From the Guidelines
If you're experiencing heavy bleeding from an IUD, the most effective treatment option is to take nonsteroidal anti-inflammatory drugs (NSAIDs) for 5-7 days, as recommended by the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1. When managing heavy bleeding from an IUD, it's essential to explore patient goals, including continued method use or method discontinuation, and provide reassurance and advice on managing bleeding irregularities 1. Key considerations for managing heavy bleeding from an IUD include:
- Taking NSAIDs, such as ibuprofen or mefenamic acid, for 5-7 days to reduce bleeding and manage pain 1
- Considering hormonal treatment, such as low-dose combined oral contraceptives or estrogen, for 10-20 days, especially for LNG-IUD users 1
- Using antifibrinolytic agents, such as tranexamic acid, for 5 days to help reduce bleeding 1
- Ruling out underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, and treating or referring for care if necessary 1 It's crucial to prioritize the patient's preferences, treatment goals, and medical history when selecting a treatment option 1. In cases where the patient desires removal or discontinuation of the IUD, it's essential to remove the device, offer counseling on alternative contraceptive methods, and initiate another method if desired 1.
From the Research
Treatment Options for Heavy Bleeding from IUD
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen, mefenamic acid, and ibuprofen have been shown to be effective in reducing menstrual bleeding and pain associated with IUD use 2, 3, 4.
- Antifibrinolytic agents such as tranexamic acid may also be effective in reducing menstrual blood loss 2, 5, 4.
- Vitamin B1 has been shown to reduce the number of pads used per day and the number of bleeding days in women with copper IUDs 2.
- Levonorgestrel 52-mg intrauterine device (IUD) has been shown to reduce blood loss by more than 90% over 6 months compared to baseline for most users with heavy menstrual bleeding 6.
Prevention of Heavy Bleeding from IUD
- NSAIDs such as tolfenamic acid and ibuprofen may be effective in preventing heavy menstrual bleeding in women with copper IUDs 2, 3, 4.
- Antifibrinolytic agents such as tranexamic acid may also be effective in preventing heavy menstrual bleeding in women with copper IUDs 4.
- Prophylactic use of NSAIDs around the time of IUD insertion may not be effective in preventing heavy menstrual bleeding 3.