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.