From the Research
An IUD in the myometrium requires prompt removal by a healthcare provider to prevent further complications and ensure effective contraception. The removal procedure will depend on the degree of embedment and may range from a simple office procedure to a hysteroscopic removal under anesthesia 1. While waiting for removal, it is essential to use alternative contraception as the embedded IUD is likely ineffective. Symptoms of an embedded IUD may include pelvic pain, abnormal bleeding, or missing IUD strings. This condition occurs when the IUD penetrates the endometrial lining into the muscular myometrium, which can happen during insertion or gradually over time due to uterine contractions.
Some key points to consider:
- Uterine perforation is a rare but significant complication of IUD use, with an estimated frequency of 0.05 to 13 per 1000 insertions 2.
- Laparoscopic removal of a perforated IUD is a viable option, with a success rate of 64.2% in one systematic review 3.
- In some cases, laparotomy may be necessary, especially if there are severe pelvic adhesions or unexpected complications 1.
- Asymptomatic patients may benefit from conservative management, but surgical removal is often recommended for symptomatic patients 4.
It is crucial to seek medical attention promptly if an IUD is suspected to be embedded in the myometrium. A healthcare provider will assess the situation and determine the best course of action for removal and subsequent contraceptive management. After removal, the provider will discuss alternative contraceptive options, as reinsertion of an IUD may not be recommended immediately depending on the extent of myometrial involvement and healing needed 1.