An intrauterine device (IUD) is a small, T-shaped contraceptive device inserted into the uterus by a healthcare provider. IUDs offer highly effective, long-acting reversible contraception, preventing pregnancy for several years. While widely used and safe, a rare potential complication is IUD perforation.
What is IUD Perforation?
IUD perforation occurs when the device partially or completely penetrates the wall of the uterus. This can happen during insertion, as the IUD or instruments might inadvertently pass through uterine tissue. Less commonly, perforation can develop gradually, where the device slowly erodes through the uterine wall. A perforation can be complete, meaning the entire IUD is outside the uterine cavity, or partial, with part of the device still within the uterine wall.
How Often Does It Occur?
IUD perforation is uncommon, occurring in approximately 1 to 2 out of every 1,000 insertions. Certain factors increase this likelihood. Insertion during the postpartum period, especially within 36 weeks after giving birth, carries a higher risk. The risk is seven times greater for insertions made between four days and six weeks postpartum.
Breastfeeding at the time of IUD insertion also elevates the risk, with rates around 6 per 1,000 insertions compared to non-breastfeeding individuals. The experience level of the healthcare provider can influence the perforation rate, with less experienced clinicians having higher instances. Individual uterine anatomy, such as a retroverted uterus or certain uterine abnormalities, contributes to an increased risk. Many perforations are not identified immediately, sometimes being discovered months or even years later.
Recognizing and Addressing Perforation
Recognizing signs of IUD perforation involves paying attention to changes in your body. Common indicators include persistent pelvic or abdominal pain more severe than typical menstrual cramps. Other symptoms include unusual or heavy vaginal bleeding, changes in menstrual patterns, or pain during sexual intercourse. If you can no longer feel your IUD strings, or if they feel shorter or longer than usual, seek medical attention.
If you suspect IUD perforation, contact a healthcare provider promptly. To diagnose, a healthcare professional begins with an ultrasound to locate the device. If the IUD cannot be seen on ultrasound, an X-ray determines if it has moved outside the uterus. A computed tomography (CT) scan assesses for complications. If confirmed, the IUD is removed surgically, often laparoscopically.
Minimizing Risk
Minimizing the risk of IUD perforation involves several steps. Selecting an experienced healthcare provider for insertion is important, as their skill reduces potential complications. Before insertion, a thorough assessment of the uterus, including its depth and position, should be performed for proper placement. This pre-insertion evaluation helps the provider understand your anatomy.
Following post-insertion care instructions, such as regularly checking your IUD strings, is important. While IUD perforation is a rare complication, IUDs remain a highly effective and safe contraception option. Understanding these measures can help ensure the safe and effective use of an IUD.