Intrauterine Devices are a First-Line Option for Adolescents with Bleeding Disorders

Intrauterine Devices are a First-Line Option for Adolescents with Bleeding Disorders 150 150 Mary Bates, PhD

Among adolescents with heavy menstrual bleeding, study shows no difference in IUD expulsion rate between adolescents with bleeding disorders and those without.

In a new study, researchers from Nationwide Children’s evaluated the use of intrauterine devices (IUDs) in two young women’s hematology clinics. They found that young women with bleeding disorders did not experience a higher IUD expulsion rate than their peers with heavy menstrual bleeding who were not found to have an underlying bleeding disorder. The findings provide further support for IUD placement as a first-line option for adolescent women with bleeding disorders.

Approximately 20-30% of adolescents presenting with heavy menstrual bleeding are diagnosed with an inherited bleeding disorder. Long-acting, reversible contraceptives, including IUDs, are commonly used to manage heavy menstrual bleeding. Some studies in adults suggest that women with bleeding disorders may have more issues with IUD expulsions; however, little is known about the use of IUDs for treating heavy menstrual bleeding in adolescents with bleeding disorders.

For the new study, researchers retrospectively analyzed data from adolescents evaluated for heavy menstrual bleeding at two young women’s hematology clinics (Nationwide Children’s and Children’s Medical Center in Dallas, Texas). They compared adverse events in adolescents with and without bleeding disorders who underwent placement of an IUD between 2014 and 2020.

Overall, the researchers found that about 10% of patients with heavy menstrual bleeding experienced IUD expulsion. But importantly, there were no significant differences in expulsion rate between young women with and without bleeding disorders.

The researchers also found that breakthrough bleeding after IUD insertion was relatively common, and again similar between those with and without bleeding disorders.

Senior study author Sarah O’Brien, MD, a pediatric hematologist and investigator in the Center for Health Equity and Outcomes Research at The Abigail Wexner Research Institute at Nationwide Children’s, says that young women should be counseled that breakthrough bleeding is common and may require intervention after IUD placement.

“In our practice, when a patient with a bleeding disorder is transitioning from an oral contraceptive to an IUD, we will continue the oral contraceptive for the first four to six months after IUD placement to help control breakthrough bleeding,” she says. “That is something I recommend providers think about when they have a patient with heavy menses who is interested in having an IUD placed.”

The researchers say that IUDs, along with hormonal contraceptive pills, should be considered first-line options in adolescents with heavy menstrual bleeding and bleeding disorders.

“In our patient population of about 80 young women with heavy menstrual bleeding, only a minority were sexually active and their mean age at the time of IUD placement was 15 years old,” says Dr. O’Brien.

“I hope this study helps dispel some of the misconceptions that IUDs are only for sexually active, older teenagers or young adults because they really are a great treatment option for a variety of patients. IUDS, along with contraceptive pills, are effective first-line treatment options for heavy menses in this age group.”


Kendel NE, Zia A, Rosenbaum LE, Stanek JR, Haamid FW, Christian-Rancy M, O’Brien SH. Intrauterine Device Outcomes in Young Women with Heavy Menstrual Bleeding: Comparing Patients with and without Inherited Bleeding Disorders. Journal of Pediatric Adolescent Gynecology. 2022 Jul 9:S1083-3188(22)00252-2. Doi: 10.1016/j.jpag.2022.07.003. Epub ahead of print.

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.