Breakthrough bleeding with an IUD

A hormonal intrauterine device can cause irregular spotting after insertion and may later make periods lighter or absent. A copper device may make menstrual bleeding heavier or more crampy, particularly after fitting. Bleeding can also come from causes unrelated to the device, including cervical irritation, infection, pregnancy, hormonal change, or a condition affecting the uterus.

A change after a previously settled pattern deserves attention, especially if it follows sex or comes with pelvic pain, unusual discharge, fever, or missed periods. Bleeding alone does not show whether the IUD has moved; position is assessed from symptoms, the threads, examination, and imaging when indicated.

Record the days of bleeding, flow, clots, pain, discharge, and whether bleeding follows sex. If you have been taught to check the threads, note whether they feel different, but do not pull them or try to reposition the device. Arrange a clinical review for persistent bleeding, a changed thread length, or threads you cannot feel.

Use alternative contraception and seek advice if you think the IUD may have moved or come out. Take a pregnancy test if your period is late, pregnancy symptoms develop, or there has been a possible contraceptive failure. A clinician can check for infection, pregnancy, cervical causes, and device position before discussing treatment or removal.

Seek urgent care for very heavy bleeding, fainting, marked weakness, severe or one-sided pelvic pain, shoulder-tip pain, fever, foul-smelling discharge, or a positive pregnancy test with pain or bleeding. These features require assessment for blood loss, infection, or pregnancy outside the uterus. If the device is partly visible at the vaginal opening, avoid pulling it and obtain prompt medical advice.

Ask whether the bleeding fits the type of IUD and timing of insertion, whether pregnancy or infection testing is appropriate, and whether the device position needs checking. Discuss options for controlling bleeding, how they interact with your health history, and when replacement or removal would be considered.