From the Guidelines
When a Mirena IUD loses its strings, the most appropriate 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. This approach is crucial in identifying whether the IUD is still in place within the uterus or if it has been expelled or perforated the uterine wall. Key considerations include:
- If ultrasonography is available, it should be used to locate the IUD, as it provides a clear image of the IUD's position within the uterus or elsewhere.
- If the IUD cannot be located via ultrasonography, it might have been expelled, which could lead to a loss of contraceptive effectiveness, or it might have perforated the uterine wall, a condition that requires immediate medical attention.
- The patient should be advised to seek care promptly if symptoms such as heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever occur, as these could indicate complications related to the IUD's displacement or other issues.
- It is essential for the patient to use a backup contraceptive method, such as condoms, until the position and functionality of the IUD are confirmed to prevent unintended pregnancy.
- Patients should not attempt to locate or retrieve the IUD themselves, as this could lead to further complications, including injury or displacement of the IUD.
- Healthcare providers may use special instruments to retrieve the strings or remove and replace the IUD if necessary, ensuring the patient's safety and the effectiveness of the contraceptive method.
From the Research
Management of Missing IUD Strings
When an IUD, such as MIRENA, loses its strings, the most appropriate step is to follow a stepwise approach to management. This approach includes:
- Obtaining a history of the patient's IUD use and any symptoms they may be experiencing
- Using in-office tools to attempt to reveal the IUD strings
- If the strings are still not visible, obtaining a transvaginal ultrasound to locate the IUD and determine its position 2
- If the IUD is found to be in a suitable position, IUD removal can be attempted using tools for uterine instrumentation that do not require cervical dilation and allow for grasping of the device 2
Importance of Proper Management
Proper management of missing IUD strings is crucial to prevent complications, such as unintended pregnancy or pelvic inflammatory disease. The risk of these complications can be minimized by following the stepwise approach outlined above and by being aware of the potential risks associated with IUD use, such as the risk of bacterial vaginosis 3 or pelvic inflammatory disease 4.
IUD Effectiveness and Safety
IUDs, including MIRENA, are highly effective and safe contraceptive methods. They have been shown to have a low risk of complications, such as pregnancy or ectopic pregnancy, and can provide long-term, reversible contraception 5, 6. However, it is essential to follow proper management procedures when complications, such as missing IUD strings, arise to ensure the best possible outcomes for patients.