From the Guidelines
For patients experiencing bleeding with an IUD, the recommended treatment options include NSAIDs for 5-7 days, and for hormonal IUDs, additional treatments such as hormonal therapy or antifibrinolytic agents like tranexamic acid may be considered, as outlined in the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1. To manage bleeding irregularities while using an IUD, it is essential to explore patient goals, including continued method use or method discontinuation, and provide reassurance and advice on managing side effects, as suggested by the 2024 guidelines 1.
- Key considerations for managing IUD-related bleeding include:
- For Cu-IUD users, NSAIDs for 5-7 days may be considered for spotting, light bleeding, or heavy/prolonged bleeding.
- For LNG-IUD users, treatment options may include NSAIDs, hormonal therapy, or antifibrinolytic agents like tranexamic acid.
- It is crucial to consider underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, and treat or refer for care as needed, as recommended by the guidelines 1.
- In terms of specific treatment options, NSAIDs, such as ibuprofen, may be taken for 5-7 days to reduce bleeding, and for hormonal IUDs, hormonal therapy or tranexamic acid may be prescribed to control excessive bleeding, as outlined in the guidelines 1.
- It is essential to prioritize patient safety and well-being, and if bleeding is extremely heavy, persists beyond 6 months, or is accompanied by severe pain, fever, or foul-smelling discharge, seek medical attention immediately, as this could indicate infection, expulsion, or perforation, and is not explicitly addressed by the guidelines but is a critical consideration in real-life clinical practice.
From the Research
Treatment Options for Bleeding with IUD
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen, mefenamic acid, and ibuprofen have been shown to be effective in reducing menstrual bleeding and pain associated with IUD use 2, 3, 4.
- Antifibrinolytic agents such as tranexamic acid may also be effective in reducing menstrual bleeding, but the evidence is limited 2, 4.
- Vitamin B1 has been shown to reduce menstrual bleeding and pain in some studies 2.
- Levonorgestrel IUD (LNG IUD) may be effective in reducing menstrual bleeding, but the evidence is limited 2, 5.
- Combined hormonal contraceptives (CHCs) and antifibrinolytic agents may be used concomitantly to manage heavy menstrual bleeding, but further research is needed to confirm their safety and efficacy 6.
Prevention of Bleeding with IUD
- NSAIDs such as tolfenamic acid and ibuprofen may be effective in preventing heavy menstrual bleeding associated with IUD use 2, 3, 4.
- Antifibrinolytic agents such as tranexamic acid may also be effective in preventing heavy menstrual bleeding, but the evidence is limited 2, 4.
- Prophylactic use of NSAIDs around the time of IUD insertion may not be effective in preventing bleeding or pain 3.
Management of Heavy Menstrual Bleeding
- The first-line treatment for idiopathic abnormal uterine bleeding (AUB) is medical, with options including levonorgestrel IUD, tranexamic acid, oral contraceptives, and NSAIDs 5.
- Conservative surgical treatment may be considered for women who do not respond to medical treatment or who have idiopathic AUB and do not wish to become pregnant in the future 5.
- Concomitant use of CHCs and antifibrinolytic agents may be effective in managing refractory heavy menstrual bleeding, but further research is needed to confirm their safety and efficacy 6.