An intrauterine device (IUD) is a T-shaped long-acting reversible contraception inserted into the uterus. While generally safe, complications can occur, including the rare event of an IUD becoming embedded. Understanding IUD embedding and its potential indicators is important for IUD users.
Understanding IUD Embedding
An embedded IUD occurs when a portion or the entirety of the device grows into the muscular wall of the uterus, known as the myometrium, rather than remaining freely within the uterine cavity. This differs from perforation, where the IUD breaches the entire uterine wall and enters the abdominal cavity. Uterine contractions can contribute to embedding, particularly if the IUD’s size is disproportionate to the uterine cavity. While uncommon, embedding can sometimes occur without a complete breach of the uterine wall.
Recognizing the Signs
A noticeable indicator of a potential issue is a change in the IUD strings. If the strings feel significantly shorter, longer, or cannot be felt at all, it may suggest the IUD has shifted. To check for strings, wash your hands, then squat or sit and insert a finger into your vagina to locate your cervix, which feels firm like the tip of your nose. Feel for the thin strings protruding from the cervix, but avoid pulling on them.
Persistent or worsening pelvic pain, cramping, or abdominal discomfort not typical for your menstrual cycle could signal an embedded IUD. Unusual or heavy vaginal bleeding between periods or after sexual intercourse also warrants attention. Some individuals may experience pain during intercourse, which can indicate the IUD is out of place.
Other signs include unexpected pregnancy symptoms, as a misplaced IUD may lose effectiveness. In rare instances, an infection might occur, indicated by symptoms such as fever or chills. Some people might even feel the hard plastic part of the IUD itself protruding from the cervix.
When to Seek Medical Attention
Contact a healthcare provider promptly if you experience any symptoms like changes in IUD string length, persistent pain, or unusual bleeding. Seek medical advice if you cannot feel your IUD strings or suspect a pregnancy. Using a backup method of contraception is advisable until your IUD’s position can be confirmed.
A doctor will typically perform a pelvic exam to assess the IUD strings and cervix. Imaging tests, such as an ultrasound, are commonly used to determine the IUD’s exact location within the uterus. If the IUD is suspected to have perforated the uterine wall or migrated outside the uterus, an X-ray might be necessary to locate it. Never attempt to remove or adjust an IUD yourself, as this could cause injury or further complications.
Addressing an Embedded IUD
Once an embedded IUD is diagnosed, removal by a healthcare professional is necessary. The method of removal depends on how deeply the device is embedded. If embedding is mild and the strings are visible, it might be possible to remove the IUD during an office visit using specialized tools. If the IUD is more deeply embedded in the uterine wall or difficult to access, a hysteroscopy may be performed.
During a hysteroscopy, a thin, lighted tube with a camera is inserted through the cervix into the uterus, allowing the doctor to visualize and remove the IUD. This procedure can be performed under anesthesia. For IUDs that have completely perforated the uterus or migrated into the abdominal cavity, a laparoscopic procedure may be required. Laparoscopy involves small incisions in the abdomen to insert instruments and a camera to retrieve the device. After removal, your healthcare provider will discuss follow-up care and contraceptive options.