What are the possible complications of intrauterine devices (IUDs)?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Complications from IUD placement are relatively rare. The most common complication is IUD expulsion, which occurs in approximately 2-10% of cases. [5] Patients should be encouraged to feel for their IUD strings on a regular basis at home to ensure correct placement. Placement in the immediate postpartum period is associated with a higher expulsion rate than delayed postpartum insertion. [13] Similarly, insertion immediately following first and second trimester spontaneous or elective abortion is also associated with a higher expulsion rate than delayed insertion. [14] There are, however, numerous advantages to postprocedural and postpartum insertion, which may outweigh the risk of expulsion (see Timing of Insertion).

Method failure is an exceedingly uncommon complication of IUD use. The 52-mg levonorgestrel-releasing intrauterine system (Mirena) has a failure rate of 0.2% in the first year of use. The 13.5-mg levonorgestrel-releasing intrauterine system (Skyla) has a failure rate of 0.4% in the first year of use. [15] The copper T380A IUD has a 1-year failure rate of 0.8%. [5] When pregnancy does occur following IUD placement, the pregnancy is more likely to be ectopic. [16] The World Health Organization and the U.S. Food and Drug Administration both recommend IUD removal if pregnancy occurs. Pregnancies that persist with an IUD in place are associated with high risk of complications, including spontaneous abortion and septic abortion. [17, 9]

Another uncommon complication of IUD placement is uterine perforation, which occurs in 0.1% of cases. [18] Severe pain or loss of resistance with sounding for IUD insertion are signs of perforation. If perforation is suspected, the procedure should be stopped and postponed. The patient’s vital signs should be assessed to identify and signs of hemorrhage. If any of these signs are evident, the patient should be transported to an emergency facility rapidly.

Rarely, a patient may experience a vasovagal episode as a result of cervical or uterine manipulation. If this occurs, the procedure should be stopped and patient’s condition managed appropriately.


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