From the Guidelines
When an intrauterine device (IUD) is embedded in the myometrium, it is crucial to seek immediate medical care from a gynecologist to determine the best course of action for removal, as attempting to remove it yourself can lead to further complications. If the IUD is embedded, the gynecologist will likely perform an ultrasound to confirm the position and depth of embedding, as recommended by the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1. This ultrasound examination is essential to determine the location of the IUD and to assess whether it has perforated the uterine wall or has been expelled. Key considerations for the patient include:
- Monitoring for signs of infection, such as fever or abnormal vaginal discharge
- Managing pain and bleeding with NSAIDs like ibuprofen (400-800mg) or naproxen (500mg) as needed
- Discussing alternative contraceptive options with the doctor after removal The removal method will depend on the degree of embedding, with options including hysteroscopy, laparoscopy, or in severe cases, laparotomy. It is essential to follow up with the gynecologist to ensure proper healing and to address any concerns or questions about future contraceptive use. Symptoms of embedding, such as pelvic pain, abnormal bleeding, shortened or missing IUD strings, and signs of infection, should be promptly reported to the healthcare provider. By seeking immediate medical attention and following the recommended course of action, patients can minimize the risk of complications and ensure the best possible outcome.
From the Research
Management of Embedded IUD
When an intrauterine device (IUD) is embedded in the myometrium, the following steps can be considered:
- Removal of the IUD is recommended, especially in symptomatic patients, as it can cause pelvic pain and abnormal bleeding 2.
- Asymptomatic patients should have their individual history and desire for future pregnancy weighed against the risk and benefits of treatment 3.
- Office hysteroscopy can be used to guide the removal of a deeply embedded IUD, providing direct visualization and sufficient force 4.
- In some cases, the IUD may migrate spontaneously, and removal may be necessary to prevent further complications 5.
- Fragmented IUDs embedded in the cervical canal and myometrium can be managed with careful consideration of the patient's symptoms and medical history 6.
Diagnostic Techniques
- Three-dimensional ultrasound can be used to detect abnormally located IUDs, which can help identify the cause of pelvic pain and bleeding 2.
- Transvaginal ultrasound can confirm the presence and location of the IUD 5.
- Computed tomography can be used to confirm the location and extent of IUD migration or embedding 5.
Considerations
- Uterine anomalies, such as a bicornuate uterus, can increase the risk of IUD complications 3.
- The risk and benefits of treatment should be weighed against the patient's individual history and desire for future pregnancy 3.
- Removal of asymptomatic ectopic IUDs may be necessary to prevent further complications 5.