Pre-insertion uterine artery Doppler indices may predict intrauterine contraceptive device-related heavy menstrual bleeding

Abstract

Objective: To test the hypothesis whether initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of copper-T 380 intrauterine contraceptive device (IUCD) could predict IUCD-related heavy menstrual bleeding or not. Methods: This prospective observational study was conducted on 332 women who requested insertion of copper IUCD. Uterine artery PI and RI were measured before insertion and repeated at 3 and 6 months after IUCD insertion. Participants were divided into two groups according to their menstrual calendar and hemoglobin concentration; Normal bleeding group (n = 188) and heavy menstrual bleeding group (n = 144). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the prognostic value of uterine artery PI and RI in prediction of IUCD-related heavy menstrual bleeding. Results: Uterine artery Doppler indices does not show significant change 3 and 6 months after IUCD insertion in both groups (p > .05). Uterine artery PI < 1.5 was associated with heavy menstrual bleeding after IUCD insertion (sensitivity 82% and specificity 90%, with area under the curve, AUC of 0.92 and p-value <.001). Also, uterine artery RI < 0.65 was associated with heavy menstrual bleeding after IUCD insertion (sensitivity 80% and specificity 90%, AUC 0.91 and p-value <.001). Conclusion: Initial uterine artery Doppler studies could be beneficial as a predictor of IUCD related heavy menstrual bleeding and should be implemented during counseling of women desiring long acting reversible contraception. Keywords: Intrauterine contraceptive device, Heavy menstrual bleeding, Uterine artery Doppler, Pulsatility index, Resistance index