Intrauterine Device Outcomes in Young Women with Heavy Menstrual Bleeding: Comparing Patients with and without Inherited Bleeding Disorders

Study Objective: To evaluate the use of intrauterine devices (IUDs) in two young women's hematology clinics and compare adverse events in adolescents with and without inherited bleeding disorders (BDs)Design: Retrospective multicenter cohort study from February 2014 through February 2020Setting: Young women's hematology clinics at Nationwide Children's Hospital in Columbus, Ohio, and Children's Medical Center in Dallas, TexasParticipants: Female patients evaluated for heavy menstrual bleeding (HMB) who underwent IUD placementInterventions and Main Outcome Measures: Rates of IUD expulsion, malposition, and ongoing HMB requiring additional medical treatment Results: We identified 43 patients with BDs and 35 patients without BDs who underwent placement of an IUD for HMB. The mean age was 14.9 years (range 11.0-21.4 years) at the time of presentation and 15.8 years (range 11.0-21.4 years) at IUD placement. Those with BDs were younger at the time of IUD insertion. Most patients (90%) had previously failed other methods to control HMB. The annual rate of IUD adverse events was 0.25 per year of use, and all adverse events occurred in the first 20 months after placement. There were no significant differences in adverse IUD events in patients with and without BDs, although those without BDs requested IUD removal more frequently.Conclusions: In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB.

Automated summary

There is no association between the presence of inherited bleeding disorders (BDs) and higher intrauterine device (IUD) expulsion rates in adolescent females. IUD placement should be considered as a first-line option for adolescents with BDs experiencing heavy menstrual bleeding (HMB).