a) As in pre-method choice counseling, women should be informed that menses are normally heavier with the IUD and intermenstrual bleeding may occur, especially in the first few months. Inert IUDs should not be the first choice, for this reason.
Give nutritional advice on the need to increase the intake of iron-containing foods.
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a) In general, IUDs (especially inert IUDs) commonly increase the amount of menstrual blood loss, according to IUD type, particularly in the first few months post-insertion.
- Cohen B, Gibor Y. Anemia and menstrual blood loss. Obstetrical and Gynecological Survey 1980;35(10):597-618.
Copper IUDs may increase normal menstrual blood loss by 50%, which may be clinically significant for women who are already anemic. (Progestin-releasing IUDs decrease menstrual blood loss; the more progestin an IUD releases, the more effectively it decreases menstrual blood loss.)
- Andrade A, Pizarro E. Quantitative studies on menstrual blood loss in IUD users. Contraception 1987;36(1):129-144.
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b) For mild to moderate bleeding and pain in the first month post-insertion, with no evidence of clinically apparent pelvic infection, and if reassurance is not sufficient but the woman wants to keep the IUD, a short course of a non-steroidal anti-inflammatory agent other than aspirin (e.g., ibuprofen) may be given.
c) Bleeding generally decreases over time. If bleeding is heavy or the woman is anemic, treatment using oral iron can improve hemoglobin levels.
d) If bleeding or pain is severe, or the client wishes to discontinue use, remove the IUD.
e) If suspected, abnormal conditions which cause prolonged or heavy bleeding should be evaluated and treated as appropriate.
f) If pelvic infection is diagnosed, remove the IUD, and treat with antibiotics. (In the case of mild uterine tenderness without any other evidence of pelvic infection, broad spectrum antibiotics or chemotherapeutics may solve the problem; use clinical judgement regarding whether or not to remove the IUD).
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b) Non-steroidal anti-inflammatory drugs (e.g., ibuprofen*) decrease uterine bleeding and cramping.
1) Drug facts and comparisons. St. Louis, MO, Facts and Comparisons 1993, p 251.
* NOTE: Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) should be used instead of aspirin because of aspirin's stronger and longer-lasting inhibitory effects on platelet aggregation (aspirin promotes bleeding).
- American Hospital Formulary Service Drug Information. Bethesda, MD, American Society of Hospital Pharmacists, 1994, p 1208.
- Field CS. Dysfunctional uterine bleeding. Primary Care 1988;15(3):561-574.
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