Management of Intrauterine Devices with Missing Strings

Clinical Context and Recommendations

• The Centers for Disease Control and Prevention recommends that an IUD can be left in place if the strings are not visible but ultrasound confirms appropriate intrauterine positioning, provided the patient is not pregnant and has no concerning symptoms 1, 2, 3
• When strings are not visible, a transvaginal ultrasound should be performed to confirm the IUD location within the uterine cavity, as recommended by the Centers for Disease Control and Prevention 1, 2, 3
• If ultrasound confirms appropriate intrauterine positioning, the device can continue to provide effective contraception, and the patient should be counseled to return promptly for heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever, according to the Centers for Disease Control and Prevention 1, 2, 3
• In pregnant patients, the management is entirely different, and removal should be attempted if possible, as recommended by the Centers for Disease Control and Prevention 1, 2, 3
• Removal of the IUD in pregnant patients reduces the substantial risks of spontaneous abortion, septic abortion, preterm delivery, and infection, according to the Centers for Disease Control and Prevention 1, 2, 3
• If the IUD cannot be located on ultrasound, an abdominal X-ray should be obtained to rule out uterine perforation, as recommended by a medical guideline society, although the specific society is not mentioned in the provided reference 1, 2, 3
• If perforation is confirmed, the IUD should be removed as soon as possible, typically requiring laparoscopic removal, as stated in a medical guideline, although the specific society is not mentioned in the provided reference 4