An intrauterine device (IUD), often referred to as a coil, is a small, T-shaped device placed inside the uterus to prevent pregnancy and sometimes to manage heavy menstrual bleeding. This method is highly effective, offering long-term, reversible contraception lasting three to ten years depending on the type. While insertion is a medical procedure, removal is typically a much quicker process performed in a healthcare provider’s office. This article details what to expect before, during, and after the IUD removal appointment.
Why Patients Choose Removal
A common reason for seeking IUD removal is reaching the device’s expiration date. The contraceptive effect diminishes over time, requiring replacement to maintain protection. Many individuals also choose removal when they decide to attempt pregnancy, as the IUD is a rapidly reversible method of birth control. Fertility can return almost immediately after the device is taken out.
Sometimes, removal is motivated by intolerable side effects, which vary by IUD type. Hormonal IUDs may cause persistent spotting, headaches, or mood changes, while copper IUDs can cause heavier bleeding or more intense cramping. Removal is also necessary if a complication arises, such as the device shifting out of place, becoming embedded in the uterine wall, or if a pelvic infection develops. Patients have the right to request removal at any time for any personal reason, including switching to an alternative contraceptive method.
How to Prepare for the Appointment
The first step involves consulting with a healthcare provider to discuss the timing of the removal and the plan for future contraception. If pregnancy is not desired immediately, it is important to have an alternative method ready to begin right away. Fertility can return almost instantly, so unprotected intercourse just before the appointment could result in pregnancy shortly after removal.
For comfort, taking an over-the-counter pain reliever, such as ibuprofen, 30 to 60 minutes before the appointment can help manage potential cramping. Although removal is often less uncomfortable than insertion, this proactive measure can ease any brief discomfort felt as the device exits the cervix. It is also recommended to avoid unprotected intercourse for about seven days before the removal appointment if a new device will not be placed immediately. This precaution prevents the risk of sperm surviving long enough to fertilize an egg once the contraceptive is gone.
What Happens During the Removal Procedure
The IUD removal procedure is typically quick, often lasting only a few seconds once the device’s strings are located. The patient will be positioned on the examination table for a standard pelvic exam, with feet in stirrups. A healthcare provider will first insert a speculum into the vagina to hold the walls open and allow a clear view of the cervix.
The provider will then look for the IUD strings, which are thin threads extending from the cervix. Once the strings are visible, the provider uses a specialized grasping tool, such as ring forceps, to gently secure them. They apply a slow, steady pull on the strings, which causes the flexible arms of the T-shaped IUD to fold upward. This folding action allows the device to slide easily through the cervix and out of the body.
The sensation during this action is commonly described as a quick pinch or a brief, sharp cramp, which usually subsides immediately. If the IUD strings are not visible, the provider may use a cytobrush or a specialized hook tool to gently sweep the cervical canal to coax the strings into view. In rare instances where the device is not easily removed—due to it being embedded or the strings having retracted—further steps may be necessary, such as using an ultrasound or performing a hysteroscopy for visualization and removal.
Post-Removal Expectations and Fertility
Following the removal of the coil, it is common to experience mild side effects, such as light spotting or vaginal bleeding. This bleeding is usually minimal and should resolve within a few hours or a day. Some individuals may also feel mild cramping, which is temporary and can be managed with over-the-counter pain relief.
One significant aspect of IUD removal is the rapid return of fertility. For both hormonal and copper IUDs, the contraceptive effect is reversed almost immediately upon removal. A patient can potentially become pregnant during the very first menstrual cycle after the device is taken out.
The regular menstrual cycle typically resumes within a month of removal for those who used a copper IUD, as it does not affect hormonal cycles. For those who used a hormonal IUD, the cycle may return to its previous pattern within a few weeks, though full regulation may take a few months. If pregnancy is not desired, it is important to start a new contraceptive method on the same day the IUD is removed, as ovulation can occur quickly.