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Abnormal menstrual bleeding associated with IUC use

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Spotting, light bleeding, heavy or prolonged bleeding is common in the first 3-6 months of copper IUCD use

Irregular bleeding and spotting is common in the first 6 months after insertion of the levonorgestrel intrauerine system (LNG-IUS). By 1 year after LNG-IUS insertion amenorrhoea or oligomenorrhoea is usual women

Abnormal bleeding whilst using an intrauterine contraceptive device

  • all causes of abnormal bleeding should be considered (i.e. the type of intrauterine method used, concurrent gynaecological pathology, pregnancy, infection and STIs). A short course of NSAIDs, taken during the days of bleeding, can be used to treat spotting or light bleeding with a copper IUCD. Heavier and longer menstrual bleeding can be treated with NSAIDs or antifibrinolytics (tranexamic acid)

  • although not specific to women using intrauterine contraception, guidance on the management of menorrhagia suggests investigation if menorrhagia persists despite medical management

  • women using the LNG-IUS with persistent bleeding may warrant re-examination and an assessment of the uterine cavity (e.g. ultrasound scan and endometrial biopsy)


  • norethisterone has been used in short courses (e.g. norethisterone 5mg tds for one week) for patients experiencing the irregular bleeding associated after insertion of an LNG-IUS - however this management option is not suggested in the FSRH guidance (1)


  1. FSRH Guidance (November 2007) Intrauterine Contraception.

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