IUD Removal Procedure
Standard Removal Technique
- The Centers for Disease Control and Prevention (CDC) recommends locating the IUD strings during speculum examination and removing the device by pulling gently on the strings 1, 2
- The CDC advises women to return promptly if they experience heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever after removal 1, 2
- If the IUD is removed and the woman desires continued contraception, the CDC recommends counseling her on alternative contraceptive methods and offering another method immediately 3, 4
Management When Strings Are Not Visible
- The CDC recommends performing or referring for ultrasound examination to determine the IUD location if strings are not visible and cannot be retrieved safely from the cervical canal 1, 5, 2
- The CDC states that ultrasound can determine if the IUD has been expelled, remains in the uterus, or has perforated the uterine wall 1, 5
Special Clinical Scenarios
- The CDC recommends removing the IUD as soon as possible by pulling gently on the strings if a woman with an IUD is found to be pregnant and the strings are visible 1, 6, 2
- The CDC advises evaluating for possible ectopic pregnancy before removing the IUD in a pregnant woman 6, 2, 7
- The CDC recommends counseling that leaving the IUD in place increases risks of spontaneous abortion and preterm delivery, while removal reduces these risks but may not decrease risk to baseline levels of pregnancy without an IUD 1, 6
IUD Removal with Pelvic Inflammatory Disease (PID)
- The CDC states that the IUD does not need to be removed immediately if the woman has PID and needs ongoing contraception 3, 7, 4
- The CDC recommends initiating appropriate antibiotic treatment according to CDC STD Treatment Guidelines and reassessing in 24-48 hours 3, 7, 4