A 32-year-old multiparous woman attends the family planning clinic for IUCD insertion. She is counselled about the most common side effect of copper-bearing IUCDs. Which of the following is the most frequent complaint reported by users of copper IUCDs?

Explanation

## Most Common Side Effect of Copper IUCDs **Key Point:** Increased menstrual bleeding (menorrhagia) and dysmenorrhoea are the most frequent complaints in copper IUCD users, occurring in 20–30% of users within the first 3–6 months. ### Mechanism Copper ions trigger a local inflammatory response in the endometrium, leading to: 1. Increased prostaglandin production (especially PGE₂ and PGF₂α) 2. Enhanced uterine contractility 3. Increased vascular permeability and endometrial bleeding 4. Intensified uterine cramps ### Clinical Presentation - **Menorrhagia:** 20–30% of users report heavier periods - **Dysmenorrhoea:** Often accompanies increased bleeding - **Timing:** Usually develops within first 3–6 months; may improve after 6–12 months - **Management:** NSAIDs (mefenamic acid, ibuprofen) are first-line; if intolerable, IUCD removal and alternative contraception ### Why Copper Causes This Unlike hormonal IUCDs (LNG-IUS), which suppress endometrial growth and reduce bleeding, copper IUCDs exert a **local inflammatory effect** that increases menstrual flow. **High-Yield:** This is the leading reason for IUCD discontinuation in the first year, especially in nulliparous women and those with pre-existing heavy periods. **Clinical Pearl:** Copper IUCDs are contraindicated in women with: - Menorrhagia or dysmenorrhoea (relative contraindication) - Heavy or painful periods at baseline In contrast, the **LNG-IUS (Mirena)** reduces menstrual bleeding by 50–90% and is preferred in women with heavy periods.