Hormone Testing Timing for Patient with Copper IUD and Continuous Bleeding
For a patient with elevated testosterone who has a copper IUD causing continuous bleeding, proceed with hormone testing immediately without waiting for bleeding to stop, as the copper IUD does not interfere with hormone measurement timing and standard early follicular phase timing (days 3-6 of the cycle) remains appropriate. 1
Key Recommendation
Draw labs now during the continuous bleeding episode. The presence of an IUD—including copper IUDs—does not alter hormone testing timing, and standard early follicular phase timing (days 3-6 from the start of bleeding) remains appropriate. 1 Since your patient is experiencing continuous bleeding from the copper IUD, you can consider the current bleeding as equivalent to menses and proceed with testing.
Rationale for Immediate Testing
- The copper IUD does not release hormones and therefore does not interfere with endogenous hormone measurements. 2
- For patients with irregular cycles or continuous bleeding, testing can be performed on any day when clinically indicated, though interpretation may be more challenging. 1
- The original recommendation to test 7-10 days after bleeding completes assumes normal, self-limited menstrual bleeding—not the continuous bleeding pattern caused by copper IUD placement. 1
Optimal Testing Protocol
Measure the following hormones during what would correspond to early follicular phase (ideally days 3-6 from when the current bleeding episode started): 1
- Total testosterone (to confirm and quantify the elevation) 3
- LH and FSH (ideally from an average of three blood samples taken 20 minutes apart during this window to differentiate exogenous vs. endogenous testosterone overproduction) 1, 3
- DHEAS (to rule out adrenal pathology and differentiate adrenal from gonadal source) 1, 3
- Hematocrit/hemoglobin (to assess for erythrocytosis from elevated testosterone, which poses thrombotic risk) 3
Critical Diagnostic Consideration
The LH level is crucial for determining the etiology of elevated testosterone: 3
- Suppressed or low LH with elevated testosterone strongly suggests exogenous testosterone use (supplements, partner transfer from topical preparations), as it suppresses the hypothalamic-pituitary-gonadal axis. 3
- Normal or elevated LH with elevated testosterone indicates endogenous overproduction from a testosterone-secreting tumor or other pathologic condition requiring immediate endocrinology referral. 3
Management of the Bleeding
While the bleeding from the copper IUD is a separate issue from the hormone testing timing, if it persists and is unacceptable to the patient, consider assisting with choosing another contraceptive method. 2 The copper IUD itself requires no backup contraception and provides immediate contraceptive protection. 2
Common Pitfall to Avoid
Do not delay hormone testing indefinitely waiting for bleeding to stop. With continuous bleeding from a copper IUD, you may wait weeks to months unnecessarily, delaying diagnosis and management of potentially serious causes of elevated testosterone (such as testosterone-secreting tumors). 1, 3 The clinical urgency of evaluating significantly elevated testosterone outweighs the theoretical benefit of testing during a "clean" cycle.