EVALUATION OF SUBENDOMETRIUM BLOOD FLOW IN CASES OF EXCESSIVE MENSTRUAL BLEEDING AFTER INTRAUTERINE CONTRACEPTIVE DEVICE

Abstract

Background: There is several possible mechanisms that explain the cause of menorrhagia in patient
using intrauterine contraceptive device (IUCD). Abnormal uterine bleeding may be excessive to the
extent of causing iron deficiency anemia. The aim of the present study was to compare of the Doppler
parameter of subendometrium and uterine artery of the patients that complain of excessive menstrual
bleeding after IUCD insertion to other patients have no excessive menstrual bleeding. Patients and
methods: This study includes 54 women divided into three groups. Group I; included 18 women using
copper intrauterine device (Tcu 380A) and complaining of menorrhagia, Group II; included 18 women
using copper IUCD and not complaining of abnormal uterine bleeding and group III; included 18
women not using any contraceptive method and not complaining of abnormal uterine bleeding.
Results: There is statistically significant difference between the studied groups regarding left uterine
artery RI and PI. The cutoff of sub-endometrial RI in prediction of excessive menstrual bleeding if IUD
inserted is ≥0.755 with area under curve 0.701 at which sensitivity 77.8%, specificity 69.4%, positive
predictive value 56%, negative predictive value 86.2% and accuracy 72.2% (p<0.05). The best cutoff
of uterine RI in prediction of excessive menstrual bleeding if IUD inserted is ≥0.775 with area under
curve 0.807, at which sensitivity 77.8%, specificity 72.7%, positive predictive value 58.3%, negative
predictive value 86.7% and accuracy 74.1% (p<0.05). Conclusion: Uterine arteries RI and PI were
significantly lower in women with copper IUD induced menorrhagia. Subendometrial blood flow RI,
PI were significantly lower in women with Copper IUD induced menorrhagia than women of group II
and III.