Intrauterine devices (IUDs) are a highly effective and convenient form of long-acting, reversible birth control. While generally safe, it is important to understand potential complications. One rare but possible complication is uterine perforation, where the IUD passes through the wall of the uterus. Understanding this event can help promote informed decisions.
What is Uterine Perforation?
Uterine perforation occurs when an IUD, during or after insertion, pierces through the wall of the uterus, moving from its intended position inside the uterine cavity to an area outside. Estimates suggest this happens in approximately 0.4 to 2.2 out of every 1,000 IUD insertions.
Perforations are categorized into two main types based on how far the IUD moves. A complete perforation means the IUD has fully passed through the uterine wall and is located entirely outside the uterus, often in the abdominal cavity. A partial perforation involves the IUD being partially embedded within the uterine wall, with some part still within the muscle. Most perforations are thought to occur at the time of insertion.
Factors That Increase Risk
Certain circumstances can slightly increase the likelihood of uterine perforation, though the overall risk remains low. Insertion during the postpartum period, especially within six weeks after childbirth, is associated with a higher risk. The uterus may be softer and more pliable during this time, making it more susceptible to perforation.
Lactation or breastfeeding is another factor that can increase the risk. Hormonal changes associated with breastfeeding can lead to lower estrogen levels, which may cause the uterine wall to be thinner and softer. This can make the uterus more vulnerable to injury during IUD placement.
The experience level of the healthcare provider performing the insertion can also play a role, with less experienced providers having a slightly elevated risk. Additionally, certain uncommon uterine anatomical variations may contribute to the risk.
Recognizing the Signs and Seeking Care
While uterine perforation is rare, recognizing potential signs is important for prompt medical attention. Symptoms can include severe or persistent abdominal pain that feels different from typical IUD insertion discomfort or menstrual cramps. Some individuals may also experience abnormal vaginal bleeding or spotting.
A common indicator of a displaced IUD, which could suggest perforation, is missing IUD strings. However, missing strings can also occur if the IUD has been expelled or if the strings have retracted into the cervix. Pain during sexual intercourse can also be a sign.
Uterine perforation can also occur without any immediate noticeable symptoms. If any of these symptoms appear, or if there is any concern about the IUD’s position, contact a healthcare provider promptly. Regularly checking for IUD strings can help monitor the device’s position.
What Happens After Perforation?
If uterine perforation is suspected, healthcare providers will use various methods to confirm the IUD’s location. An ultrasound is often the initial diagnostic tool, especially if partial embedding is suspected. If the IUD cannot be located with ultrasound, an X-ray or CT scan may be used to find the device, particularly if it has migrated into the abdominal cavity.
Once a perforation is diagnosed, the IUD typically needs to be removed. Surgical removal is the usual approach, often performed using minimally invasive techniques like laparoscopy. This involves small incisions and a camera to locate and retrieve the device from the abdominal cavity. If the IUD is partially embedded in the uterine wall, it might be removed via hysteroscopy, a procedure that involves inserting a thin scope through the cervix into the uterus.
Potential consequences of perforation can include infection, damage to nearby organs such as the bowel or bladder, or unintended pregnancy. Most perforations have a favorable outcome, and serious complications are uncommon. Early medical attention after suspected perforation leads to better outcomes.