OBJECTIVE: To evaluate the possible cause(s) of IUCDs induced menorrhagia in women wearing TCu 380 IUCDs, when compared with non-menorrhagic women wearing the same device.

SUBJECT: One hundred women were enrolled in the study during the period from 1993 to 1997. They were divided into Group (1): Eighty normally menstruating women asking for an IUCD application. Group (2): Twenty women having menorrhagia exclusively due to IUCDs applied one year before the study.

INTERVENTIONS: Endometrial biopsy from the lateral and posterior uterine wall in the late secretory phase were taken from Group (1) women before TCu 380 IUCDs insertion (control group) and every 3 months after, until a planned one year follow up was completed. Similar biopsy was taken once from Group (2) women . Each biopsy was served for histological, histochemical and electron microscopic studies.

RESULTS: Seventy three women (91.25%) completed the follow up period. Out of them, 66 (90.4%) showed no menstrual or investigational changes. Seven women (9.6%) showed no statistically significant increase in their menstrual duration. There were no statistically significant changes in their endometrial epithelium, blood vessels, stromal cell nucleus and endoplasmic reticulum. On the other hand, there were statistically significant changes in the endometrial stroma, glycogen content, succinic dehydrogenase activity, acid phosphatase reaction and the mitochondrial amount. In group (2) already menorrhagic women, statistically high significant changes in all the study parameters were observed.

CONCLUSION: The use of IUCD is practical, as its side effects could be considered tolerable and reversible when it is well managed. Proper selection of the cases can minimize to a great extent, the potential menorrhagia in IUCD users. Histopathological scrutiny of an office endometrial biopsy can give a good idea about the endometrium before IUCDs insertion to avoid malselection of cases.