Abnormal menstrual bleeding associated with IUCD use

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)

Notes:

• 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)

Reference:

1. FSRH Guidance (November 2007) Intrauterine Contraception.