T IUD prolongs menstruation by about 1 day while the progestogen-releasing IUD prolongs it by about 2 days. Prolongation of menses rarely contributes to discontinuation. Ways to manage bleeding disturbances other than removal include counseling before insertion and when disturbances occur; in cases of heavy blood losses antifibrinolytic agents nonsteroidal anti-inflammatory drugs and iron supplementation; and in cases of IMB changing either the IUD or its location. The most important way to minimize the consequences of IUD-related bleeding problems and increase IUD acceptability is good counseling from professionals with experience confidence and adequate knowledge of the effect of the IUD on bleeding patterns.