Out, Damned Spot: Managing Nuisance Bleeding Associated with Intrauterine Contraception

Tranexamic acid modestly improved bleeding and spotting compared with placebo — but nuisance bleeding generally improves on its own.

Nuisance bleeding is common during the first 3 months after placement of the levonorgestrel-releasing intrauterine system (LNG-IUS). To evaluate whether tranexamic acid or the nonsteroidal anti-inflammatory drug (NSAID) mefenamic acid can reduce this initial bleeding, researchers conducted an industry-funded, randomized trial in Denmark, Ireland, and Norway. All 187 participants were instructed to take their study medication (tranexamic acid 500 mg, mefenamic acid 500 mg, or placebo) three times a day until they were free of bleeding and spotting, and to restart whenever bleeding or spotting recurred.

Median number of bleeding or spotting days during the 90-day study period was reduced by 6 days with tranexamic acid and by 3 days with mefenamic acid compared with placebo (total days, 25 [tranexamic acid], 29 [mefenamic acid], and 33 [placebo]), but neither change was statistically significant. Women's bleeding profiles varied, and in multivariable models, neither age, body-mass index, smoking status, nor study medication predicted the extent of bleeding. Regardless of study medication, the proportion of women with dysmenorrhea fell from 40% at baseline to approximately 20% after 90 days of LNG-IUS use.

CITATION(S):

Sørdal T et al. Management of initial bleeding or spotting after levonorgestrel-releasing intrauterine system placement: A randomized controlled trial. Obstet Gynecol 2013 May; 121:934.