Bleeding and Cramping in the First 90 Days After Copper or Levonorgestrel Intrauterine Device Placement

Introduction We describe bleeding and cramping patterns during the first 90 days after intrauterine device (IUD) placement. Methods This was a planned sub‐analysis of a prospective cohort study of IUD users in the United States who initiated the copper T380A (Cu‐IUD) or the levonorgestrel 52 mg intrauterine device (LNG IUD) at any time in the menstrual cycle. Participants rated bleeding and cramping from 1 (no bleeding or cramping) to 4 (heavy bleeding or severe cramping). We included participants providing ≥ 60 days of continuous responses and described overall bleeding/cramping. Results Of 230 participants enrolled, 137 (60%) met inclusion criteria (Cu‐IUD n = 69, 50% and LNG IUD n = 68, 50%). Cu‐IUD users reported fewer days with any bleeding (26 days, IQR 18–31) compared with LNG IUD users (38 days, IQR 27–55, p < 0.001). LNG IUD users reported more spotting days (median 31 [IQR 17–41] vs. 13 [IQR 10–20], p < 0.01). Total bleeding/spotting days were similar for each IUD type regardless of placement timing or prior contraceptive method. Median reported cramping days were similar for both IUDs (Cu‐IUD 18, IQR 7–29 and LNG IUD 18, IQR 10–38, p = 0.18). Cramping was most common in the week following placement for both IUD types, decreased over the 90‐day period, and did not vary by IUD type. Conclusion LNG IUD users reported more days with any bleeding in the first 90 days after placement overall compared with Cu‐IUD users, largely driven by more than twice the number of spotting days. Cramping was most common in the first week following IUD placement and decreased over time. Trial Registration Clinicaltrials.