From the Guidelines
Bleeding and pain 6 months after Intrauterine Device (IUD) insertion is not normal and may indicate an underlying issue.
Expected Bleeding Patterns
- Unscheduled spotting or light bleeding is common during the first 3–6 months of IUD use, but it should decrease with continued use 1.
- Heavy or prolonged bleeding is uncommon during IUD use, especially after 6 months, and may indicate an underlying gynecological problem such as IUD displacement, STD, pregnancy, or new pathologic uterine conditions like polyps or fibroids 1.
Evaluation and Management
- If a woman experiences heavy or prolonged bleeding 6 months after IUD insertion, an underlying gynecological problem should be considered and evaluated 1.
- Treatment options for bleeding include nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term treatment (5–7 days) 1.
- If bleeding persists and is unacceptable to the woman, alternative contraceptive methods should be considered and offered 1.
From the Research
Bleeding and Pain after IUD Insertion
- Bleeding and pain are common side effects experienced by women after IUD insertion, as reported in studies 2, 3.
- A study published in 2009 found that menstrual bleeding is often heavier in women with copper IUDs than in women who do not use IUDs, and may be associated with menstrual pain 2.
- Another study published in 2014 found that during the 6-month postinsertion period, 59% of adolescents and 43% of adults initiated IUD-related clinical contact after insertion, most commonly for bleeding changes and pelvic or abdominal pain 3.
- A 2020 study comparing post-placental IUD insertion with interval IUD insertion found that irregular bleeding or spotting was more common in interval insertion than in the post-placental group, with a statistically significant difference at 6 weeks and 6 months 4.
Duration of Bleeding and Pain
- The duration of bleeding and pain after IUD insertion can vary, but studies suggest that these side effects can persist for several months 2, 3.
- A study published in 2014 found that adolescents and adults experienced similar clinical concerns about bleeding and pain during the 6-month postinsertion period 3.
- Another study published in 2020 found that the difference in irregular bleeding or spotting between post-placental and interval IUD insertion groups was not statistically significant at 1 year 4.
Factors Influencing Bleeding and Pain
- Preprocedure anxiety has been found to correlate with more pain during IUD insertion 5.
- The type of IUD used can also influence the risk of bleeding and pain, with copper IUDs associated with heavier menstrual bleeding and the levonorgestrel IUD associated with a marked reduction in menstrual blood loss and irregular bleeding 2.
- Patient age may also be a factor, with adolescents initiating more clinical follow-up visits after IUD insertion due to bleeding changes and pelvic or abdominal pain 3.