The IUD (Intrauterine Device)(2):

When and How to Remove It?

Choosing the IUD: Advantages and Disadvantages

IUD (Intrauterine Device): Risks and Complications


Dr. Claude Allouche, Gynecologist,Diu 2 general english 

Ahuza Clinic, Raanana, Israel, 058 726 02 64

When and How to Remove It?

Lifespan of the IUD

  • Duration: Depending on the model, an IUD can be kept for 3 to 5 years. After this period, it must be removed.
  • Replacement: A new IUD can be inserted immediately after removal if the patient wishes to continue using this contraceptive method.

When to Remove the IUD?

  • Upon Request: If the patient wishes to conceive before the IUD's expiration.
  • Placement Issues: If the IUD is not in place, is transfixing, or in cases of uterine perforation immediately after insertion.
  • Infectious Complications: In case of an infection, such as salpingitis, after or distantly from insertion.
  • Abnormal Bleeding: In case of persistent menorrhagia or abnormal metrorrhagia.
  • Menopause: When menopause is confirmed.

How is the Removal Done?

  • Gynecological Consultation: Removal occurs during a gynecological consultation at any time during the cycle.
  • Procedure:
    • With Visible Strings: Removal is done by pulling on the visible strings attached to the end of the IUD using long forceps. This is usually quick and painless.
    • Without Visible Strings: If the strings are not visible, a fine forceps (Kelly forceps, Terrhun forceps, or Novak cannula) is introduced into the uterine cavity to remove the IUD, which can be more uncomfortable.
    • Failure to Remove: If removal fails, a diagnostic hysteroscopy may be needed to locate the IUD strings and remove them under visual guidance. In very rare cases, general anesthesia may be required if the hysteroscopy fails.
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Choosing the IUD: Advantages and Disadvantages Diu5ia
There are two main types of IUDs: the copper IUD and the hormonal IUD. Here’s a brief overview to help you choose.

  1. Copper IUD

    • Models: Novaplus T380®, Nova T®, Mona Lisa®.
    • Sizes: "Short" and "standard" to fit different uterine sizes.
    • Advantages:
      • Preserves Natural Cycles: No hormones, so menstrual cycles remain natural (if regular and painless).
      • Long Effectiveness: Can stay in place for 3 to 5 years.
      • No Hormones: Ideal for women wanting to avoid hormones.
    • Disadvantages:
      • Heavy Periods: May lengthen the duration and increase the amount of bleeding.
      • Pain: Does not affect menstrual pain.
      • Drug Interactions: Effectiveness may be reduced with anti-inflammatory drugs or corticosteroids, sometimes requiring another contraceptive method alongside.

  2. Hormonal IUD

    • Models: Mirena®, Kyleena®, Janess® (Jaydess® in France). Janess® is effective for 3 years, the others for 5 years.
    • Advantages:
      • Reduces Periods: Often reduces periods to the point of causing amenorrhea (total absence of periods).
      • Less Pain: Decreases dysmenorrhea (pain during menstruation).
      • Treats Conditions: Can treat pelvic endometriosis and functional menorrhagia related to fibroids.
      • Unaffected Effectiveness: Its effectiveness is not affected by anti-inflammatories.
    • Disadvantages:
      • Amenorrhea: The absence of periods may be poorly accepted by some women.
      • Repeated Bleeding: Minor repeated bleeding can occur, especially during the first 2-3 months.
      • Side Effects: Rarely, weight gain or acne flare-ups.

Common Disadvantages of Both IUD Types:

  • Insertion: Can be painful, with cramps similar to menstrual pain.
  • Bleeding: Minor bleeding may persist for a few days after insertion.
  • Infectious Risks: Can increase the risk of endometritis or salpingitis, especially in the 3 weeks following insertion.
  • Ectopic Pregnancies: Does not protect against ectopic pregnancies, as it only prevents implantation in the uterus.
  • Follow-Up: Requires a check-up within 2 months of insertion to verify the IUD's position.

Conclusion:
Both types of IUDs are highly effective. The choice will primarily depend on personal preferences and tolerance to hormones. If you have heavy and painful periods, the hormonal IUD may be more comfortable. If you prefer a natural cycle without hormones, the copper IUD may be the best option.

 

IUD (Intrauterine Device): Risks and Complications

While IUDs are effective contraceptive methods, their use can lead to certain risks and complications, although these events are rare. Here’s an overview of the main risks associated with their use:

  1. Vagal Malaise:Diu6ia

    • Description: Insertion of the IUD can cause pain similar to menstrual cramps and, in rare cases, lead to vagal malaise.
    • Advice: Report any persistent discomfort to your doctor.

  2. Bleeding:

    • Description: Minor bleeding may occur after IUD insertion and generally resolves within 3 months.
    • Advice: Consult your doctor if bleeding persists or becomes heavy.

  3. Uterine Perforation:

    • Description: Very rare (0.6 per 1000 insertions), this complication occurs when the IUD perforates the uterine wall.
    • Consequence: The IUD may end up in the abdominal cavity, requiring laparoscopy under general anesthesia for removal.
    • Advice: Contact your doctor immediately if you experience severe pain or suspect perforation.

  4. IUD Expulsion:

    • Description: Estimated at 4%, expulsion is more frequent within three months of insertion, especially after childbirth or abortion.
    • Advice: It’s crucial to check the IUD's position within two months of insertion.

  5. Pelvic Inflammatory Disease:

    • Description: The presence of the IUD can increase the risk of endometritis or salpingitis (infection of the uterus or fallopian tubes), especially in the three weeks following insertion.
    • Advice: This risk is higher in women with multiple sexual partners. Monitor for any infection symptoms and consult a doctor if you have pain or fever.

  6. Infertility:

    • Description: The risk of infertility may increase due to the higher risk of pelvic inflammatory disease, which can damage the fallopian tubes and pelvis.
    • Advice: If you have difficulty conceiving after IUD removal, discuss it with your doctor.

  7. Pregnancy with IUD:

    • Description: Although rare, pregnancy can occur if the IUD moves or is expelled without the patient realizing it.
    • Advice: If you suspect a pregnancy, consult your doctor immediately.

  8. Ectopic Pregnancy:

    • Description: The IUD does not protect against ectopic pregnancies. It prevents implantation in the uterus but cannot stop implantation in the fallopian tubes.
    • Advice: Report any suspicious symptoms to your doctor.

  9. Ovarian Cysts (Hormonal IUD):

    • Description: Functional cysts may form with a hormonal IUD, often asymptomatic and discovered during ultrasound checks. They can also cause pelvic pain or heaviness.
    • Advice: They require ultrasound monitoring and generally resolve within a few months.

Conclusion:
The risks associated with the IUD are relatively rare and often manageable. Regular follow-up and vigilance regarding any abnormal symptoms are essential to minimize complications. Always consult your doctor for any concerns or for post-insertion follow-up.