From the Guidelines
Breakthrough bleeding on an IUD can be managed with watchful waiting, NSAIDs, or hormonal treatments, and the most effective approach depends on the type of IUD and the individual patient's needs, as recommended by the most recent guidelines 1.
Treatment Options
- For Cu-IUD users, NSAIDs such as ibuprofen (400-800mg three times daily for 5-7 days) can reduce bleeding by decreasing prostaglandin production 1.
- For LNG-IUD users, treatment options include NSAIDs, hormonal treatment with low-dose COCs or estrogen, and antifibrinolytic agents such as tranexamic acid 1.
- Hormonal treatments, including combined oral contraceptives (one pill daily for 1-3 months) or tranexamic acid (1000-1300mg three times daily during bleeding episodes), may also help reduce bleeding 1.
Evaluation and Management
- If bleeding persists, patients should be evaluated for underlying causes such as infection, pregnancy, expulsion, or malposition of the IUD 1.
- Ultrasound imaging may be necessary to confirm proper IUD placement 1.
- Patients should understand that irregular bleeding is a common side effect, especially with hormonal IUDs in the first few months, and typically improves over time as the body adjusts to the device 1.
Key Considerations
- The type of IUD and the individual patient's needs should guide the treatment approach 1.
- Patients should be counseled on alternative contraceptive methods if bleeding persists and is unacceptable 1.
From the Research
Treatment Options for Breakthrough Bleeding on an Intrauterine Device (IUD)
- Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in reducing menstrual bleeding and pain associated with IUD use 2.
- NSAIDs such as naproxen, suprofen, mefenamic acid, ibuprofen, indomethacin, flufenamic acid, alclofenac, and diclofenac can be used to treat breakthrough bleeding on an IUD 2.
- If NSAIDs are ineffective, tranexamic acid may be considered as second-line therapy 2.
- Prophylactic use of NSAIDs has mixed results, and prophylactic ibuprofen administration with the first six menses after insertion may not be warranted 2.
- Combined hormonal contraceptives (CHCs) may be considered as an alternative to progesterone-only pills (POPs) for breastfeeding mothers experiencing breakthrough bleeding, as CHCs are associated with a lower risk of breakthrough bleeding 3.
- Norethindrone acetate may be superior to combined oral contraceptive pills in delaying menstruation and preventing breakthrough bleeding when started late in the cycle 4.
Considerations for Treatment
- The choice of treatment for breakthrough bleeding on an IUD should be individualized based on the woman's medical history, preferences, and lifestyle.
- Women experiencing breakthrough bleeding on an IUD should be counseled on the available treatment options and the potential risks and benefits of each option.
- Further research is needed to fully understand the dose-response relationships for combined oral contraceptives and breakthrough bleeding 5.