Management of IUD Embedded in Myometrium

Assessment and Removal Considerations

• A malpositioned IUD extending into the myometrium requires prompt removal, especially when associated with symptoms such as pelvic pain 2
• An IUD that has perforated into the myometrium should be removed as soon as possible and should not be replaced on the same day due to increased risks of complications including pain, bleeding, infection, and reduced contraceptive efficacy 1

Removal Procedure

• If IUD strings are visible or can be retrieved safely from the cervical canal, the device should be removed by gently pulling on the strings 1
• For IUDs embedded in the myometrium: Ultrasound examination should confirm the exact location of the IUD if strings are not visible 1
• Depending on the depth of myometrial penetration, specialized instruments or imaging guidance may be necessary 2

Why Same-Day Replacement is Not Recommended

• The myometrium needs time to heal after removal of an embedded IUD 3
• Immediate reinsertion increases the risk of infection at the site of previous perforation 3
• Immediate reinsertion increases the risk of pain and bleeding from the traumatized tissue 1

Post-Removal Management

• After removal, patients should be advised to return promptly if they experience heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 3, 2
• After removal, patients should be counseled about alternative contraceptive methods if continued contraception is desired 1
• After removal, patients should be scheduled for a follow-up appointment to ensure proper healing before considering IUD reinsertion 2

Timing for Reinsertion

• Wait at least 4-6 weeks after removal to allow complete healing of the myometrium before considering reinsertion of a new IUD 3
• For patients with factors that may have contributed to the perforation, consideration of alternative contraceptive methods is recommended 1