I have a history of Graves' disease and a copper (intrauterine device) IUD, what could be causing my intermenstrual bleeding 1-2 weeks after my period?

Intermenstrual Bleeding with Copper IUD: Evaluation and Management

Your intermenstrual bleeding 1-2 weeks after your period requires clinical evaluation to rule out IUD displacement, pregnancy, sexually transmitted infections, or new uterine pathology (polyps or fibroids), especially if you've had the IUD for more than a few months and this bleeding pattern is new. 1

Understanding Your Bleeding Pattern

While unscheduled spotting or light bleeding is common during the first 3-6 months of copper IUD use and generally not harmful, your situation warrants investigation because: 1

• Timing matters: Bleeding occurring 1-2 weeks after your period (mid-cycle) suggests intermenstrual bleeding rather than prolonged menstrual bleeding 1
• Duration of use: If you've had your copper IUD for several months or longer and this represents a new bleeding pattern, underlying gynecological problems become more likely 1

Required Clinical Evaluation

You need to be evaluated for the following conditions, in order of clinical priority: 1

1. IUD displacement - Check for presence of IUD strings and proper positioning 1
2. Pregnancy - Must be ruled out, especially with a changed bleeding pattern 1
3. Sexually transmitted infections (STDs) - Can cause intermenstrual bleeding 1
4. New uterine pathology - Polyps or fibroids that may have developed since IUD insertion 1

Graves' Disease Consideration

Your Graves' disease history is unlikely to be directly causing this bleeding pattern, as thyroid disorders typically affect menstrual cycle regularity and flow rather than causing isolated intermenstrual bleeding. 2 However, ensure your thyroid function is adequately controlled, as uncontrolled hyperthyroidism can affect overall menstrual patterns.

Treatment Algorithm

If evaluation reveals an underlying problem: Treat the specific condition identified or obtain appropriate referral for specialized care 1

If no underlying gynecological problem is found and bleeding persists:

• First-line treatment: NSAIDs (such as ibuprofen, mefenamic acid, or indomethacin) for 5-7 days during bleeding episodes 1, 3

  • Multiple studies demonstrate significant reductions in menstrual blood loss with NSAID use in copper IUD users 1, 3
  • NSAIDs are more effective for heavy menstrual bleeding than for intermenstrual spotting specifically 1, 3

• Alternative consideration: Tranexamic acid has shown effectiveness in reducing blood loss, but carries an FDA warning against use in women with active thromboembolic disease or history/risk of thrombosis 1

  • Critical caveat: Given your Graves' disease, assess your thrombotic risk profile before considering tranexamic acid

• Avoid aspirin: High-dose aspirin can actually increase menstrual blood loss 1

If bleeding persists despite treatment and you find it unacceptable: Consider counseling about alternative contraceptive methods and switching if desired 1

Important Clinical Pitfalls

• Don't assume all bleeding is "normal IUD bleeding" - New-onset intermenstrual bleeding after stable patterns requires investigation 1, 4
• Don't remove the IUD without investigating underlying causes first 4
• Don't attribute bleeding to the IUD "wearing off" when other pathology is more likely 4
• Limited evidence exists for treating intermenstrual spotting specifically - most studies focus on heavy menstrual bleeding rather than mid-cycle spotting 1, 3