ORIGINAL RESEARCH ARTICLE

Menstrual Problems and Side Effects

Associated With Long-Term TCu 380A
IUD Use in Perimenopausal Women
Damrong Reinprayoon and Surasak Taneepanichskul
The study assessing menstrual problems and side effects
associated with long-term TCu 380A intrauterine device
(IUD) use in perimenopausal women is reported. Fifty
perimenopausal TCu 380A IUD acceptors who had IUD
inserted after age 40 and used IUD at least 36 months were
recruited. The mean age of acceptors at time of insertion
was 44.2 years with an average parity of two live births.
The mean body weight at insertion was 62.13 kg. Most of
the bleeding patterns were regular cycles. Intermenstrual
bleeding and pelvic pain were the side effects most often
reported. No pregnancies, pelvic inflammatory disease, or
IUD expulsions occurred during the follow-up period. This
study suggests that the use of TCu 380A IUD in perimenopausal women is safe and effective. CONTRACEPTION 1998;57:
417 419 1998 Elsevier Science Inc. All rights reserved.
KEY WORDS: menstrual problems, side effects, TCu 380A
IUD, perimenopausal women

Introduction

he perimenopause refers to the 510 years

before the menopause and continues up to 5 or
10 years afterward.1 Women in this period are
still potentially fertile and pregnancy in this age
group is attended with increased maternal mortality,
spontaneous abortion, fetal anomaly, and perinatal
mortality.2 Most perimenopausal women have completed their family size and need safe and effective
long-term contraception. The copper T 380A intrauterine device (IUD) (TCu 380A) has been found to be
a safe and effective contraceptive worldwide.3 However, little data have assessed menstrual problems and
side effects in the perimenopausal period. The objectives of this study were to evaluate menstrual problems

Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn

University, Bangkok, Thailand
Name and address for correspondence: Dr. Damrong Reinprayoon, MD,
Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn
University, Rama IV Road, Bangkok 10330, Thailand. Tel.: 1662-256-4701; Fax:
1662-256-9292
Submitted for publication January 13, 1998
Revised April 27, 1998
Accepted for publication April 27, 1998

1998 Elsevier Science Inc. All rights reserved.

655 Avenue of the Americas, New York, NY 10010

and side effects associated with long-term TCu 380A

IUD use in perimenopausal women.

Materials and Methods

For purposes of evaluating menstrual problems and
side effects associated with long-term TCu 380A IUD
use in perimenopausal women, the charts of women
(aged more than 40 years who had used the TCu 380A
IUD at least 36 months prior to the chart review),
who had an IUD inserted after age 40 and had at least
four follow-up visits post insertion were reviewed.
Fifty perimenopausal TCu 380A IUD acceptors were
recruited to the study. All of them had IUD insertion
at the Family Planning Clinic, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bankok, Thailand, by staff of
the family planning unit. The acceptors were healthy
and had no contraindication to IUD use. As part of the
initial visit, a physical and pelvic examination including weight and blood pressure and a Papanicolaou
smear was performed. All acceptors were asked to
complete questionnaires regarding their age, parity,
occupation, family income, and menstrual history.
The acceptors were asked to return for follow-up
visits at 6 8 weeks after insertion, after which follow-up visits were at 6-month intervals and any time
complications were perceived. At every visit, the
women were asked about their menstrual history and
side effects. Menstrual history was coded as either
amenorrhea, regular cycle, or irregular cycle. Amenorrhea was defined as the absence of menstruation for
3 months or longer. Regular cycles were defined as
periodic withdrawal bleeding within 28 6 7 days.
Irregular cycles were defined as intermenstrual or
prolonged or heavy bleeding at irregular intervals.4
Annually, each acceptor received a physical and pelvic examination and Papanicolaou smear.
All data were coded, recorded, and analyzed by the
authors. The descriptive and analytic statistics were
run on all data where appropriate. SPSS/PC1 for
Windows (SPSS Inc., Chicago, IL), was used to analyze
data. The descriptive statistics were percentage,
ISSN 0010-7824/98/$19.00
PII S0010-7824(98)00050-X

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Reinprayoon and Taneepanichskul

Contraception
1998;57:417 419

Table 1. Characteristics of perimenopausal IUD acceptors

(N 5 50)
Variable
Age (years) at insertion
Parity
Body weight at insertion
(kg)
Blood pressure at insertion
Systolic
Diastolic
Income (Baht)
Occupation
Housewife
Employee
Other

X 6 SD

95% CI

44.1 6 2.0
2.0 6 0.83

43.644.8
1.762.24

62.13 6 9.3

Table 3. Reported side effects of perimenopausal IUD

acceptors during 36 months of followup
Side Effects

59.564.8

114.3 6 5.4
76.1 6 5.1
7659.6 6 4899.3

113116
74.777.5
62679052

30 (60%)
16 (32%)
4 (8%)

45.273.6
19.546.7
2.219.2

Menstrual problems
Dysmenorrhea
Intermenstrual pelvic pain
Intermenstrual bleeding
Inflammation or infection
Vaginitis/moniliasis

Number
(N 5 50)

95% CI

7 (14%)
9 (18%)
15 (30%)

5.826.7
8.631.4
17.944.6

2 (4%)

0.413.7

IUD expulsion were noted among the acceptors during the follow-up period.

Discussion
mean, standard deviation, and 95% confidence interval. The statistical analyses were performed using the
paired t test for comparison of means. Statistical
significance was expressed at the level of 0.05 for all
analyses.

Results
During the period of study, there were 50 acceptors
who met the inclusion criteria. Characteristics of the
perimenopausal women who used the TCu 380A IUD
are shown in Table 1. The mean age of acceptors at
time of insertion was 44.2 years with an average
parity of two live births. The mean body weight at
insertion was 62.13 kg. The major occupations of the
acceptors were housewife (60%) and employee (32%).
The average family income per month was 7659.6
Baht. Considering the menstrual patterns, most of the
bleeding patterns were regular cycles, followed by
irregular cycles during the study period (Table 2). No
acceptor had amenorrhea in this study. The major
side effects reported at 36 months of follow-up are
shown in Table 3. Intermenstrual bleeding and pelvic
pain were the most often reported side effects. No
abnormal Papanicolaou smears were noted among
acceptors. There were no significant differences in
body weight and blood pressure at the time of insertion and at the 36-month follow-up (Table 4). No
pregnancies, cases of pelvic inflammatory disease, or

Table 2. Menstrual patterns of perimenopausal IUD acceptors (N 5 50)

Time After IUD Insertion
Menstrual Pattern
Regular cycle
Irregular cycle

12 Months

24 Months

36 Months

43 (86%)
7 (14%)

39 (78%)
11 (22%)

35 (70%)
15 (30%)

The IUD is a safe and effective method of long-term

contraception.3,5 However, little previous data have
assessed menstrual patterns in perimenopausal IUD
users. Based on historic controls, the study found that
intermenstrual bleeding incidence was only 30%,
similar to other age groups using IUD.3,5 The rate of
intermenstrual pelvic pain, dysmenorrhea, and vaginal infection was similar to that reported for younger
age groups.3,5 Long-term use of the TCu 380A IUD
did not have any adverse effect on body weight and
blood pressure. Therefore, perimenopausal women
who have problems with obesity or high blood pressure can use IUDs for contraception. This study also
confirmed the effectiveness and safety of the TCu
380A IUD in perimenopausal women. No pregnancy,
pelvic inflammatory disease, or IUD expulsion was
observed during 36 months of follow-up. These findings were also demonstrated by other studies assessing the Nova T and Copper T-200 IUD.5 Pelvic
inflammatory disease may be less frequent with the
use of IUD in perimenopausal women because these
women are more likely to be in a mutually monogamous relationship.
In conclusion, the use of the TCu 380A IUD in
women who were over 40 years old at the time of
insertion was found to be safe and effective. Therefore, this IUD can be used up to menopause in women
Table 4. Mean body weight and blood pressure at the time
of insertion and at 36 months follow-up (N 5 50)

Variable
Body weight (kg)
Blood pressure
(mm Hg)
Systolic
Diastolic

At the
Time of
Insertion

At the
36-Month
Follow-Up

95% CI

62.12 6 9.3

63.21 6 8.2

24.62.4

114.3 6 5.4
76.1 6 5.1

115.2 6 4.9
76.8 6 5.4

22.951.15
22.781.38

Contraception
1998;57:417 419

who do not have contraindications. However, we

suggest a liberal removal policy if some complications or side effects such as bleeding, pain, or infection occur during IUD use.

References
1. Davey DA. The menopause and climacteric. In: Whitefield CR, ed. Dewhursts Textbook of Obstetrics and
Gynecology for Post Graduates. Oxford: Blackwell Scientific Publications, 1986:646 76.

TCu 380A IUD Use in Perimenopause

419

2. Shaaban MM. The perimenopause and contraception.

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3. Petta CA, Amatya R, Farr G. Clinical evaluation of the
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Norplantt implant among Thai women in Bangkok.
Contraception 1996;53:33 6.
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