Can an Intrauterine Device (IUD) that has perforated into the myometrium be removed and replaced on the same day?

Management of IUD Embedded in Myometrium

An IUD that has perforated into the myometrium should be removed as soon as possible and should not be replaced on the same day due to increased risks of complications including pain, bleeding, infection, and reduced contraceptive efficacy. 1

Assessment and Removal Considerations

• A malpositioned IUD extending into the myometrium requires prompt removal, especially when associated with symptoms such as pelvic pain 2
• The incidence of uterine perforation by IUDs is relatively rare, occurring in approximately 0.12-0.68 per 1000 insertions, but represents a serious complication that requires intervention 3
• Perforation can occur during insertion or develop later through migration of the device 4

Removal Procedure

• If IUD strings are visible or can be retrieved safely from the cervical canal, the device should be removed by gently pulling on the strings 1
• For IUDs embedded in the myometrium:
  • Ultrasound examination should confirm the exact location of the IUD if strings are not visible 1
  • Depending on the depth of myometrial penetration, specialized instruments or imaging guidance may be necessary 2
  • In cases of complete perforation into the peritoneal cavity, laparoscopic removal is typically required 5

Why Same-Day Replacement is Not Recommended

• The myometrium needs time to heal after removal of an embedded IUD 6
• Immediate reinsertion increases the risk of:
  • Creating a new perforation through the same weakened tissue 4
  • Infection at the site of previous perforation 6
  • Pain and bleeding from the traumatized tissue 1

Post-Removal Management

• After removal, patients should be:
  • Advised to return promptly if they experience heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 6, 2
  • Counseled about alternative contraceptive methods if continued contraception is desired 1
  • Scheduled for a follow-up appointment to ensure proper healing before considering IUD reinsertion 2

Timing for Reinsertion

• Wait at least 4-6 weeks after removal to allow complete healing of the myometrium before considering reinsertion of a new IUD 6
• For patients with factors that may have contributed to the perforation (such as uterine anomalies, recent childbirth), consideration of alternative contraceptive methods is recommended 1
• Patients with a history of IUD perforation should be informed about the slightly increased risk of recurrence with future IUD placements 4

Complications of Untreated Perforations

• Migrated IUDs can cause serious complications if left in place:
  • Damage to surrounding organs including intestine and bladder 4
  • Adhesion formation in the peritoneal cavity 7
  • Increased risk of pregnancy complications if the patient becomes pregnant with a perforated IUD 8
• Approximately half of patients with perforated IUDs present with pain, while about one-third may be completely asymptomatic 4