David Hubacher, Pai-Lien Chen, and Sola Park

Abstract

Background—The copper intrauterine device (IUD) can cause side effects in some women; increased uterine bleeding and pain may cause early removal. Because of simplified reporting from previous research, little is known about how side effects might change over time.

Study Design—This is a secondary analysis of a prospective study of 1,947 first-time copper IUD users. Over a one year period, we collected detailed information on side effects and looked for trends using generalized mixed effects regression modeling.

Results—During menses, most bleeding and pain side effects were found to decrease over time (p <0.05). During intermenstrual intervals, overall spotting and pain complaints remained unchanged, but number of days with these problems increased (p <0.05). Serious side effects that prompted either a clinic visit or IUD removal had a varied pattern over time, depending on the type of problem.

Conclusion—Side effects from the copper IUD can be troubling for both user and clinician. Some problems improve over time while others do not. This information may be helpful to counsel women who are considering an IUD and to current users who are contemplating removal due to side effects.

Summary: One of the H&Ps I chose to write up was a patient with a copper IUD who complained of heavy menses, so I wanted to find an article that attempted to define the timing and severity associated with side effects from copper IUDs. Copper IUDs are nonhormonal and long-acting, some last as long as 20 years. Up to 15% of copper IUD patients have the device removed within 1 year due to bleeding and pain. This secondary analysis of an RCT followed 1,947 patients with copper IUDs for 1 year after placement.  Most of the results of the analysis showed that pain and bleeding decreased over time, however 25% of participants had the device removed within 1 year due to worsening bleeding. There was a notable improvement in bleeding associated with menses, conversely intermenstrual bleeding did not improve. The authors conclude that although some evidence was found that side effects decreased over time, there were still problems that caused premature removal of the device, and more research is needed to determine whether newer products are equally effective with fewer side effects.