The effect of hormonal contraception and intrauterine device on the pattern of menstrual cycle

Background
Many women discontinue their contraceptives owing to dissatisfaction with the method. Unscheduled bleeding is one of the main reasons cited by women for stopping a birth control method. Improving counseling and management of these adverse effects will aide in increasing satisfaction with contraceptive methods.
Objective
The aim of the work is to study the effects of hormonal contraceptives and intrauterine device on the pattern of menstrual cycle.
Patients and methods
This study was a descriptive study in family planning clinic at Women's Health Hospital, Faculty of Medicine, Assiut University, and Childhood and Maternity Care Center in the city of Dirout, Assiut, Egypt, on women using hormonal contraceptives or intrauterine devices. This study was done by using interviewing questionnaire.
Results
It was observed that the progestogen-only hormonal contraceptives like progestin-only pills (POPs), Depo-Provera, and Implanon produced disturbances in bleeding pattern in the majority of their users. With POPs, it was found that 22.4% of users were amenorrheic and 77.6% were menstruating. The menstrual cycle was regular in 57.9% and irregular in 42.1%. Menstrual disorders were found in 42.1% in the form of polymenorrhea in 62.5% and metrorrhagia in 32.5%. With Depo-Provera, it was found that 76.5% of users were amenorrheic and 23.5% were menstruating. The menstrual cycle was regular in 36.4% and irregular in 58.3%. Menstrual disorders were found in 58.3% in the form of oligomenorrhea in 21.4%, polymenorrhea in 42.9%, and metrorrhagia in 35.7%. With Implanon, it was found that 50.8% of users were amenorrhoeic and 49.2% were menstruating. The menstrual cycle was regular in 53.3% and irregular in 46.7%. Menstrual disorders were found in 46.7% in the form of oligomenorrhea in 50%, polymenorrhea in 14.9%, and metrorrhagia in 35.7%. Combined oral pills produced much better cycle control as compared with any of the other hormonal contraceptives. There were regular cycles in 83.7% of study users and irregular cycles in 16.3%. Menstrual disorders were found in 48.8% of study users. In this group, hypomenorrhea was seen in 66.7% and metrorrhagia was seen in 33.3%. The use of copper intrauterine device (IUD) was associated with regular menstrual cycles in 87.5% of study users and irregular in 12.5%. Menstrual disorders were found in 42.2% of study users. In this group, dysmenorrhea was found in 68.5%, metrorrhagia in 29.6%, and menorrhagia in 48.1% of these women.
Conclusion
This study concluded that hormonal contraceptive methods and IUD can affect the pattern of menstrual cycle and are considered risk factors for irregularity in vaginal bleeding patterns and discontinuation of the method.