Treatment of increased menstrual blood loss in IUD users

Abstract

Although bleeding problems represent the commonest side effect of IUDs and an important medical reason for discontinuation of use, its pathogenesis still remains incompletely understood and a standard universally acceptable therapy is not yet available. Proper insertion, change in size, material or shape of the IUD, as well as custom fitting to avoid dimensional incompatibilities, did not significantly improve the IUD-associated bleeding problems. Addition of copper to inert devices seemed to slightly improve the bleeding by reducing the antifibrinolytic activity but probably more was achieved through reducing the device size. Hormone-releasing devices appear to reduce the amount of bleeding significantly but a post-insertion phase of irregular spotting is a common complaint. Locally released antifibrinolytic agents were tried in limited investigations but a short period of drug release restricted further evaluation. Systemic administration of antifibrinolytic agents and non-steroidal anti-inflammatory drugs hold promise for the control of IUD-induced menorrhagia. The duration of bleeding and intermenstrual spotting still remains an unresolved clinical problem that requires further evaluation. This area of clinical concern in IUD use needs more in depth understanding and testing of new agents, particularly in the area of local release of antihemorrhagic agents.

PIP: Bleeding problems represent the most common side effect of IUD use and are an important factor in IUD discontinuation. The prevention and treatment of IUD-induced bleeding problems depends on control of the probable predisposing causes or the addition of factors that improve the hemostatic mechanisms. Mechanical approaches to this problem include changes in the size, material, or shape of the IUD, while pharmacologic approaches include local or systemic administration of various agents. Proper insertion, custom fitting to avoid dimensional incompatibilities, or changes in the size, material, or shape of the IUD have failed to significantly improve IUD-associated bleeding problems. The addition of copper to inert devices appears to slightly improve bleeding by reducing antifibrinolytic activity, although the improvement may be related more to reductions in the size of the device. Hormone-releasing devices significantly reduce the amount of bleeding, but a post-insertion phase of irregular spotting often occurs. Locally released antifibrinolytic agents have been tried in limited investigations, without conclusive results. Systemic administration of antifibrinolytic agents and nonsteroidal anti-inflammatory drugs have potential for the control of IUD-induced menorrhagia. The duration of bleeding and intermenstrual spotting remain unresolved clinical problems that require further evaluation. The more IUD-induced bleeding can be understood and therefore controlled, the more likely it is that better acceptance and continuation rates can be achieved for this form of contraception.