Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study

Abstract

ObjectiveWe assess change in bleeding, cramping, and IUD satisfaction among new copper (Cu) IUD users during the first six months of use, and evaluate the impact of bleeding and cramping on method satisfaction.MethodsWe recruited 77 women ages 18–45 for this prospective longitudinal observational cohort study. Eligible women reported regular menses, had no exposure to hormonal contraception in the last three months, and desired a Cu IUD for contraception. We collected data prospectively for 180 days following IUD insertion. Monthly, participants reported bleeding scores using the validated pictorial blood loss assessment chart (PBAC), IUD satisfaction using a five-point Likert scale, and cramping using a six-level ordinal scale. We used multiple imputation to address nonrandom attrition. Structural equation models for count and ordered outcomes were used to model bleeding, cramping, and IUD satisfaction growth curves over the six monthly repeated assessments.ResultsBleeding significantly decreased (approximately 23%) over the course of the study from an estimated PBAC = 195 at one month post-insertion to PBAC = 151 at six months (t = -2.38, p<0.05). Additionally, IUD satisfaction improved over time (t = 2.65, p<0.01), increasing from between “Neutral” and “Satisfied” to “Satisfied” over the six month study. Cramping decreased notably over the six month study from between biweekly and weekly, to once or twice a month (t = -4.38, p<0.001). Finally, bleeding, but not cramping, was associated with IUD satisfaction across the study (t = -2.31, p<0.05) and at study end (t = -2.81, p<0.01).ConclusionsNew Cu IUD users reported decreasing bleeding and cramping, and increasing IUD satisfaction, over the first six months. Method satisfaction was negatively associated with bleeding.

The Fine Line Between Informing and Coercing: Community Health Center Clinicians’ Approaches to Counseling Young People About IUDs

“…Many providers were more willing to remove the IUD after a year, by which time they believed most side eff ects would have resolved. While there is evidence indicating that IUD side eff ects often dissipate 47 and method satisfaction increases, 30 some people actually experience increased side eff ects-and as many as 15-20% of people report being dissatisfi ed with the IUD after one year. 29,31 More signifi cantly, providers are not acknowledging that people' s experiences with a method vary and that their desire to discontinue a method should always be honored, regardless of whether side eff ects will eventually subside.…”

“…24 Contraceptive decision making and use often change over time, as patients refl ect on prior experiences and their pregnancy intentions fl uctuate. 25 Even though method satisfaction may be higher for IUDs than for other methods, some people will choose to discontinue them in the fi rst year of use [26][27][28][29][30] for reasons including general method dissatisfaction, side eff ects-such as changes in bleeding volume and frequency, cramping and pain-and the desire for pregnancy. 26,29,31 However, patients have reported resistance from providers when requesting IUD removals, 8,32 and some clinicians acknowledge discouraging or actively resisting such removals in the hope that the patients' symptoms will resolve.…”

Sexual Functioning, Satisfaction, and Well-Being Among Contraceptive Users: A Three-Month Assessment From the HER Salt Lake Contraceptive Initiative

“…Other time-varying measures, all of which assessed the patients' experiences in the past four weeks, included changes in vaginal bleeding and experiences of side effects as measured by 10 items adapted from the Menstrual Symptom Questionnaire (MSQ; Chesney & Tasto, 1975;Negriff et al, 2009;Sanders, Adkins, et al, 2018). These items asked participants to report whether they had experienced any of the following side effects: headaches, bloating, breast tenderness, moodiness or irritability, acne flare-up, cramping, weight gain, weight loss, depressed mood, or constipation or diarrhea.…”

Comparing levonorgestrel intrauterine system versus hysteroscopic resection in patients with postmenstrual spotting related to a niche in the caesarean scar (MIHYS NICHE trial): protocol of a randomised controlled trial

“…Women's satisfaction with treatment (five-point Likert scale, very unsatisfied, unsatisfied, neutral, satisfied, very satisfied). 27 5. Hormonal-related side effects such as mood changes, weight gain, breast pain and libido.…”