Acta Obstet Gynecol Scand 54: 315-318, 1975
INFLUENCE OF COPPER INTRAUTERINE CONTRACEPTIVE DEVICES (Cu-7-IUD) ON THE MENSTRUAL BLOOD-LOSS Bertil Larsson, Lars Hamberger and Goran Rybo From the Department of Obstetrics and Gynecology (Head: Ass. Prof. Inge Jansson), University of Goteborg, Goteborg, Sweden and Karnsjukhuset (Head: Ass. Prof. Goran Rybo), Skovde, Sweden
Abstract. In a series of 43 healthy women menstrual blood loss was determined before and after insertion of a copper IUD (Gravigard). The menstrual blood loss before insertion was compared with the blood loss 1,2, 3 , 4 , 5 , 6 , 7 and 12 months after insertion. An increase amounting to approximately 20 ml per period without significant variations during the study was recorded. No significant influence upon serum iron and TIBC was found in 15 of the subjects selected by random. Compared with plastic I U D s the tested copper IUD causes a less pronounced increase of the menstrual blood loss. The menstrual blood loss in a small group of women with menorrhagia was determined before and up to 5 months after insertion of copper IUD. No aggravation of the menorrhagia was however recorded in this group.
In accordance with other contraceptives the use of intrauterine devices may be accompanied by certain side effects. Thus distrubances of the menstrual bleeding pattern may occur. According to Lippes (6) around 90% of women using Lippes’ loop exhibit some alterations of their menstrual pattern most pronounced during the frst months after the insertion. Such side effects may result in removal of the IUD, and in previous reports the IUD was removed because of bleeding abnormalities during the first year after insertion in 5-16 % of the women studied (1, 10). The alterations of the menstrual bleeding pattern caused by IUD’s are predominantly of two types. One is small uterine bleedings occurring between the periods (“spotting”), and the other type is heavy menstrual blood loss during the p e r i o b menorrhagia. In studies where the menstrual blood loss was measured objectively the increase in the menstrual blood loss was as an average 82-106 %during the first three months after insertion of Lippes’ loop@orSaf-T-coil@,33 S (2,lO). Such an
increase of the blood loss may in some women be followed by iron deficiency. In a population study of the menstrual blood loss Hallberg et al. (3) found a median value of 30 ml, and when the blood loss exceeded 80 ml per period the risk for iron deficiency was considerable. The increase of the blood loss due to the use of IUD’s may therefore be associated with such a risk, especially in populations in which the iron balance situation is critical because of a low dietary intake of iron. Previous studies on the effect of IUD’s on the menstrual blood loss were performed with the old types of IUD-e.g. Lippes’ loop@or [email protected] the introduction of the new and considerably smaller copper IUD it has been assumed that the frequency of some side effects should diminish and it has also been supposed that heavy menstrual blood losses should be less frequent. The aim of the present study was to quantify the menstrual blood loss before and after the insertion of one of the most commonly used copper IUD’s (Cu7-IUD, Gravigard@).The study has been extended for one year to make it possible to follow the variation of the menstrual blood loss during a relatively long period and to study the effect of the alterations of the blood loss on some parameters reflecting the iron balance.
MATERIAL AND METHODS One type of copper IUD, Cu-7, Gravigard’, with a copper surface of 200 mmz was used throughout the study. Forty-three healthy women with normal menstrual blood losses and four women with menorrhagia (i.e. blood loss above 80 ml per period) were included in the study. All subjects were studied with reference to the menstrual blood loss before and after the insertion of IUD. The mean age of Acta Obstet Gynecol Scand 54 (1975)
316 B. Larsson et al. Table 1. Menstrual blood loss (ml) before and after insertion of IUD (Cu-7) Control periods
No. of subjects Mean menstrual blood loss 5 S . E . M . Mean increasen +S.E.M. Increase in percent of control periods Mean Hb conc., g/lOO ml (I
Periods after insertion
1
2
I
2
3
4
5
43
42
39
36
29
27
25
38.2f2.7
34.3k1.4
54.3k4.1
58.6f4.6
58.4k5.4
58.825.5
55.9f4.!
-
-
18.0f3.1
22.3f3.1
22.1k3.8
22.5k3.2
19.6k3.:
-
-
50
61
61
62
54
13.1fO.1
13.3k0.2
13.3f0.1
13.4k0.2
13.2f0.2
13.0k0.2
13.0fO.Z
The increases are in all groups statistically significant (P
INFLUENCE OF COPPER INTRAUTERINE CONTRACEPTIVE DEVICES (Cu-7-IUD) ON THE MENSTRUAL BLOOD-LOSS Bertil Larsson, Lars Hamberger and Goran Rybo From the Department of Obstetrics and Gynecology (Head: Ass. Prof. Inge Jansson), University of Goteborg, Goteborg, Sweden and Karnsjukhuset (Head: Ass. Prof. Goran Rybo), Skovde, Sweden
Abstract. In a series of 43 healthy women menstrual blood loss was determined before and after insertion of a copper IUD (Gravigard). The menstrual blood loss before insertion was compared with the blood loss 1,2, 3 , 4 , 5 , 6 , 7 and 12 months after insertion. An increase amounting to approximately 20 ml per period without significant variations during the study was recorded. No significant influence upon serum iron and TIBC was found in 15 of the subjects selected by random. Compared with plastic I U D s the tested copper IUD causes a less pronounced increase of the menstrual blood loss. The menstrual blood loss in a small group of women with menorrhagia was determined before and up to 5 months after insertion of copper IUD. No aggravation of the menorrhagia was however recorded in this group.
In accordance with other contraceptives the use of intrauterine devices may be accompanied by certain side effects. Thus distrubances of the menstrual bleeding pattern may occur. According to Lippes (6) around 90% of women using Lippes’ loop exhibit some alterations of their menstrual pattern most pronounced during the frst months after the insertion. Such side effects may result in removal of the IUD, and in previous reports the IUD was removed because of bleeding abnormalities during the first year after insertion in 5-16 % of the women studied (1, 10). The alterations of the menstrual bleeding pattern caused by IUD’s are predominantly of two types. One is small uterine bleedings occurring between the periods (“spotting”), and the other type is heavy menstrual blood loss during the p e r i o b menorrhagia. In studies where the menstrual blood loss was measured objectively the increase in the menstrual blood loss was as an average 82-106 %during the first three months after insertion of Lippes’ loop@orSaf-T-coil@,33 S (2,lO). Such an
increase of the blood loss may in some women be followed by iron deficiency. In a population study of the menstrual blood loss Hallberg et al. (3) found a median value of 30 ml, and when the blood loss exceeded 80 ml per period the risk for iron deficiency was considerable. The increase of the blood loss due to the use of IUD’s may therefore be associated with such a risk, especially in populations in which the iron balance situation is critical because of a low dietary intake of iron. Previous studies on the effect of IUD’s on the menstrual blood loss were performed with the old types of IUD-e.g. Lippes’ loop@or [email protected] the introduction of the new and considerably smaller copper IUD it has been assumed that the frequency of some side effects should diminish and it has also been supposed that heavy menstrual blood losses should be less frequent. The aim of the present study was to quantify the menstrual blood loss before and after the insertion of one of the most commonly used copper IUD’s (Cu7-IUD, Gravigard@).The study has been extended for one year to make it possible to follow the variation of the menstrual blood loss during a relatively long period and to study the effect of the alterations of the blood loss on some parameters reflecting the iron balance.
MATERIAL AND METHODS One type of copper IUD, Cu-7, Gravigard’, with a copper surface of 200 mmz was used throughout the study. Forty-three healthy women with normal menstrual blood losses and four women with menorrhagia (i.e. blood loss above 80 ml per period) were included in the study. All subjects were studied with reference to the menstrual blood loss before and after the insertion of IUD. The mean age of Acta Obstet Gynecol Scand 54 (1975)
316 B. Larsson et al. Table 1. Menstrual blood loss (ml) before and after insertion of IUD (Cu-7) Control periods
No. of subjects Mean menstrual blood loss 5 S . E . M . Mean increasen +S.E.M. Increase in percent of control periods Mean Hb conc., g/lOO ml (I
Periods after insertion
1
2
I
2
3
4
5
43
42
39
36
29
27
25
38.2f2.7
34.3k1.4
54.3k4.1
58.6f4.6
58.4k5.4
58.825.5
55.9f4.!
-
-
18.0f3.1
22.3f3.1
22.1k3.8
22.5k3.2
19.6k3.:
-
-
50
61
61
62
54
13.1fO.1
13.3k0.2
13.3f0.1
13.4k0.2
13.2f0.2
13.0k0.2
13.0fO.Z
The increases are in all groups statistically significant (P
