Where did this advice come from? One small study of 18 women measured menstrual blood loss before and after insertion of the copper IUD, as measured by the alkaline hematin method. Nevertheless, there was no significant change in hemoglobin levels among participants over the course of the study. Rather than assessing the amount of bleeding while using the copper IUD, the goal of this study was to assess whether women with heavy menstrual bleeding at baseline were more likely to discontinue their copper IUD by 12 months.
Interestingly, the study did not show that women with heavy or moderately heavy menstrual bleeding were more likely to request the copper IUD be removed. Some might argue that this is a more clinically relevant outcome. This may be interpreted as a weakness or strength of the study.
As a weakness, the investigators did not quantify the baseline menstrual bleeding pattern objectively. However, as a strength, the study is practical, as providers do not perform objective measurements of menstrual blood loss in the office. In the Hobby et al study, women reporting heavy or moderately heavy menstrual bleeding were just as happy to continue the copper IUD as women reporting light or moderate menstrual bleeding.
The authors speculated that these women may be more tolerant of heavy menstrual bleeding in general. This may reflect that women with heavy menstrual bleeding self-selected out of the copper IUD group in the first place.
Despite these limitations, this study reminds us that, as providers, we must try to prevent our biases from entering the exam room and counsel all women honestly about the copper IUD.
We should not assume automatically that women with heavy menstrual bleeding would not be interested in the copper IUD or that all women would prefer the levonorgestrel IUD. Experts speculate that the increase in menstrual blood loss seen with the copper IUD is caused by higher levels of prostaglandins in the endometrium.
Nevertheless, for most women, these side effects will decrease over time and are manageable. Although prophylactic ibuprofen has not been shown to decrease copper IUD removals, the use of nonsteroidal anti-inflammatory drugs NSAIDs can be helpful for a current bleeding episode with the copper IUD. Progestin works to prevent pregnancy in several ways: it thickens cervical fluid to prevent sperm from travelling into the uterus, thins the uterine lining, and also sometimes suppresses ovulation 3.
Ovulation suppression depends on the dose of progestin released from the IUD. For example, IUDs with a lower progestin dose are less likely to suppress ovulation in comparison IUDs with a higher progestin dose 4,5.
The rate of ovulation suppression also seems to decrease the longer the IUD is worn 4. The presence of the IUD within the uterus causes an irritation, creating an inflammatory reaction in the uterus that makes it inhospitable to both egg and sperm 5. A single hormonal IUD can last for 3 to 5 years, depending on the type. How will my period change on the hormonal IUD? Since the hormonal IUD thins the uterine lining and may inhibit ovulation the release of an egg from the ovary your period is likely to be different.
Two out of three hormonal IUD users experience lighter bleeding within six months 6. In studies, people using a hormonal-IUD had a decreased amount of blood flow to the uterus and thinner endometrial lining thickness, in comparison to people who were using a copper IUD or who were not using hormonal contraceptives Some people report spotting or unscheduled bleeding between periods 10, Many people using hormonal IUDs also report a decrease in cramping. You might stop getting your period at all 10, All of these changes are considered normal.
The hormonal IUD may be helpful for people who experience unmanageable pain with menstruation dysmenorrhea , heavy menstrual bleeding, or endometriosis 11, The copper IUD is a device that is inserted into the uterus by a medical professional. Like the hormonal-IUD, the copper IUD also causes physical irritation, creating an inflammatory reaction in the uterus 3. The copper IUD does not contain hormones and therefore does not exert any changes to your hormone profile. People using copper IUDs will still ovulate and have a menstrual period.
A single copper IUD can protect against pregnancy for up to 10 years, depending on brand. Copper IUDs can also be used as an emergency contraceptive device when they are inserted up to 5 days after intercourse 10, If your bleeding is very heavy or happening at other times in your cycle, you may have another medical issue. Hormonal IUDs have the opposite effect. Periods typically become lighter and less painful with time. During a clinical trial, women with heavy periods reported an 80 to 90 percent reduction in bleeding during the first six months after insertion.
Heavy periods, which occur in a condition known as menorrhagia, may have other causes. Hormone imbalances in the amount of estrogen and progesterone in the body can occur. When your period comes, this thick lining sheds and results in a heavy period. An imbalance can also be caused by anovulation. This can result in very low progesterone levels. Over time, this can lead to a thickened uterine lining and heavy menstrual bleeding. Fibroids are benign tumors that can form in the walls of your uterus.
Polyps are smaller noncancerous growths that can form in the uterine lining. They can also cause abnormal or heavy bleeding and may indicate high hormone levels. In some cases, heavy bleeding may be a sign of pelvic inflammatory disease PID , especially if it occurs in the 20 days after getting an IUD.
This serious infection can lead to infertility, sterility, and even chronic pain. If you experience any of these symptoms and have had your IUD placed recently, contact your doctor right away. Tissue from the endometrium can end up in the muscle of the uterus and cause pain and excess bleeding. Pregnancy may cause bleeding that may be mistaken for a late period.
If you suspect you may be pregnant, see your doctor. Heavy bleeding can also be a symptom of miscarriage or ectopic pregnancy. Certain medications and other medical conditions may cause excessive bleeding as well. You should also mention if you have:. Are you interested in using an IUD for birth control? Talk with your doctor about your medical history.
There are certain risk factors that may increase your chances of excessive menstrual bleeding. Also, women who have never been pregnant have a higher rate of IUD removal due to bleeding and cramping. They also have a higher rate of IUD expulsion.
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