Management of Lost Intrauterine Device (IUD)

What Is an IUD?

IUDs, short for intrauterine devices, are a highly effective and long-lasting form of birth control. They are inserted into the uterus and can remain in place for three to 10 years, offering a safe and surgery-free contraception option. Unlike some other methods, such as condoms, IUDs do not protect against sexually transmitted infections (STIs).

There are two primary types of IUDs which are copper IUDs and hormonal levonorgestrel IUDs. Both have plastic frames that adopt a T-shape within the uterus, and a string extends into the vagina for easy removal. They are the second most popular reversible birth control method.

IUDs work by triggering an immune response in the body, which identifies the device as foreign and creates an environment in the uterus that is inhospitable to sperm survival. This prevents fertilization and pregnancy.

Advantages of IUDs:

• High success rate.

• There is no need for contraception immediately before sexual activity.

• Cost-effective over time.

• Safe removal when planning to conceive.

• Suitable for long-term contraception without regular maintenance.

• No concerns about missed birth control pills or injections.

Risks Associated with IUDs:

• Possibility of expulsion from the uterus.

• Rare risk of perforation during insertion.

• Infection risk during insertion.

IUDs are a reliable and convenient option for individuals seeking long-term birth control, but it is essential to consult with a healthcare provider to determine the best contraceptive method based on individual needs and circumstances.

What Is Considered a Missing Intrauterine Contraceptive Device?

A missing intrauterine contraceptive device is defined as the absence of retrieval strings for a specific type of intrauterine device during a physical examination. Several factors can contribute to this situation, including:

• Expulsion of IUD: The IUD may have been expelled from the uterus.

• Migration: The IUD could have moved from its original position within the uterus.

• Detachment of Thread: The threads attached to the IUD for removal may have detached.

• Uterine Perforation of IUD: In rare cases, the IUD may have punctured the uterine wall and migrated elsewhere.

• Embedded IUD: The IUD might have become embedded in the uterine wall, making it difficult to detect.

The presence or absence of the intrauterine device can be confirmed through various imaging techniques, including:

• Plain Radiograph: Anteroposterior and lateral abdominal radiographs can be performed to visualize the position and presence of the IUD.

• Ultrasound: Ultrasound is a useful tool for evaluating the presence of the IUD. It can also determine whether the intrauterine device is correctly positioned within the uterus.

• Computed Tomography: While rarely used, computed tomography can be employed to assess the position of the IUD in certain cases.

What Are the Risk Factors for IUD Expulsion?

While not very common, IUD expulsion occurs in approximately 4% of cases. Several factors can contribute to the expulsion of an intrauterine device, including:

• Nulliparity (Never Given Birth): Women who have never experienced childbirth are at a higher risk of IUD expulsion.

• Heavy Menstrual Bleeding: Experiencing heavy menstrual bleeding may increase the risk of IUD expulsion.

• Severe Menstrual Cramps: Severe menstrual cramps can be associated with a higher likelihood of IUD expulsion.

• Prior Device Expulsion: If a woman has previously experienced IUD expulsion, there is an elevated risk of it happening again.

• Age Below 20 Years: Women under the age of 20 may face a slightly higher risk of IUD expulsion.

• Insertion Immediately After an Abortion: Inserting an IUD immediately after an abortion can also elevate the risk of expulsion.

How to Check for IUD Strings?

• Many women may not exhibit symptoms of IUD expulsion, making it essential to check for the presence of the device strings. Here's how to perform this check:

  • After the initial days following IUD insertion, women should regularly check for the strings during the first few weeks and between menstrual periods.

  • If the strings cannot be felt or if they seem loose or out of place, there is a possibility of device expulsion.

  • The likelihood of IUD expulsion is higher in the first few months of use, especially during the menstrual period. It is advisable to check sanitary pads, tampons, or menstrual cups for any signs of expulsion.

  • It is crucial for individuals with IUDs to be aware of these risk factors and to perform routine checks for device strings to ensure that the IUD remains in its proper position. If there are concerns about expulsion, consulting a healthcare provider is advisable.

How to Manage Missing IUDs?

Managing a missing IUD involves a systematic approach to assess the situation and determine the appropriate course of action. Here is a step-by-step guide on how to manage a missing IUD:

• Take a Comprehensive History: Gather information about the patient's menstrual history and recent sexual activity to rule out the possibility of pregnancy. If the patient is not pregnant, proceed with the evaluation and removal of the lost IUD.

• Pregnant Women: If the woman is pregnant, refer her to an early pregnancy unit for a rapid ultrasound scan. The ultrasound will assess the viability of the pregnancy, the site of implantation, and the gestational age. If the IUD is present in the uterus and the pregnancy is under 12 weeks gestation, carefully remove the IUD by exploration of the cervical canal.

• Non-Pregnant Women:

If the woman is not pregnant, proceed with the following steps:

• Explore the Cervical Canal: Use narrow artery forceps to explore the cervical canal to locate the IUD threads. If the threads are not found, recommend alternative contraception until an ultrasound scan is performed.

• Ultrasound Evaluation: During the ultrasound scan, if it reveals a low or misplaced IUD, manage the patient based on the symptoms and degree of displacement. If the IUD is correctly placed in the uterus, leave it in place until it is time for removal.

• Explore the Cervical Canal: If the IUD threads are found in the cervical canal, and the device has not felt in the canal, there is no need for further action unless the patient is symptomatic.

• Abdominal X-ray: If the IUD is not found in the uterus during the ultrasound or if there are concerns about its location, perform an abdominal X-ray.

If the IUD is located in the abdominal cavity, it may require laparoscopic surgery for removal.

• Laparoscopic or Laparotomy Surgery: Laparoscopic surgery is typically the preferred method for removing an IUD from the abdominal cavity.

In rare cases where the IUD is firmly attached to surrounding tissues, a laparotomy surgery may be necessary.

• Recognized Expulsion: If the IUD is not located in the uterus or seen on the abdominal X-ray, it may be considered a recognized expulsion of the device.

Conclusion

An intrauterine device (IUD) is a reliable, long-term contraceptive option that can be taken out when necessary. It is widely used and generally well-tolerated. However, there are situations where an IUD might go missing for various reasons. Sometimes, women might not even notice any major symptoms.

If suspect that an IUD might be missing, it is important to consult a doctor right away. Handling this situation with care is essential. Following the appropriate procedures can ensure the patient's health and contraception needs are addressed effectively. For the best guidance and assistance, it is advisable to reach out to a healthcare provider who specializes in managing IUDs. They can offer the necessary support and expertise to help in such situations.