Can vomiting be a symptom of pregnancy with an Intrauterine Device (IUD)?

Can Vomiting Be a Symptom of Pregnancy with an IUD?

Yes, vomiting can absolutely be a symptom of pregnancy that occurs with an IUD in place, and this presentation should prompt immediate pregnancy testing and urgent evaluation, as pregnancies with IUDs carry significantly elevated risks of serious complications including spontaneous abortion, septic abortion, preterm delivery, and chorioamnionitis. 1

Why This Matters Clinically

While IUDs are highly effective contraception (fewer than 1 in 100 women become pregnant in the first year), pregnancy can still rarely occur. 1 When pregnancy does occur with an IUD in situ, the clinical stakes are dramatically higher than typical early pregnancy:

• Women with retained IUDs face the greatest risk of adverse pregnancy outcomes, including spontaneous abortion, preterm delivery, septic abortion, and chorioamnionitis 2
• Early IUD removal improves outcomes but does not eliminate risks entirely 2
• The absolute risk of ectopic pregnancy is extremely low due to IUD effectiveness, but when pregnancy does occur with an IUD, the relative likelihood of ectopic pregnancy increases greatly 1

Recognizing Pregnancy Symptoms with an IUD

Nausea and vomiting are among the most common symptoms of early pregnancy, affecting approximately 80% of pregnant women. 3 These symptoms:

• Occur predominantly during the first trimester 4
• Can continue throughout the entire pregnancy in a subgroup of patients 4
• Range from mild "morning sickness" to severe hyperemesis gravidarum requiring hospitalization 3, 5

The presence of an IUD does not prevent or alter typical pregnancy symptoms—if a woman with an IUD develops vomiting, nausea, or other pregnancy symptoms, pregnancy must be ruled out immediately. 1

Critical Action Steps

Immediate Evaluation

• Perform a pregnancy test immediately when any woman with an IUD presents with vomiting, nausea, or other pregnancy symptoms 1
• Be aware that pregnancy tests may not detect very recent conception, and sensitivity varies with timing relative to missed menses 1
• Evaluate for ectopic pregnancy if pregnancy is confirmed, as this is a life-threatening emergency 6

If Pregnancy is Confirmed

• The IUD should be removed as soon as possible if strings are visible or can be safely retrieved to reduce (though not eliminate) the risk of serious complications 6, 7, 2
• Counsel the patient that even with IUD removal, risks remain elevated compared to pregnancies without an IUD 2
• When the LNG-IUD is left in situ during pregnancy, 8 in 10 pregnancies end in spontaneous abortion 2

Common Pitfalls to Avoid

• Do not assume the IUD is providing complete protection—pregnancy can occur, and symptoms should never be dismissed 1
• Do not delay pregnancy testing based on the assumption that signs and symptoms of pregnancy are reliable screening tools, as studies show these criteria do not substantially improve diagnostic performance 1
• Do not attempt to manage confirmed pregnancy with IUD in situ without specialist consultation, given the high complication rates 1, 2
• Remember that qualitative pregnancy tests may remain positive for several weeks after termination of pregnancy, which can complicate interpretation 1