An intrauterine device, or IUD, is a contraception method a woman might choose because she cannot, or prefers not, to take a daily oral contraception pill; because she knows she does not want children for several years; or because specific circumstances make the IUD a good choice to prevent unwanted pregnancy. It is a small device that is easy for an obstetrician to insert and is very effective. Removal is usually a simple procedure that takes only a few minutes. Complications of removal, though rare, do exist.
Bleeding
According to the prescribing information from Mirena, which is one of the two IUDs used in the United States, one possible complication of IUD removal is bleeding from the uterus. Drs. Daniela Carusi and Alisa Goldberg of Harvard Medical School write in the medical reference UpToDate that some bleeding is a complication that can be considered normal. Because a device is being removed from the uterus via the vagina, if it brushes up against either the wall of the uterus or the vagina, this might result in bleeding.
Cramping
Carusi and Goldberg add in their UpToDate article that cramping is also a possible, normal complication of IUD removal. The Mirena Full Prescribing Information for physicians also mentions this possibility, but the cause of cramping is not clear. A patient who experiences cramps shortly after removal of her IUD should be assured that this is a normal response.
IUD Embedded in Uterus
A much more rare complication related to IUD removal is the possibility that the IUD becomes embedded in the uterus. In such cases, removal of the IUD is not quite as simple. Instead of being able to tug on the strings attached to the IUD and pull the whole device out, the obstetrician might need to use a forceps, an IUD hook or suction to remove the device.
In some cases, using an ultrasound machine to provide a visual guide of where the IUD is located might help. In these more complex IUD removal situations, Carusi and Goldberg report that lidocaine can be injected into the uterus to numb the area. If all of the above methods do not work in removing the IUD, surgical removal is an option.
Pregnancy
Both the Mirena website and physicians Goldberg and Carusi writing in UpToDate suggest the same precaution to patients: Upon removal of an IUD, fertility can return very quickly. So a patient who gets her IUD removed and then has unprotected intercourse is at risk for an unplanned pregnancy. Because of this possible complication, patients should be made aware that as soon as the IUD is removed, either a new IUD should be placed or a new method of contraception should be begun immediately.
