A 32-year-old multiparous woman attends the family planning clinic for IUCD insertion. She has no contraindications. Which is the most common reason for IUCD discontinuation within the first year of insertion?

Explanation

## Most Common Reason for IUCD Discontinuation **Key Point:** Menorrhagia and dysmenorrhea are the leading causes of IUCD discontinuation, accounting for 10–15% of removals within the first year, particularly with copper IUCDs. ### Mechanism Copper IUCDs trigger a local inflammatory response in the endometrium, leading to: - Increased prostaglandin production - Enhanced uterine contractility - Heavier menstrual bleeding (20–50% increase in blood loss) - Increased menstrual pain ### Comparison of Common IUCD Complications | Complication | Incidence | Timing | Management | |---|---|---|---| | Menorrhagia/dysmenorrhea | 10–15% | First 3–6 months | NSAIDs, reassurance, consider LNG-IUS | | Expulsion | 3–5% | First year, especially first 3 months | Re-insertion after exclusion of pregnancy | | Perforation | 0.1–0.3% | At insertion | Surgical retrieval if symptomatic | | PID | 0.5–1% | Variable, peak at insertion | Antibiotics; removal if unresponsive | ### Clinical Pearl **High-Yield:** While expulsion and perforation are more dramatic, menorrhagia/dysmenorrhea is far more common and is the primary reason women request removal. Copper IUCDs increase menstrual blood loss by an average of 20–50 mL per cycle. ### Counselling Point Women should be counselled pre-insertion about expected increase in bleeding and dysmenorrhea. NSAIDs (ibuprofen, mefenamic acid) reduce symptoms in 70% of cases. If unacceptable, switching to a levonorgestrel-releasing intrauterine system (LNG-IUS) is an option, as it typically reduces bleeding. [cite:Park 26e Ch 23]