An intrauterine device (IUD) is a highly effective, long-acting contraceptive method placed directly into the uterus. A standard IUD removal is a quick office procedure where a healthcare provider gently pulls on the visible strings, causing the device’s arms to fold and the IUD to slide out. The term “embedded IUD” describes a complication where the device, or often just one of its arms, has penetrated the inner muscular layer of the uterus, known as the myometrium. This penetration anchors the device so securely that it cannot be removed via the standard string-pulling method, requiring specialized medical intervention.
Identifying IUD Embedding
The first step in managing a difficult IUD removal is to determine the exact position of the device within the pelvic anatomy. If the IUD retrieval strings are not visible or if the device resists gentle traction, imaging studies are immediately necessary to confirm embedment or other malpositioning. Transvaginal ultrasound is the primary diagnostic tool used for this purpose, offering detailed visualization of the uterus and the device’s location.
Modern three-dimensional (3D) ultrasound is particularly helpful because it allows the clinician to see a coronal view of the uterus, clearly showing the device’s T-shape and whether any arm is penetrating the myometrium. If the device has migrated completely outside the uterine muscle or cannot be seen clearly on ultrasound, a plain abdominal X-ray or a Computed Tomography (CT) scan may be utilized. These secondary imaging methods confirm the IUD’s presence and rule out uterine perforation, which is the complete migration of the device outside the uterus into the abdominal cavity.
Preparation for Specialized Removal
Once imaging confirms the IUD is embedded, the removal procedure is no longer a routine office visit and requires specialized preparation. The procedure is typically performed by a gynecologist with advanced training in operative hysteroscopy or minimally invasive surgery. Depending on the depth of the embedment, the removal may be scheduled in a specialized procedure room or a hospital operating theater.
Anesthesia or pain management is a central part of the preparation, as specialized removal is more invasive than a standard office removal. Options range from local anesthesia, such as a paracervical block, to conscious sedation or general anesthesia, especially for more complex cases. This controlled environment ensures the patient is comfortable and still, allowing the surgeon to use delicate instruments with precision. The patient is also typically prepared with prophylactic antibiotics to minimize the risk of infection before the surgical procedure begins.
Specialized Removal Techniques
The technique chosen for removal depends on the degree of embedment and the IUD’s accessibility. For the majority of embedded IUDs, the primary method of removal is hysteroscopy, a minimally invasive procedure. This technique involves inserting a narrow telescope, called a hysteroscope, through the cervix and into the uterine cavity, allowing the surgeon to directly visualize the device.
Hysteroscopy
The embedded IUD arm is often covered by a thin layer of myometrium or scar tissue, which the surgeon must carefully dissect away using specialized tools passed through the hysteroscope. Once the device is freed from the uterine wall, the surgeon uses hysteroscopic forceps or a specialized grasper to secure the IUD and pull it through the cervix. The entire procedure is performed under continuous visual guidance, minimizing trauma to the surrounding uterine tissue. This method is highly successful and allows the IUD to be retrieved without an abdominal incision.
Laparoscopy and Laparotomy
For cases where the IUD has migrated deep into the myometrium or caused a partial perforation, a laparoscopic approach may be necessary. Laparoscopy involves making several small incisions in the abdomen to insert a camera and long, thin surgical instruments. The surgeon uses the instruments to access the outside of the uterus and gently push the embedded IUD back into the uterine cavity, where it can be retrieved, often with the assistance of a hysteroscope. In rare circumstances, if the IUD has perforated into the abdominal cavity and is adhered to other organs, a more open surgical procedure, known as a laparotomy, may be required for safe removal.
Post-Procedure Care and Recovery
Following the specialized removal of an embedded IUD, the patient will have a recovery period that is slightly longer than a standard IUD removal. Patients who undergo hysteroscopic removal often experience mild to moderate cramping and spotting for a few days, similar to a heavy menstrual period. Recovery from hysteroscopy is relatively quick, with most patients returning to normal activities within one or two days.
If the IUD was removed via laparoscopy, the recovery time will be slightly longer due to the abdominal incisions, typically requiring a few days of rest and limited activity for a week. Patients are advised to monitor for signs of infection, such as fever, persistent severe pain, or foul-smelling vaginal discharge, and to attend a follow-up appointment to confirm healing. Since fertility returns immediately upon removal, patients who do not wish to become pregnant should discuss alternative contraceptive methods with their provider before the procedure.