Out, Damned Spot: Managing Nuisance Bleeding Associated with Intrauterine Contraception

Nuisance bleeding is common during the first 3 months after placement of the levonorgestrel-releasing intrauterine system (LNG-IUS). To evaluate whether tranexamic acid or the nonsteroidal anti-inflammatory drug (NSAID) mefenamic acid can reduce this initial bleeding, researchers conducted an industry-funded, randomized trial in Denmark, Ireland, and Norway. All 187 participants were instructed to take their study medication (tranexamic acid 500 mg, mefenamic acid 500 mg, or placebo) three times a day until they were free of bleeding and spotting, and to restart whenever bleeding or spotting recurred.

Median number of bleeding or spotting days during the 90-day study period was reduced by 6 days with tranexamic acid and by 3 days with mefena…