An intrauterine device (IUD) is a highly effective, long-acting reversible contraceptive method. Because no birth control is perfect, pregnancy can rarely occur while an IUD is in place. If a person decides to seek an abortion in this situation, specific medical considerations are involved. Close collaboration with a healthcare provider is required to ensure a safe and effective procedure, including managing the IUD and selecting the appropriate abortion method.
Pregnancy and IUD Presence
It is medically possible to have an abortion even with an IUD present. Pregnancy with an IUD is uncommon, with a failure rate less than one percent per year of use. Conception often occurs due to partial expulsion of the device or, less frequently, despite correct placement.
The first step is a medical evaluation, including an ultrasound, to confirm the pregnancy location. Because an IUD is highly effective at preventing implantation, there is a higher risk that the pregnancy could be ectopic (located outside the uterus). If the pregnancy is confirmed to be intrauterine, the IUD’s presence introduces specific considerations for the abortion procedure.
Managing the IUD During the Procedure
The IUD must be removed as part of the abortion process, especially if the pregnancy is intrauterine. The device’s presence during a continuing pregnancy significantly increases the risk of complications, such as infection. Removal is necessary to minimize pelvic infection and ensure the abortion procedure is effective.
The standard method for IUD removal involves the provider gently pulling on the strings that extend through the cervix. The device’s arms fold up, allowing it to slip out quickly. If the strings are not visible, the provider uses imaging, such as an ultrasound, to locate the IUD. Specialized instruments may be used to retrieve it, sometimes requiring a minor procedure like a hysteroscopy.
Procedural Considerations and Safety
The IUD’s presence influences the choice between a medication abortion and a surgical abortion. For a medication abortion, the IUD must be removed before the first pill is administered. This is because the IUD can interfere with the medications’ ability to fully expel the pregnancy or increase the risk of infection.
Surgical abortion methods, such as aspiration, are often preferred because the IUD can be removed immediately prior to or during the procedure. This single-visit approach simplifies the process, especially if the IUD strings are not visible or if removal is complicated.
The safety risks associated with an abortion are low. However, removing the IUD during the procedure may slightly increase the risk of a pelvic infection compared to an abortion without an IUD. Healthcare providers manage this risk carefully, often administering prophylactic antibiotics before the procedure. Consultation is essential to weigh the procedural options based on the specific circumstances of the pregnancy and the IUD’s location.
Planning Future Contraception
Following the abortion and IUD removal, fertility returns almost immediately. It is important to establish a new contraceptive plan right away. Most methods, including the pill, patch, ring, or implant, can be started on the same day as the abortion to prevent a rapid subsequent unintended pregnancy.
If the individual wishes to continue using an IUD, a new one can often be inserted immediately after a surgical abortion. Immediate reinsertion is safe and highly effective, though the risk of the new device being expelled may be slightly higher than insertion done later. After a medical abortion, the new IUD can be inserted once it is confirmed that the pregnancy has been fully expelled. The decision to immediately reinsert an IUD or choose an alternative method is made in consultation with a healthcare provider.