What are the indications for intrauterine device (IUD) removal?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Ideally, the indication for IUD removal is desire for pregnancy. Alternatively, IUD removal is indicated after 5 years for the levonorgestrel-releasing intrauterine system and after 10 years for the copper T380A IUD. [6, 11] In this setting, patients should be counseled that return of fertility after removal may be immediate and rates of pregnancy within the first year after removal approximate those in women without contraception. [12] In women seeking continued contraception, a new IUD can be placed at the same visit as the removal of an expired device.

IUD removal should be performed at any time secondary to patient request. The most common reasons cited by patients requesting IUD removal are side effects, including bleeding, pain, or infection (45%); this is followed by device-related issues (32%), fears or misconceptions (12.6%), and desire for current pregnancy (9.7%). [13] Current literature suggests that many of these requests for removal, particularly those requested secondary to side effects and fears or misconceptions may be prevented by thorough preinsertion counseling regarding expectations with IUD insertion and continued use. [14, 15]

Mild pain with insertion is common, and some women continue to experience cramping pain for days to weeks following insertion. Severe pain is uncommon and is cause for prompt evaluation and, possibly, IUD removal. Patients who present requesting IUD removal secondary to unscheduled bleeding, amenorrhea, or pain should have a history and physical examination performed. They should be counseled that these effects maybe an expected outcome with IUD use. A urine pregnancy test should also be performed. If the patient feels the side effects are not acceptable to her despite counseling, or laboratory or examination results are concerning for malposition of IUD or pregnancy, then the IUD should be removed.

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