Abstract
Background
Bleeding irregularities, such as intermenstrual spotting or heavy or prolonged menstrual
bleeding, are common among copper-containing intrauterine device (Cu-IUD) users and
are one of the leading reasons for method discontinuation. This review evaluates the
evidence for effective therapeutic and preventive treatments for bleeding irregularities
during Cu-IUD use.
Study Design
We searched the PubMed database for peer-reviewed articles that were published in
any language from inception of the database through March 2012 and were relevant to
treatments for irregular bleeding during Cu-IUD use. We used standard abstract forms
and grading systems to summarize and assess the quality of the evidence.
Results
From 1470 articles, we identified 17 articles that met our inclusion criteria. Evidence
from two studies of poor quality demonstrated that antifibrinolytic agents or nonsteroidal
anti-inflammatory drugs (NSAIDs) have been used for intermenstrual bleeding or spotting
among a small number of Cu-IUD users with mixed results. Evidence from 10 studies
of fair to poor quality suggested that some NSAIDs may significantly reduce menstrual
blood loss or bleeding duration among Cu-IUD users with heavy or prolonged menstrual
bleeding. Antifibrinolytic drugs or antidiuretics may also help reduce blood loss.
High-dose aspirin was shown to increase blood loss among those with baseline menorrhagia.
Evidence from five studies of fair to poor quality suggested that bleeding irregularities
among new Cu-IUD users may be prevented with NSAIDs, although one large study of good
quality suggested that prophylactic treatment with ibuprofen does not affect continuation
of Cu-IUD use. Evidence from two studies of fair to poor quality suggested that antifibrinolytic
agents might be helpful in preventing heavy or prolonged menstrual bleeding among
new Cu-IUD users.
Conclusions
Limited evidence suggests that NSAIDs may be effective treatments for bleeding irregularities
associated with Cu-IUD use; antifibrinolytic agents and antidiuretics have also been
studied as possible treatments in a small number of subjects, but their safety has
not been well documented. NSAIDs and antifibrinolytics may also prevent bleeding irregularities
among new CU-IUD users. Preventive NSAID use, however, does not impact Cu-IUD continuation.
Keywords
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Article info
Publication history
Published online: November 30, 2012
Accepted:
September 6,
2012
Received in revised form:
August 31,
2012
Received:
July 3,
2012
Footnotes
���Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
