Complications of IUD Removal

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An intrauterine device (IUD) is a long-acting, reversible form of contraception. An IUD can be a good option for women who cannot or prefer not to take hormonal contraceptive pills or for whom individual circumstances make it a good choice to prevent unwanted pregnancy. Two types of IUD are available in the US, a copper device (ParaGard) and hormone-releasing devices (Kyleena, Liletta, Mirena, Skyla). These IUDs are small, easily inserted by a healthcare provider and highly effective. Removal is typically a simple procedure that only takes a few minutes. Short-term effects sometimes occur but true complications of IUD removal are rare.

Bleeding and Cramping

A small amount of vaginal bleeding or spotting and cramping can occur after IUD removal. These effects are considered a normal response to gently pulling the device from the uterus and through the cervix and vagina during removal. Minor scraping of these structures by the device during removal can cause a small amount of bleeding or spotting that usually lasts no more than a day or two -- unless the device is removed during your menstrual period.

Lightheadedness

Some women experience lightheadedness during or immediately following removal of an IUD. This is a normal nervous system reaction called a vasovagal response. Tell your healthcare provider if you feel dizzy or lightheaded. This reaction typically passes within a few minutes if you remain lying down. Sit up and stand slowly with someone standing by to assist you should you become dizzy again.

Missing or Broken Strings

An IUD is normally removed by grasping the strings with a medical instrument and gently pulling the device out of the uterus. If the strings cannot be located or break during the procedure, removal becomes a bit more complicated. Depending on the situation, your doctor might decide to use a tiny brush-like instrument or an IUD hook to try to locate the strings. If the strings cannot be located but the IUD is clearly in the uterus on ultrasound examination, your doctor might attempt to remove the device with a thin grasping instrument. Removal of an IUD under these circumstances is more time-consuming and uncomfortable than an uncomplicated removal.

Embedded or Displaced IUD

Although relatively rare, an IUD can become embedded in the wall of the uterus. In such cases, gentle tugging of the strings is met with resistance and the device remains firmly in place. Even more rarely, an IUD may be displaced outside the uterus. These situations require one or more imaging tests to determine the exact location of the IUD. Your doctor will then discuss the best option or options for removal with you. If the IUD is located outside the uterus, surgical removal is necessary.

Breakage

Breakage of an IUD during the removal process is another rare but possible complication. This situation is often immediately obvious when your healthcare provider examines the removed device. Leaving IUD fragments in the uterus could increase your risk for a uterine infection, which might lead to infertility. Pain, cramping and/or bleeding due to uterine irritation by IUD remnants are possible symptoms. Ultrasound or another type of imaging is typically used to locate the fragments, which can then be removed using a suction device or another procedure.

Pregnancy

Fertility typically returns very quickly after removal of an IUD. If a woman does not want to become pregnant, it's important place a new IUD or begin another form of contraception immediately to avoid an unwanted pregnancy.

Warnings and Precautions

Talk with your healthcare provider if you've recently had an IUD removed and experience any unusual symptoms, including prolonged bleeding, severe or persistent cramps, abnormal discharge, fever, chills, or abdominal or pelvic pain.

Reviewed and revised by: Tina M. St. John, M.D.

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