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Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review.

AbstractBACKGROUND:
Bleeding irregularities, such as intermenstrual spotting or heavy or prolonged menstrual bleeding, are common among copper-containing intrauterine device (Cu-IUD) users and are one of the leading reasons for method discontinuation. This review evaluates the evidence for effective therapeutic and preventive treatments for bleeding irregularities during Cu-IUD use.
STUDY DESIGN:
We searched the PubMed database for peer-reviewed articles that were published in any language from inception of the database through March 2012 and were relevant to treatments for irregular bleeding during Cu-IUD use. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence.
RESULTS:
From 1470 articles, we identified 17 articles that met our inclusion criteria. Evidence from two studies of poor quality demonstrated that antifibrinolytic agents or nonsteroidal anti-inflammatory drugs (NSAIDs) have been used for intermenstrual bleeding or spotting among a small number of Cu-IUD users with mixed results. Evidence from 10 studies of fair to poor quality suggested that some NSAIDs may significantly reduce menstrual blood loss or bleeding duration among Cu-IUD users with heavy or prolonged menstrual bleeding. Antifibrinolytic drugs or antidiuretics may also help reduce blood loss. High-dose aspirin was shown to increase blood loss among those with baseline menorrhagia. Evidence from five studies of fair to poor quality suggested that bleeding irregularities among new Cu-IUD users may be prevented with NSAIDs, although one large study of good quality suggested that prophylactic treatment with ibuprofen does not affect continuation of Cu-IUD use. Evidence from two studies of fair to poor quality suggested that antifibrinolytic agents might be helpful in preventing heavy or prolonged menstrual bleeding among new Cu-IUD users.
CONCLUSIONS:
Limited evidence suggests that NSAIDs may be effective treatments for bleeding irregularities associated with Cu-IUD use; antifibrinolytic agents and antidiuretics have also been studied as possible treatments in a small number of subjects, but their safety has not been well documented. NSAIDs and antifibrinolytics may also prevent bleeding irregularities among new CU-IUD users. Preventive NSAID use, however, does not impact Cu-IUD continuation.
AuthorsEmily M Godfrey, Suzanne G Folger, Gary Jeng, Denise J Jamieson, Kathryn M Curtis
JournalContraception (Contraception) Vol. 87 Issue 5 Pg. 549-66 (May 2013) ISSN: 1879-0518 [Electronic] United States
PMID23199413 (Publication Type: Journal Article, Review)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Chemical References
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antifibrinolytic Agents
Topics
  • Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
  • Antifibrinolytic Agents (therapeutic use)
  • Female
  • Humans
  • Intrauterine Devices, Copper (adverse effects)
  • Menorrhagia (drug therapy, etiology, prevention & control)
  • Metrorrhagia (drug therapy, etiology, prevention & control)

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