IUD Perforation: Symptoms and Treatment
IUD perforation requires prompt surgical removal, typically via laparoscopy, as it can lead to serious complications including adhesions, abscess formation, and damage to surrounding organs. 1, 2
Symptoms of IUD Perforation
Symptoms of IUD perforation may include:
- Abdominal or pelvic pain - Often described as colic-type pain 3
- Abnormal vaginal bleeding 4
- Missing IUD strings - A key sign that perforation may have occurred 4
- Pregnancy - Unintended pregnancy may occur as the IUD is no longer effective 1
However, it's important to note that many patients with IUD perforation are asymptomatic at the time of diagnosis 1, 2. Approximately 43% of women with perforated IUDs have no symptoms 2.
Diagnostic Approach
When IUD perforation is suspected:
- Physical examination - Check for visible IUD strings 3
- Ultrasound - To determine IUD location 4, 3
- X-ray or CT scan - If the IUD cannot be located by ultrasound 5
- MRI - May be used in some cases for precise localization 5
If the IUD strings are not visible and cannot be retrieved safely, ultrasound examination should be performed to determine if the IUD has been expelled or has perforated the uterine wall 4.
Treatment of IUD Perforation
The World Health Organization recommends surgical removal of migrated IUDs 5:
- Laparoscopy - The preferred method for removal of intraperitoneal IUDs 6, 2
- Hysteroscopy - May be used in conjunction with laparoscopy 2
- Conversion to laparotomy - Required in approximately 11% of cases with complex perforation 2
Complications of Untreated Perforation
Untreated IUD perforation can lead to:
- Dense adhesion formation - Occurs in 57% of cases, more common with copper IUDs (71%) than with LNG-IUDs 2
- Damage to surrounding organs - Including bowel and kidney damage 1
- Abscess formation - Can occur as a long-term complication 2
- Fistula formation - Including rectouterine fistulas 2
- Peritonitis - A potentially life-threatening infection 1
Risk Factors for Perforation
- Uterine fibroids (increase risk of IUD problems) 3
- Distorted uterine cavity 3
- Inadequate insertion technique 3
- Timing of insertion in relation to recent delivery or abortion 1
- Experience level of the clinician 1
Important Considerations
- The incidence of IUD perforation is approximately 0.12-0.68 per 1000 insertions 1
- A perforated IUD provides no contraceptive protection 1
- Copper IUDs cause a greater inflammatory response than LNG-IUDs when perforated 2
- Even asymptomatic perforations should be addressed promptly once identified 2
While some have questioned whether surgical removal is always necessary for asymptomatic patients 7, the current standard of care remains surgical removal due to the risk of serious complications including adhesions and damage to surrounding organs 1, 2.