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Heavy bleeding with copper IUD — DFSRH MCQ

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ModerateIntrauterine methodsHeavy bleeding with copper IUDDFSRH

A 45-year-old woman has a copper IUD fitted 6 years ago and now has very heavy regular periods causing ferritin deficiency. She wants ongoing contraception and improved bleeding. What is the most appropriate contraceptive method?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Replace with a 52 mg levonorgestrel IUD if suitable

A 52 mg LNG-IUD offers effective contraception and can reduce heavy menstrual bleeding if suitable. Continuing the copper IUD does not address iron-deficiency symptoms. CHC may be an option for some but needs age-related risk assessment, while cycle tracking is less reliable and UPA is EC rather than bleeding treatment. The pearl is to consider method side-effect profiles when symptoms develop during contraceptive use.

Reference: FSRH Guideline: Intrauterine Contraception; NICE Heavy Menstrual Bleeding