What are the consequences of an expired Intrauterine Device (IUD)?

Consequences of Expired IUD

An expired IUD should be removed and replaced as it significantly increases the risk of unintended pregnancy due to decreased contraceptive efficacy beyond its approved duration of use. 1

Risk of Unintended Pregnancy

When an IUD remains in place beyond its approved duration:

• The contraceptive effectiveness gradually diminishes as the active components (copper or levonorgestrel) deplete over time
• Risk of pregnancy increases, with studies showing pregnancy rates of up to 5% in women with expired IUDs 2
• If pregnancy occurs with an expired IUD in place, there are substantial risks:
  • Increased risk of spontaneous abortion (including life-threatening septic abortion)
  • Higher risk of preterm delivery
  • Risk of infection (chorioamnionitis) 1, 3

Management of Expired IUDs

Assessment

• Confirm IUD expiration based on insertion date and type:
  • Copper IUDs (ParaGard): typically approved for 10-12 years
  • Hormonal IUDs (Mirena, Liletta): typically approved for 5-7 years
• Evaluate for symptoms of complications:
  • Abnormal vaginal bleeding
  • Abdominal pain
  • Missing IUD strings 4

Removal Procedure

• For visible strings: remove by gently pulling on the strings
• For non-visible strings: ultrasound examination to determine IUD location
  • If IUD cannot be located, it may have been expelled or perforated the uterine wall
  • Surgical removal may be necessary for migrated IUDs, with laparoscopy being the preferred method 4

Fertility After IUD Removal

Return to fertility after IUD removal is generally excellent:

• Studies show that approximately 64% of women conceive within 6 months after removal
• Over 83% conceive within one year
• Nearly 95% conceive within two years 5

The duration of IUD use does not appear to negatively affect return to fertility or pregnancy outcomes 5. However, some research suggests that levonorgestrel IUDs may have longer-lasting effects on endometrial morphology and gene expression, potentially affecting fertility, particularly in nulliparous women with long-term use 6.

Common Pitfalls to Avoid

1. Leaving an expired IUD in place: This significantly increases risk of unintended pregnancy and complications
2. Ignoring symptoms with an expired IUD: Abnormal bleeding, pain, or missing strings require prompt evaluation
3. Assuming immediate fertility return: While most women regain fertility quickly, some may experience delays, especially with hormonal IUDs
4. Forgetting to provide alternative contraception: If pregnancy is not desired, offer alternative contraceptive methods at the time of IUD removal 1

Special Considerations

If pregnancy occurs with an expired IUD in place:

• Evaluate for possible ectopic pregnancy
• If the IUD strings are visible, remove the device as soon as possible to reduce risks
• If strings are not visible, ultrasound guidance may be needed
• Advise the woman to seek care promptly if she experiences heavy bleeding, cramping, pain, abnormal discharge, or fever 1, 7