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

Abstract ObjectiveWe assess change in bleeding, cramping, and 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 with a history of regular menstrual cycles 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. Participants reported bleeding scores using the validated pictorial blood loss assessment chart (PBAC), IUD satisfaction using a monthly five-point Likert scale, and cramping using a seven-level ordinal scale. We used multiple imputation to address nonrandom attrition. Structural equation modeling growth curves for count and ordered outcomes modeled bleeding, cramping, and satisfaction trajectories over time. Multiple imputation analyses corrected for moderate attrition bias. ResultsBleeding significantly decreased (approximately 25%) over the course of the study from an estimated PBAC=195 at one month post IUD insertion to PBAC=151 at six months (t=?2.38; p<0.05). Additionally, IUD satisfaction improved overtime (t=2.65; p<0.01), increasing from between ″Neutral″ and ″Satisfied″ to ″Satisfied″, over the six month study. Cramping decreased sharply over the six-month study from between bimonthly and weekly, to once or twice a month (t=?4.38; p<0.001). Finally, bleeding, but not cramping, was associated with IUD satisfaction (mean IUD satisfaction across study: t=?2.31; p<0.05; IUD satisfaction at study end: t=?2.81; p<0.01). ConclusionsNew Cu IUD users reported decreasing bleeding and cramping, and increased IUD satisfaction, over the first six months. Method satisfaction was inversely related to bleeding.