Comparison of levonorgestrel and copper releasing intrauterine contraceptive device on body iron stores and menstrual bleeding patterns: experience on Indian women.

INTRODUCTION: The search for an ideal contraceptive device most suited for women of developing countries with anemia poses a challenge.

AIM: This study was conducted to compare the effects of levonorgestrel releasing (LNG) and copper releasing (Cu T) intrauterine contraceptive devices (IUCD) on body iron stores and menstrual bleeding patterns.

METHODS: Hundred women desiring contraception were divided into two groups of fifty each where either LNG or Cu T 200 IUCD was inserted. Outcome parameters evaluated were change in menstrual bleeding patterns, serum ferritin and hemoglobin level post insertion at three, six and twelve months. Main outcome measures were change in serum ferritin, hemoglobin concentration, menstrual bleeding and spotting days 12 months after insertion.

RESULTS: Menstrual bleeding days increased initially at three month for both IUCD's, but by 12 months, mean number of bleeding days reduced from preinsertion 4.96 +/- 1.61 to 3.14 +/- 1.72 days (p < 0.05) in the LNG group while in Cu T number of bleeding days remained higher at 12 months (4.76 +/- 0.96 days) compared to pre-insertion level (4.46 +/- 0.91 days, p = NS). At 12 months, 60% women developed hypomenorrhoea and 20% had amenorrhea in LNG group. Higher (p < 0.05) serum ferritin (24.17 + 5.97 vs. 20.80 + 5.78) and hemoglobin (12.45 + 0.46 vs. 11.95 + 11.042 gm/dl) concentration was noted in the LNG group as compared to Cu T by the end of 1 year.

CONCLUSION: LNG reduced the number of menstrual bleeding days and increased the hemoglobin and serum ferritin levels, thus preventing loss of body iron. This may be especially important for women in developing countries like India where decrease in blood loss may improve iron deficient situations.