Role of uterine artery doppler indices in prediction of the risk of heavy menstrual bleeding following copper intrauterine contraceptive device ( CuT ‐375) insertion

Objective Copper intrauterine contraceptive devices (CuT‐375) are highly effective but also have frequent side effects like heavy menstrual bleeding (HMB). The present study was planned to evaluate the role of pre‐insertion uterine artery Doppler indices—pulsatility index (PI) and resistance index (RI) in predicting the risk of HMB following insertion of CuT‐375. Methods This prospective clinical study included 111 women who elected to use the CuT‐375, met predefined eligibility criteria, and completed 6 months of follow‐up. Before device insertion, uterine artery Doppler assessment was performed to measure PI and RI. Following insertion, participants were categorized into two groups based on menstrual blood loss assessed through the pictorial blood assessment chart (PBAC): heavy menstrual bleeding (PBAC >100; n = 51) and non‐heavy bleeding ( n = 60). Receiver operating characteristic (ROC) curve analysis was used to determine the predictive performance of PI and RI for identifying women at risk of intrauterine contraceptive device (IUCD)‐related HMB. Results Uterine artery PI value ≤2.15 showed high predictive accuracy for heavy menstrual bleeding, yielding a sensitivity of 100%, specificity of 90%, and an AUC of 0.991 ( P < 0.001). RI value ≤0.775 demonstrated a sensitivity of 82.35%, specificity of 100%, and an AUC of 0.966 ( P < 0.001). Both parameters exhibited a strong association‐lower baseline Doppler indices had increased risk of significant post‐insertion bleeding. Women with PI and RI values below these thresholds were most likely to experience HMB. Conclusion Pre‐insertion uterine artery Doppler evaluation serves as a reliable predictor of HMB following CuT‐375 insertion. Incorporating these Doppler indices into routine pre‐contraceptive assessment may improve patient selection and counseling, potentially reducing IUCD‐related complications.