Abstract
Ninety women with an intrauterine device (IUD) in place measured their menstrual flow a maximum of 16 months after the insertion.
The average loss was 88.0 ml. Those who had subjective menorrhagia after the insertion (group II) had heavier bleeding than those without (group I), 116.7 ml as compared with 78.7 ml.
Menorrhagia (blood loss exceeding 80 ml) occurred in 42.6% of group I and in 63.6% of group II. The rate for the entire series was 47.7% (Table III).
36% had subjective menorrhagia although the blood loss was less than 80 ml, the upper limit of normal bleeding. On the average, these patients lost 53.1 ml (Table III).
The Hb level fell after the insertion of the IUD from 13.5 g/100 ml to 12.8 g/100 ml. The decrease was more marked in group II, and in 11% the level dropped by more than 1.5 g/100 ml.
The incidence of anaemia (Hb below 12.0 g/100 ml) increased from 3% to 16% after the insertion of the device. For groups I and II the increase in the rate was from 2% to 10% and from 9% to 32% respectively. All considered, a 4–5-fold increase occurred (Table V).
The Hb level as well as the menstrual blood loss were the same whether they were measured within 2 months or 2–16 months after the insertion.
The distribution of the bleeding on the individual days of the period changed. 20 women measured the loss without and 90 with the IUD.
In the group without IUD 73% of the total loss occurred during the first 2 days of the period and 90% during the first 3 days. In the women with IUD the distribution was 44% and 74%, the 90% not being reached until after the 4th day (Tables VI and VII).
Twenty women measured the menstrual loss both before and after the insertion of the device. In all the menstrual flow became heavier, increasing by an average of from 35.5 to 73.1 ml (106%). The increase was most marked in women whose menstrual flow had been scanty before the insertion of the device (Table VIII). The mean values of the menstrual bleeding measured during the 1st, 2nd, 3rd, and 4th period after the insertion were practically the same, from 65.8 to 82.2 ml, but always significantly greater than prior to the insertion. There was no tendency for the menstruation to return to a normal level (Table IX).
The increase in the use of absorptive material during the menstrual periods was not in step with the bleeding, being only 28% despite an increase of 106% in the blood loss, and 25% of the women had an unchanged or even decreased consumption of absorptive material after the insertion of the IUD.