From the Guidelines
If the strings of an Intrauterine Device (IUD) cannot be found, the next step is to consider performing or referring for an ultrasound examination to determine the location of the IUD, as recommended by the U.S. selected practice recommendations for contraceptive use, 2013 1. When the IUD strings are not visible and cannot be retrieved safely, it is crucial to determine the location of the device to rule out potential complications such as expulsion or perforation of the uterine wall.
- Key considerations in this scenario include:
- The possibility that the IUD might have been expelled or have perforated the uterine wall if it cannot be located by ultrasonography 1
- The importance of advising the woman to seek care promptly if she experiences symptoms such as heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever, especially if ultrasonography is not possible or the IUD is determined to be inside the uterus 1
- The need for a thorough evaluation, potentially including a pelvic exam and ultrasound, to locate the IUD and assess its position and function
- The recommendation to use a backup birth control method, such as condoms, until the IUD's position and function can be confirmed, as a displaced IUD may not provide effective contraception It is essential to prioritize the woman's health and safety by seeking professional assessment and care to ensure proper placement and function of the IUD, and to address any potential complications promptly.
From the Research
Next Steps for Missing IUD Strings
If the strings of an Intrauterine Device (IUD) cannot be found, the following steps can be taken:
- Perform a transvaginal or transabdominal ultrasound to confirm the position of the IUD 2, 3
- If the IUD is not visible in the uterine cavity, consider the possibility of uterine perforation or migration to the pelvic/abdominal cavity 2, 4, 5
- Use cross-sectional imaging such as CT or MRI scan to rule out adjacent organ involvement before surgical removal 2
- If the IUD is found to be outside the uterine cavity, a multidisciplinary procedure may be necessary for removal, especially if there is a risk of perioperative bleeding 2
- An abdominal overview X-ray image can be taken to locate the IUD if it is not visible in the uterine cavity 5
- In some cases, the IUD may be in the uterine cavity but the strings are not visible, in which case probing the uterine cavity or performing a pelvic ultrasound may be sufficient to locate the IUD 6, 3
Considerations for Uterine Perforation
- Uterine perforation is a rare but possible complication of IUD insertion, especially in women with a scarred uterus due to cesarean delivery 2
- If uterine perforation is suspected, it is essential to evaluate the patient thoroughly, including imaging studies, to determine the location of the IUD and plan for its removal 2, 4
- The risk of uterine perforation and IUD migration highlights the importance of proper evaluation and follow-up after IUD insertion, especially in women with a history of cesarean delivery or other uterine surgery 2, 4, 5