Non-contraceptive effects – dysfunctional uterine bleeding

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


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


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