Definition and Overview
An IUD is placed in the uterus and is a long-term contraceptive option that may work anywhere between 3 to up to 10 years. It has to be removed when it has reached the end of its usage cycle or when there are other reasons to do so, such as an existing medical problem or when the patient wishes to become pregnant.
Who should undergo and expected results
IUD removal is beneficial for women who has had an IUD inserted but now requires it to be removed due to:
- Medical condition
- Planning to get pregnant again
- Infection due to the IUD
- Intolerance to the IUD's side effects
IUD expiration tends to differ based on what type is used. For a Mirena IUD, a woman can leave it in place for up to 5 years. A Skyla IUD, however, has a shorter usage cycle of only 3 years. A ParaGard IUD, on the other hand, can be used for up to 10 years.
A woman's fertility is expected to return promptly once the intrauterine device is removed. This means that if a woman undergoes an IUD removal but does not plan on getting pregnant again, a new contraceptive method must be used immediately after the procedure. If the IUD has simply expired, it can be replaced with a new one during the same visit.
There is no evidence associating previous IUD use with long-term infertility. The patient's chances of getting pregnant again are similar to that of women who also previously used other contraceptive methods.
How the procedure works
IUD removal is a quick procedure that may take just a few minutes, with minimal levels of pain and discomfort. Most patients find IUD insertion to be more painful and uncomfortable than the removal of the device. Nonetheless, to help patients with the discomfort, most doctors may allow them to take a mild pain reliever, such as ibuprofen, even before the procedure.
The procedure begins with the patient lying down on an exam table with her legs in stirrups. To facilitate easier access to the uterus, doctors first insert a speculum into the vagina. Most patients experience some discomfort at this point. Once the speculum is in place, the doctor will look for the strings attached to the intrauterine device. This may be done by hand or with the use of another tool that is inserted through the cervix. Once the strings are found, the doctor will gently but steadily pull on it until the IUD is taken out of the cervix and out of the vagina. The speculum will then be removed.
IUD removal may be done at any time, even when the patient has an ongoing menstruation. In fact, some studies show that due to the natural softening of the cervix during menstruation, it is easier to remove the IUD at this time.
Possible risks and complications
An IUD removal is a safe routine procedure with a very low risk of serious complications. If there is an infection, it can be treated with prescription antibiotics. Most patients also complain of cramping or abdominal pain following the procedure, but these should go away after a few days.
There are isolated cases wherein the doctor has some difficulty finding the IUD strings, such as when they have slipped into the cervical canal, has retracted up into the uterus, or the strings were cut too short during the insertion process. A sonogram may be used to check if the IUD is indeed there and has not accidentally slipped out without the patient noticing. If it is confirmed that the IUD is still in place, the IUD can be removed using a cytobrush or an IUD hook, or it can be carefully removed from the uterus using forceps or a clamp. If, however, the IUD still cannot be grasped by forceps, the doctor may use a sonogram for guidance. In such cases, there is a small risk of some injury to the uterus.
There are also cases wherein the IUD has become embedded in the uterus; such cases may require a hysterectomy for successful IUD removal.
These complications during IUD removal may cause a higher level of discomfort among patients. Thus, in such cases, anesthetics are often administered.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2011 Jul;118(1):184-96. PMID: 21695583.