What should I do if my Intrauterine Device (IUD) is causing bleeding during sex?

Managing Bleeding During Sex with an IUD

If you are experiencing bleeding during sex with an IUD, you should first rule out infection and then consider non-steroidal anti-inflammatory drugs (NSAIDs) as a first-line treatment option while maintaining your IUD in place. 1

Causes of Bleeding During Sex with IUD

Bleeding during intercourse (post-coital bleeding) with an IUD can occur due to several reasons:

• Microtrauma to the endometrium - The physical presence of the IUD can cause small injuries during intercourse 2
• Increased endometrial sensitivity - IUDs, particularly copper IUDs, may increase endometrial sensitivity
• Possible subclinical infection - Bacterial colonization may contribute to bleeding symptoms 2
• Normal adjustment period - Bleeding is common during the first three months of IUD use 3

Evaluation Steps

1. Check for infection signs:

   • Fever, unusual discharge, pelvic pain outside of intercourse
   • If these symptoms are present, seek immediate medical attention as this could indicate pelvic inflammatory disease (PID)

2. Determine IUD type:

   • Copper IUDs are more likely to increase menstrual bleeding and cramping 1
   • Levonorgestrel IUDs (hormonal) typically reduce bleeding over time 1

3. Duration of symptoms:

   • If within first 3 months of insertion: Some irregular bleeding is expected
   • If beyond 3 months: Further intervention may be needed

Management Approach

First-Line Options:

• NSAIDs (ibuprofen, mefenamic acid) for 5-7 days during bleeding episodes 1

  • These medications reduce prostaglandin production and can decrease bleeding
  • Take as directed before and during intercourse if bleeding is predictable

• Tranexamic acid can be considered for more significant bleeding 1

  • This is an antifibrinolytic agent that helps stabilize blood clots

If Bleeding Persists:

• For copper IUD users: Consider switching to a levonorgestrel-releasing IUD, which typically reduces menstrual bleeding 1

• For hormonal IUD users: If bleeding persists beyond 3-6 months, discuss with your healthcare provider about:

  • Checking IUD placement
  • Ruling out other causes (polyps, fibroids, infection)
  • Possible supplemental hormonal therapy

Important Considerations

• Keep the IUD in place - Removal is usually unnecessary unless infection is present 2
• Partner evaluation may be needed if infection is suspected 2
• Avoid intercourse until any infection is treated
• IUDs should be left in place for their maximum lifespan rather than being replaced early, as insertion is when infection risk is highest 4

When to Seek Immediate Medical Attention

• Severe pain during or after intercourse
• Heavy bleeding (soaking through pad/tampon every hour)
• Fever, unusual discharge, or foul odor
• Symptoms of pregnancy

Remember that while bleeding during sex can be concerning, it's often manageable without removing the IUD, which remains one of the most effective contraceptive methods available with failure rates <1% 1.