Comparative bleeding patterns in users of hormonal IUD vs. copper IUD over 12 months
Abstract
Background: Intrauterine devices (IUDs) are widely used long-acting reversible contraceptives, available as hormonal and copper types. Objective: To compare bleeding patterns among users of hormonal IUDs and copper IUDs over a 12-month follow-up period. Methods: This prospective comparative study was conducted at Department of Obs and Gyne DHQ Bhakkar from May 2024 to may 2025 included 355 women aged 18–45 years who opted for intrauterine contraception. Participants were divided into two groups: hormonal IUD (n=178) and copper IUD (n=177). Baseline demographic data were recorded, and participants were followed at 1, 3, 6, and 12 months. Bleeding patterns, including frequency, duration, and intensity, were documented using menstrual diaries. Results: At 3 months, irregular spotting was more common among hormonal IUD users (72/178; 40.4%) compared to copper IUD users (28/177; 15.8%), whereas heavy bleeding was significantly higher in the copper IUD group (74/177; 41.8%) compared to the hormonal group (18/178; 10.1%). At 6 months, reduced bleeding was observed in 96 (53.9%) hormonal IUD users compared to 32 (18.1%) copper IUD users, while heavy bleeding persisted in 58 (32.8%) copper IUD users versus 12 (6.7%) in the hormonal group. By 12 months, amenorrhea was reported in 78 (43.8%) hormonal IUD users, whereas none of the copper IUD users developed amenorrhea; heavy bleeding continued in 41 (23.2%) copper IUD users compared to 8 (4.5%) hormonal IUD users. Conclusion: Hormonal and copper IUDs demonstrate distinct bleeding profiles over time. Hormonal IUDs are associated with reduced bleeding and higher satisfaction, whereas copper IUDs are linked to heavier menstrual patterns..