Non-contraceptive effects – dysfunctional uterine bleeding
I. Milsom
Department of Obstetrics & Gynecology, Sahlgrenska Academy at
Göteborg University, Sweden
Menstrual disorders such as menorraghia and dysmenorrhea have been reported
to seriously affect approximately 2.5 million women annually in the USA and cost
US industry 8% of the total wage bill. Dysmenorrhea is probably the commonest
form of menstrual disorder with a reported prevalence of 50–90% among young
women. In Sweden 15% of young women have been reported to suffer from
dysmenorrhea which causes absenteeism from school or work every month.
Approximately 10% of fertile women suffer from menorraghia, defined as a
menstrual blood loss of >80 ml. Excessive blood loss may lead to iron
deficiency anaemia and ultimately necssitate hysterectomy.
The use of different contraceptive techniques has been shown to influence
menstrual blood loss and the occurrence of dysmenorrhea. Some contraceptive
methods have been reported to decrease the occurrence of menorraghia while other
methods have been reported to increase the prevalence of dysmenorrhea and
menorraghia.
Combined oral contraceptives (COC) are generally accepted to provide
effective pain relief for 70–80% of women with primary dysmenorrhea. This
opinion has however been contested in a recent Cochrane review. COC’s have
also been reported to reduce menstrual blood loss by approximately 50%. On the
other hand copper (Cu) intrauterine devices (IUD) have been reported to increase
menstrual blood loss by approximately 50% and dysmenorrhea has been reported to
be more common among users of a Cu-IUD.
Thus the choice of contraceptive method can influence the occurrence of these
conditions and in some cases contraceptive methods can be used as an effective
treatment for dysfunctional uterine bleeding. The scientific evidence behind the
influence of contraceptive methods on dysfunctional uterine bleeding will be
described.
