From the Guidelines
A low-lying position of an intrauterine contraceptive device (IUCD) requires prompt medical attention, and the recommended approach is removal and replacement rather than attempting to reposition it, as it significantly reduces contraceptive effectiveness and increases the risk of pregnancy. This malposition can be diagnosed through ultrasound examination, as suggested by the U.S. selected practice recommendations for contraceptive use, 2013 1. If ultrasonography is available, it should be used to determine the location of the IUD, and if the IUD cannot be located, it might have been expelled or have perforated the uterine wall.
Some key points to consider in the management of a low-lying IUCD include:
- Common symptoms of a low-lying IUCD include abnormal bleeding, pelvic pain, discomfort during intercourse, and visible or palpable IUCD strings that are longer than expected.
- The malposition typically occurs due to improper insertion technique, uterine contractions pushing the device downward, or anatomical factors like an unusually shaped uterine cavity.
- After removal, the healthcare provider may recommend waiting until the next menstrual cycle before inserting a new IUCD to ensure proper placement.
- They might suggest a different type of IUCD or alternative contraception if repeated displacement occurs, as discussed in the context of contraception for HIV-infected adolescents 1.
- It is essential to note that IUDs are safe and effective methods of contraception, with a failure rate of less than 1%, and can be used by nulliparous adolescents and individuals with HIV, with certain precautions and considerations 1.
From the Research
Low-Lying Position of IUCD
- A low-lying IUCD is a condition where the device is not in its intended position in the uterus, which can lead to various complications 2, 3.
- The management of a low-lying IUCD is not well-established, and there is a lack of consensus among clinicians on the best course of action 2.
- Some studies suggest that a low-lying IUCD can increase the risk of migration, expulsion, or perforation of the device 4, 5.
- Factors to consider in the management of a low-lying IUCD include the patient's symptoms, medical history, and the type of device used 3.
- In some cases, a low-lying IUCD may need to be removed or repositioned, and alternative contraceptive methods may be recommended 2, 3.
Complications of Low-Lying IUCD
- Perforation of the uterus or surrounding organs is a possible complication of a low-lying IUCD 4, 5.
- Infection is also a risk, particularly if the device is not inserted or removed properly 6.
- Abnormal bleeding or pain can be symptoms of a low-lying IUCD, but these symptoms can also be caused by other factors 2, 3.