Does an Intrauterine Device (IUD) need to be removed if it is located in the cervix?

Management of an IUD Located in the Cervix

An intrauterine device (IUD) located in the cervix should be removed as soon as possible to prevent complications such as pain, abnormal bleeding, and infection. 1

Rationale for Removal

• IUDs are designed to be positioned properly within the uterine cavity, not in the cervix 1
• Malpositioned IUDs, including those in the cervix, are associated with:
  • Higher rates of pain (39.3% vs 19.4% in properly positioned IUDs) 2
  • Increased abnormal bleeding (35.7% vs 15.1% in properly positioned IUDs) 2
  • Risk of cervical perforation if left in place 3
  • Reduced contraceptive efficacy 1

Removal Procedure

• If IUD strings are visible or can be retrieved safely from the cervical canal:
  • Remove the IUD by gently pulling on the strings 1
  • No special instruments are typically needed for cervically located IUDs with visible strings 1
• If strings are not visible:
  • Ultrasound examination should be performed to confirm the location of the IUD 1, 2
  • A three-dimensional ultrasound view may be particularly helpful in visualizing the exact position 2
  • Specialized instruments may be needed for retrieval in these cases 4

Post-Removal Considerations

• After removal, patients should be counseled about alternative contraceptive options if continued contraception is desired 1
• Most patients (20 out of 21 in one study) report improvement in symptoms after removal of abnormally positioned IUDs 2
• If pregnancy is suspected with a cervically located IUD:
  • Evaluate for possible ectopic pregnancy 1
  • Removal reduces risks of spontaneous abortion, septic abortion, and preterm delivery 1

Special Considerations

• For patients with cervical stenosis or anatomical abnormalities that contributed to the malpositioning:
  • Consider alternative contraceptive methods 1
  • If another IUD is desired, consider ultrasound guidance for insertion 2
• Patients should be advised to seek care promptly if they experience heavy bleeding, cramping, pain, or abnormal discharge after the procedure 1

Clinical Pitfalls to Avoid

• Do not leave an IUD in the cervix assuming it will function properly - this is not its intended location and increases risk of complications 3, 2
• Do not confuse IUD parts (such as a hormonal sleeve displacement) with retained IUD fragments, which could lead to unnecessary invasive procedures 5
• Regular follow-up examinations are essential for patients with IUDs to detect malposition early 3