The effect of acetylsalicylic acid on menstrual blood loss in women with IUDs

Fifty-three volunteer women using Copper T 220C IUDs, complaining of increased menstrual bleeding, received per os 1 g, three times a day, of acetylsalicylic acid, for 5 days, during their menstrual periods. Menstrual bleeding for each patient was measured at least once before treatment. Bleeding estimates were also performed from the second to the fifth treatment cycle. From the 53 women admitted to the study, only 13 subjects (24.7%) had pre-treatment menstrual bleeding of more than 80 ml; 40 subjects had less than 80 ml. The group with hypermenorrhea had slightly decreased (not significant) the amount of menstrual blood loss with acetylsalicylic acid intake. On the other hand, 67.1% of women with bleeding less than 80 ml observed a significant increase in menstrual blood loss.     

Quantitative studies on menstrual blood loss in IUD users

Despite the introduction of new intrauterine devices (IUDs), the most important complication involving their use continues to be excessive menstrual bleeding. IUD use in developing countries with women who are already depleted in body iron stores may prove to be deleterious to their health. Mean amounts of menstrual blood loss (MBL) for women not using contraception in the western world is about 32 ml. This mean is increased to 52-72 ml with use of the Lippes loop and other non-medicated devices up to 24 months after insertion. For the Copper-7 and Copper-T-200 devices this mean increase is to 37-40 ml in the first month, decreasing to 30-38 ml at 12 months after IUD insertion. In the users of the Multiload-250 IUD at one month post-insertion the MBL is from 56 to 63 ml and from 36 to 39 ml at 24 months of use. The mean Multiload-375 device users at one month after insertion lose a mean of 45-73 ml at 24 months, 35-50 ml. With the progestogen-releasing IUD mean MBL is 27-36 ml at 1 month and 9-13 ml at 12 months post-insertion. Intermenstrual blood loss is significant only in the first month of use for all IUDs. Discontinuation rates for pain and bleeding with non-medicated IUDs are from 11.0-19.6 per 100 women per year, and for the copper IUDs 4.4 to 6.8 per 100 women in the first year of use. The main problem with prolonged menstrual bleeding is depletion of the body iron stores; this is highly significant with non-medicated devices, less important with copper devices and conversely, iron stores are increased in users of progestogen-releasing devices. This is based on serum ferritin measured up to 24 months after insertion. The ferritin values correlated well with the volumes of MBL. It is suggested, especially for women with low body iron stores, that there is an order of preference for IUDs to be used. This should be: firstly, the progestogen-releasing devices; secondly, the Copper-T and Copper-7 IUDs; thirdly the larger surface copper devices (Cu-T-220C, Multiload 250 and 375, Cu-T-380). Non-medicated devices are not to be recommended for these women.     

Comparative quantitation of menstrual blood loss with the Lippes Loop, Dalkon Shield, and copper T intrauterine devices

The magnitude of menstrual blood loss and the incidence of menorrhagia associated with 2 plastic intrauterine devices (IUDs), THE Lippes loop and standard-size Dalkon shield, were compared with a copper T device (TCu 300). In order to evaluate long-term as well as short-term effects, blood loss was measured at postinsertion levels of 6, 12, and 18 months in 72 women wearing the Lippes loop, in 73 wearing the Dalkon shield, and in 82 with TCu 300. Increases in the mean blood loss over controls (35.3 ml) for the Lippes loop at 6, 12, and 18 months were 112%, 60%, and 95%, respectively. Corresponding increases for the Dalkon shield were 71%, 112%, and 86%; those for the TCu 300 were 54%, 56%, and 41%. There was significantly less bleeding with the TCu 300 than with either of the other 2 devices (p.05). The Lippes loop and the Dalkon shield were associated with fluctuating blood loss values whereas blood loss with the TCu 300 was relatively stable at all study periods.     

Quantitative menstrual and intermenstrual blood loss in women using Lippes Loop and Copper T intrauterine devices

One-hundred-twenty-seven women were studied during three consecutive menstrual cycles preceding and six non-consecutive menstrual cycles during the first year following insertion of either a Lippes Loop C or Copper T intrauterine device (IUD). Both menstrual blood loss (MBL) and intermenstrual blood loss (IMBL) were quantified during these cycles. When postinsertion MBL was averaged and compared to mean preinsertion MBL, the Lippes Loop and Copper T devices increased the volume of menstrual bleeding by 99 and 42 percent, respectively. In spite of this, mean hemoglobin levels did not change significantly during the period of study.Quantifiable IMBL was experienced primarily during the first cycle postinsertion. The incidence was 90 percent in women inserted with the Lippes Loop C and 48 percent in women inserted with the Copper T during this cycle. The volume of IMBL was extremely variable among the women studied (0.7 – 398 ml). In several cases the volume nearly equalled or even exceeded the MBL of the first cycle. Incidence of IMBL fell to 6.5 percent and 5.0 percent in the second postinsertion cycle for women with loops and copper devices, respectively. Thereafter the incidence was negligible. This marked decrease in incidence apparently was not due to closures for bleeding. Average IMBL contributed less than ten percent of total blood loss experienced by the IUD users during the first year after insertion. Following the first postinsertion cycle, mean IMBL contributed less than two percent of the total blood loss.     

Assessment of menstrual blood loss in Belgian users of a new T-shaped levonorgestrel-releasing intrauterine system

OBJECTIVE: This study was conducted to evaluate the effect of a T-shaped levonorgestrel-releasing intrauterine system (Femilis, LNG IUS) on the amount of menstrual blood loss (MBL) in women with and without menorrhagia. The daily release of the LNG IUS was approximately 20 mug. MATERIALS AND METHODS: In 60 Belgian women, less than 48 years of age at study enrollment, using the Femilis LNG IUS for 4 to more than 30 months, MBL was assessed with the visual assessment technique. Twenty-eight women had normal menstrual periods at baseline (menstrual score <185) and 32 women had idiopathic menorrhagia (menstrual score > or =185). RESULTS: Menstrual blood loss scores dropped significantly during the observation period in all women except one. The median menstrual score at baseline in women with normal menstrual bleeding was 140 (range 80-160) and dropped to a median score of 5 (range 0-150) at follow-up, a decrease of 96%. In the 32 women with menorrhagic bleeding at baseline, menstrual flow dropped from a median score of 232 (range 185-450) at baseline to a median score of 3 (range 0-50) at follow-up, a decrease of 99%. Twenty women developed amenorrhea (33%): 10 in the group of women with normal menstruation and 10 in those women with menorrhagia. Most of the remaining women had oligomenorrhea requiring the use of a few panty-liners only. In one woman, MBL did not decrease, thus requiring further evaluation. CONCLUSION: The impact on MBL of this new 20 mug/day LNG-releasing IUS confirms other studies with devices releasing the same or lower amounts of LNG. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The strong effect on MBL of this contraceptive method offers an important health benefit and improvement in quality of life, particularly in women with heavy bleeding and anemia, as other treatment modalities are less effective, more costly, more invasive or not readily available.     

Comparative quantitation of menstrual blood loss with a d-norgestrel-releasing IUD and a Nova-T-copper device

A quantitative determination of menstrual blood loss by the Hallberg-Nilsson method was performed on users of a d-nor-gestrel-releasing IUD and a Nova-T-copper-IUD. The mean blood loss for three consecutive menstrual periods was found to be 20.7 ± 6.0 ml for the d-norgestrel-releasing IUD and 72.5 ± 6.2 ml for the Nova-T IUD users. Compared to the preinsertion control menstrual blood loss, there was a highly significant decrease in the d-norgestrel-releasing IUD group and a significant rise of blood loss in the Nova-T IUD group. Although changes in hemoglobin concentrations were not statistically significant, a rise in the hemoglobin concentration for the d-norgestrel-releasing IUD group was seen, whereas a slight decrease occurred in the Nova-T IUD group.     

A detailed analysis of menstrual blood loss in women using Norplant and Nestorone progestogen-only contraceptive implants or vaginal rings

Changes to the pattern of menstrual bleeding are almost universal in women using progestogen-only methods of contraception, and are an important cause of discontinuation of these methods. The present study was designed to explore the changes in menstrual bleeding patterns and objectively measure menstrual blood loss (MBL) in 110 women before and during one year of use of 4 different progestogen-only contraceptives: Norplant subdermal levonorgestrel implants; Nestorone progestogen 4-cm or 6-cm implants nominally delivering 100 microg or 150 microg daily; or a vaginal ring (CVR) delivering 100 microg of Nestorone (NES) daily (CVR users were limited to only 6 months of use). Groups could not be directly compared because of the differences in numbers of subjects and durations of treatment. The total MBL during each of the three 8-week collection periods during treatment decreased significantly in each group compared to the total blood loss in the two control cycles (greater than 50% decrease in all groups during the first 6 months), although the differences between individual women at the extremes remained considerable. The highest blood loss measured on any single day during the treatment collection periods was significantly reduced (p <0.001) in users of all four devices in all three collection periods compared to the control period (CVR users did not have a 3rd collection period). The Nestorone-releasing CVR was associated with an 88% reduction in mean MBL and a high incidence of amenorrhea at 6 months. There was considerable variation in percentage reduction in total blood loss at 6 and 12 months between individual women ranging from 100% (women with amenorrhea) to a small minority experiencing an increase compared with control cycles. The increases in measured blood loss during treatment were almost entirely in women with light bleeding in the control period and were related to prolonged episodes of light bleeding rather than heavy bleeding. Women contemplating use of a progestogen-only contraceptive method need to be counseled about alterations to the menstrual cycle but can be reassured that total blood loss will usually be much less than with normal cycles.     

Menstrual bleeding with the pill and the IUD

One of the most important causes of iron-deficiency anaemia in women is heavy menstrual bleeding. This is of special concern in developing countries where dietetic conditions are often poor and parasitic infestations are common. It is not easy, however, always to get a true picture of the amount of menstrual loss, as women are not good estimators of their own blood loss. The best way to estimate this would be by objective measurement. A study was performed at the family planning clinic in Embaba to estimate the menstrual loss objectively in women on the Pill and using IUDs, and in controls. The menstrual loss was determined by the method of Hallberg and Nilsson, in which cotton pads were used to collect the menstrual blood. The pads were placed in a plastic bag - all the women knew about the study and understood the importance of careful collection of the pads. The pads were extracted with 5% sodium hydroxide, which converted the haemoglobin to alkaline haematin. This was estimated spectrophotometrically, and enabled the amount of haemoglobin lost to be determined. The actual blood loss was calculated from the haemoglobin concentration in a venous blood sample. The women in the trial included 30 who had been on Volidan (4 mg. of megestrol acetate with .05 mg. of ethinyloestradiol) for 3-24 months, 30 who had used a Lippes loop size C for 3-24 months, and 10 controls matched for parity and age. All women were between 20 and 42 years of age and had had 2-9 children. In all cases their subjective impression of their menstrual loss was reported. The average menstrual loss in IUD users and Pill takers was compared with that of the controls. In IUD users it was about 2.5 times that of the controls (38.2 ml. against 16.3 ml.), while in Pill users it was .75 of that of the controls (12.0 ml. against 16.3 ml.). An important finding was that with continued use of IUDs there was a gradual increase in the amount of menstrual loss (30.2 ml. after 3-6 months of use, compared with 41.52 ml. after 24 months of use), while in the Pill group the loss diminished with time (15.9 ml. after 3-6 months, 8.85 ml. after 24 months). Interestingly, the subjective impression of the women was that blood loss decreased with time on IUDs as well.     

三种长效避孕皮下埋植剂对妇女月经血量的影响

为探讨国产Ⅰ、Ⅱ型和Norplant皮下埋植剂对妇女月经血量的影响,对89例健康妇女按随机分配原则,埋植国产Ⅰ型、Ⅱ型和Norplant三种长效避孕皮下埋植剂,测定埋植前及埋植后3,6,12月月经失血量及血红蛋白。埋植前3组平均月经血量(MBL)分别为43.3±6.9ml,48.9±4.3ml,43.7±5.5ml,埋植后MBL在第3周期分别为32.8±13.2ml,24.8±5.5ml,19.7±9.3ml,在第12周期分别为23.9±5.9ml,40.8±10.4ml,25.9±6.0ml,明显低于埋前水平(P<0.05～P<0.001)血红蛋白在埋植后有上升趋势。本研究提示使用长效皮下埋植剂减少妇女月经血量,增加血红蛋白,可以作为妇女选用的高效节育避孕措施。     

A rapid method for measuring menstrual blood loss using automatic extraction

A rapid method for the determination of menstrual blood loss has been evaluated. The procedure is based upon the formation of alkaline haematin after the blood has been extracted from vaginal tampons and sanitary towels by an automatic Stomacher Lab-Blender.Fifteen minutes of extraction in 2 litres of 5% sodium hydroxide is sufficient to produce a good and constant recovery. Thirteen types of tampons and towels have been tested under optimal conditions and 11 were found to produce acceptable blank values. The recovery of blood (from 5–200ml) was >82% and the coefficient of variation on replicate analysis was < 11%.     

Menstrual bleeding with copper-covered ihtrauterine contraceptive devices

The menstrual blood loss before and during three menstruations after insertion of two copper-covered intrauterine devices (TCu 200 and Cu 7 200) was studied in 82 women.

Of 66 women with normal menstruations, 50 were fitted with a TCu 200 and 16 with a Cu 7 200 device. Sixteen women with profuse menstrual bleeding were fitted with a TCu 200 device.

The menstrual blood loss was increased during the first two periods, but by only half of that reported after insertion of other intrauterine contraceptive devices (IUDs), and it was followed by an improvement in the third period. Women with menorrhagia before insertion of the devices had no significant increase in bleeding. The use of copper IUDs reduces the need of medication and control tests.     

Intrauterine devices and menstrual blood loss. A comparative study of eight devices during the first six months of use

An experiment was conducted to determine changes in menstrual blood loss caused by IUDs. 78 volunteer women of similar age and parity were randomly selected from among those requesting IUDs from the outpatient department of the National Medical Center of the Mexican Institute of Social Security. Menstrual blood loss and hemoglobin were measured for 1-2 control cycles and for 6 postinsertion cycles. Of the 8 different types of IUDs used, the Lippes Loop and the copper-releasing devices caused a statistically significant increase in blood loss and a related decrease in hemoglobin. The steroid-releasing devices caused no significant increase in blood loss and no significant changes in hemoglobin concentration. The rigid copper devices caused the greatest increase in blood loss. The noted changes were clearly established by the 3rd postinsertion cycle.     

Menstrual Health Products,Practices, and Problems

This review article examines factors affecting normal variations in menstrual flow, methods used to estimate vaginal blood loss, menstrual health problems related to hygiene practices, and methods of assessing tampon absorbancy. Preliminary studies from this laboratory suggest that normal, cycling women exhibit menstrual flow rates that are significantly higher during the day than at night; also that menstrual blood has a more acid pH than previously reported, and that it demonstrates unique biological properties unlike peripheral venous blood. Women in wheelchairs may be at special risk for the development of menstrual health problems because of difficulties with hygiene management as evidenced by results of a study of 22 women with traumatic spinal cord injuries.     

A pilot study on the assessment of a progesterone/estradiol sustained release as once-a-month-injectable contraceptive

A pilot study to assess the use of natural hormones in macrocrystalline sustained release system was undertaken in normal menstruating women. Progesterone at a dose of 100 mg in combination with 5 mg estradiol-17 beta aqueous macrocrystalline suspension (3ml) of defined particle size range (100-250 microns) were administered to five female volunteers of reproductive age, on day 5 of their normal menstrual cycles and then every 28 days consecutively for the next two months. Peripheral venous blood samples were obtained from the women three times a week for 60 days after the third injection for the measurement of serum progesterone, estradiol-17 beta, LH and FSH. The menstrual bleeding patterns were closely monitored during the study period. The results obtained indicate that the exogenous hormone administration produces blood levels similar to those observed during the luteal phase of the menstrual cycle. Follicular maturation as assessed by endogenous estradiol rise, above 150 pg/ml, occurred 29.7 days s.d. 6.4 after the injection. Ovulation as measured by progesterone levels above 5 ng/ml was documented 34.4 days s.d. 4.3 after the third injection. The bleeding patterns were regular though initially shorter but these increased progressively towards normal pattern during course of the study. The data suggest that progesterone/estradiol-17 beta combination administered as an aqueous macrocrystalline suspension is capable of producing sustained ovulation inhibition and could be applied in the design of new once-a-month injectable contraceptives.     

Menstrual blood loss in healthy Chinese women

Intrauterine contraceptive devices (IUDs) are commonly used in China, but uterine bleeding is the main problem. So far, the menstrual blood loss (MBL) is based on subjective judgments by the patients, and objective quantitative data of MBL is lacking. It is necessary to determine the baseline MBL of healthy Chinese women.MBL was determined in 131 healthy women for one period, the range was 7.5–176.5 ml; the mean value was 56.3±2.8 (S.E.) ml; the median was 50.8 ml; and the central percentile limits of 80% and 90% were 20.7–95.0 ml and 13.9–120.8 ml, respectively. The amount of MBL in 92.4% of tested subjects was within 100 ml; the 95th percentile was 120.8 ml. Hematological studies were made in 25 subjects. There was a tendency for the blood iron to decrease with increasing MBL and when the MBL reached 80–100 ml, the hemoglobin and hematocrit began to decline. When MBL increased to 100–120 ml, hemoglobin and hematocrit were reduced to the lower limit of normal value.Further investigation should be made to determine if 100 ml can be used as the upper limit of normal for Chinese women.     

Menstrual blood loss and body iron stores in Brazilian women

Menstrual blood loss (MBL) studies are relevant for developing world women as this could be an important cause of anemia. Whenever a contraceptive method is to be used by such women, consideration should be given to the method which least affects the volume of MBL. In 309 women considered as clinically healthy, MBL, serum ferritin, serum iron and hemoglobin levels were measured: a mean MBL of 23 ml was found. Age, weight, height and previous oral contraceptive use did not affect MBL. Higher parity women may have higher MBL levels but their hematologic indices are not altered. While body iron stores (as judged by serum ferritin levels) are depleted in women who bleed more than 60 ml per cycle, clinical anemia may not be present until their blood loss exceeds 80 ml per menstruation. Brazilian women who lose more than 60 ml of menstrual blood associated with multiple pregnancies without adequate iron supplementation may have a depletion of their body iron stores.     

Menstrual blood loss estimates in women using copper 7 and multiload-250 intrauterine devices

An estimate of the menstrual blood loss (MBL) in 29 women using the Cu-7 and in 33 women using the ML-250 IUDs was carried out. None of the women who took part in the study used hormonal contraceptives or IUDs for six months previous to the study. Before the insertion of the IUD, the MBL of each woman was measured for one or two cycles.Once the IUD was inserted, the MBL was measured at intervals of 1, 3, 6, 9 and 12 months after insertion. After this, the IUD was removed and the MBL measured each month thereafter for 3 months. In the pre-insertion period, the MBL was similar in both groups: 39.3 ± 5.9 for the group with the Cu-7, and 41.6 ± 5.5 ml for the one with the ML-250. After the insertion of the Cu-7, either a slight increase or no increase at all of MBL was observed during the 12 months of IUD use. When the IUD was removed, the menstrual blood loss level returned to normal, i.e. to the pre-insertion level.     

Therapies for the treatment of abnormal uterine bleeding

Abnormal uterine bleeding (AUB) is one of the most common disorders encountered by the gynecologist. Several drugs have been demonstrated to decrease menstrual bleeding in patients with menorrhagia. Non-steroidal anti-inflammatory drugs will decrease bleeding by 30% to 50%. Oral contraceptives may be useful to stop acute bleeding and will decrease menstrual flow by approximately 50%. Tranexamic acid, a plasminogen inhibitor approved for the treatment of hemophilia, will also decrease flow by approximately 50%. Danazol and GnRH analogues both have been used for the treatment of menorrhagia. However, side effects make them unsuitable for long-term use. There are currently two medicated intrauterine devices (IUDs) available in the United States. These IUDs reduce menstrual blood loss by 65% to 85%. Several minimally invasive surgical procedures, including endometrial resection and ablation, may treat menorrhagia in select patients. More recently, various office-based ablation instruments have been developed. These machines conform to the endometrial cavity and may obviate the need for hysteroscopy.     

女大学生月经失血量与机体铁营养状况评价

目的定量研究女大学生月经失血量,并对其铁营养状况进行评价。方法用简单随机抽样的方法抽取30名在校女大学生,用调查表收集一般信息。通过称量卫生巾在使用前后的重量,计算收集到卫生巾上的失血量,估计未收集到卫生巾上的失血量,两者相加得月经周期失血量。常规方法测量血中血红蛋白浓度、血清游离原卟啉与血清铁蛋白含量。采用双变量相关分析法分析月经失血量和铁营养状况之间的关系。结果女大学生平均月经周期持续天数为(4.5±1.4)天,平均失血量为(59.3±25.1)g,范围为24～110g。血清铁蛋白、游离原卟啉、血红蛋白的平均含量分别为(25.13±14.33)ng/ml、(0.06±0.01)μg/ml和(131.61±9.76)g/L,22.58%的女大学生处于铁减少期,无临床贫血者。月经失血量与血清铁蛋白含量呈负相关。结论女大学生月经失血量有很大的个体差异,临床上无贫血并不意味着铁营养状况良好,血清铁蛋白是反映机体铁营养状况的敏感指标。     

Menstrual blood loss with copper intrauterine devices

Menstrual blood loss was estimated quantitatively by Halberg &; Nilson method for 336 women: 145 normal controls (240 cycles); 91 fitted with Cu-devices (349 collected cycles); 50 fitted with Lippes loops (224 cycles) and 50 on combined steroid contraceptive therapy (236 cycles). Mean blood loss per cycle was 37 ml for controls and 49.8 ml, 78 ml and 20 ml for the other 3 groups, respectively. It is concluded that as far as bleeding is concerned with intrauterine devices, Cu-IUDs are more suitable for women, especially in developing countries, than Lippes IUDs. Nevertheless, the blood loss with the pill is still the lowest.