Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system

Abstract

Detailed information on the menstrual bleeding patterns in users of copper-releasing intrauterine devices (IUDs) and levonorgestrel-releasing intrauterine systems (IUSs) is lacking. Even less is known about the menstrual bleeding patterns associated with postabortal insertion of IUDs. We postulated that the scarcity of IUD studies including detailed analysis of bleeding could be a result of the lack of an easy-to-use computer program designed for this purpose. We therefore developed a set of graphical user interface (Windows) programs for entering, editing, and analyzing menstrual diary data. With these programs, we reanalyzed the menstrual diaries of the subjects of one of the hospital clinics that participated in a previous multicenter study comparing copper IUDs and LNg IUSs. The group included patients who had the IUD inserted postabortally. Copper IUD users had patterns of bleeding that were stable over time, and clearly more bleeding than LNg IUS users, many of whom had either infrequent bleeding, bleeding completely replaced by regularly occurring spotting, or amenorrhea. Postabortal insertion of LNg IUSs was associated with slightly better patterns of bleeding than postmenstrual insertion. Detailed statistics on bleeding help clinicians in counseling patients regarding these methods. The statistics permit assumptions to be made about the probabilities of specific menstrual disturbances and their changes over time.

PIP: Researchers used a new computer program to analyze menstrual diaries of 287 healthy women, 18-38 years old, who had been randomized to undergo postmenstrual or postabortal insertion of either a copper-releasing IUD (Cu IUD) or a levonorgestrel releasing IUD (LNG-IUD) to better understand the patterns of menstrual bleeding associated with these IUDs. The women received the IUD from the family planning clinic of the Helsinki City Maternity Hospital in Finland. The new computer program consisted of a set of graphical user interface (Windows) programs for entering, editing, and analyzing menstrual diary data. Women using the Cu IUD had menstrual bleeding patterns that tended to be stable over time. They experienced more bleeding than LNG-IUD users. LNG-IUD users often had infrequent bleeding, regular spotting during menstruation rather than bleeding, or amenorrhea. Among LNG-IUD users, postabortal insertion was associated with better bleeding patterns (i.e., fewer days of bleeding during the first 2 months) than postmenstrual insertion. It was hypothesized that levonorgestrel had an enhanced local effect on the remaining endometrium, thus explaining the better bleeding patterns. These findings confirm those of an earlier study that found LNG-IUDs to be well-suited for postabortal contraception. This study shows that the computer program provides versatile transfer of menstrual diary data to computer files and a wealth of clinically useful information and allows convenient and accurate statistical analysis.