Why am I having persistent spotting after an IUD insertion?

Hello,

Welcome to icliniq.com.

I understand your concern.

Eleven months after an intrauterine device (IUD) insertion, you should not still be spotting for 10 days before and again after your periods every cycle. Some irregular bleeding is expected in the first three to six months, but if it is persistent after almost a year, it usually means the IUD is either irritating the endometrium or not suiting you. It is important to first check whether it is a copper IUD or a hormonal IUD, because bleeding patterns differ.

It could be due to the following reasons:

• Endometrial irritation from an IUD.

• Hormonal imbalance (if copper IUD).

• If it is a hormonal IUD, sometimes irregular spotting can continue, but usually decreases over time, and does not persist.

• Local infection or malposition of the IUD.

Before deciding on the next steps, the following investigations are advisable:

• Ultrasound of the pelvis to check the IUD position.

• Complete blood count (CBC) to rule out anemia if bleeding is prolonged.

• Pap smear if not done recently.

• Vaginal swab if there is discharge or pain.

If ultrasound shows the IUD is in the correct place and no other uterine issue is present, and the bleeding is tolerable, sometimes doctors prescribe a short course of hormonal tablets or non-steroidal anti-inflammatory drugs (NSAIDs) to reduce spotting.

If the bleeding is troublesome or hemoglobin levels drop significantly, removal of the IUD and switching to another method of contraception (hormonal IUD, contraceptive pills, contraceptive injection, etc.) is reasonable.

If you are feeling weak, dizzy, or tired from prolonged spotting, IUD removal should be immediately discussed with your gynecologist.

Follow up with me after the ultrasound so I can suggest whether removal or continuation is the better option.

Preventive measures include:

• Keep track of the bleeding pattern using a diary.

• Maintain hemoglobin levels with an iron-rich diet.

• Avoid self-medication and always get examined before deciding on removal.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.