Abnormal bleeding in your female patient? Consider a progestin IUD

The LNG-IUD is less invasive and generally more acceptable to women than hysterectomy, endometrial ablation, uterine artery embolization, and myomectomy. Adverse effects. Vaginal spotting is the most commonly reported adverse effect associated with the LNG-IUD, particularly in the first 3 to 6 months postinsertion.⁴² The other common adverse effect is increased cramping, which some women experience in the first few months after insertion. Rarely women may experience ovarian cysts from unruptured follicles, which will regress on their own. Another potential problem is expulsion, which is more common in women who are using the device to control heavy bleeding (8.9%-13.6%).⁴² After the device is in place for several years, many women experience amenorrhea—a side effect that patients who have suffered from HMB and dysmenorrhea may consider a benefit.

CASE After counseling regarding her treatment options, Ms. K decides on the LNG-IUD, which her family physician inserts. At 3-month follow-up, she reports significantly less bleeding and decreased perimenstrual discomfort. If her workup had revealed adenomyosis or a hemostatic disorder, the LNG-IUD would still have been a first-line option.

CORRESPONDENCE

Erin Hendriks, MD, Wayne State University Family Medicine, 1135 West University Drive, Suite 250, Rochester Hills, MI 48307; emhhendriks@yahoo.com