Patient's question:
My mom is 58 years old this year and has been menopausal for 3 or 4 years. She has had an IUD for nearly 20 years and has never taken it out. Two or three years ago, she tried to remove it twice, but it seemed impossible because she had a cesarean section 22 years ago and once experienced a miscarriage. It appeared to be grown into her uterus, and even when they tried to remove it, it bled but couldn’t be taken out. What should she do? It seems the IUD is a spiral-shaped steel one.First follow-up question: But some doctors said there is a risk of cancer, while others mentioned that after menopause, uterine atrophy could lead to rupture or perforation. My mom is very scared now. Some people also said that if it’s not handled properly, she might end up having her uterus removed. Second follow-up question:
Doctor's answer:
Hello:Indications for IUD Removal:
⑴ Women who have had the IUD for 5 to 10 years or more and require its replacement;
⑵ Women with irregular vaginal bleeding or other symptoms that do not improve after treatment;
⑶ Women who wish to conceive again, or those who have been sterilized for 1 year;
⑷ Women experiencing severe side effects and wishing to switch to another contraceptive method;
Before removal, an ultrasound or pelvic X-ray should be performed to confirm the presence of the IUD.
Side Effects:
1. Bleeding
Currently, it is believed that the IUD increases the activity of fibrinolytic enzymes, which is the main cause of bleeding. Antifibrinolytic drugs like tranexamic acid can reduce bleeding. Mild, irregular vaginal bleeding often does not require treatment; however, if the bleeding is heavy, medication to stop the bleeding may be administered. If the bleeding does not stop after treatment, the IUD can be removed. In cases of prolonged bleeding, infection control measures may be necessary.
2. Lower back pain and abdominal discomfort
This may be caused by an oversized IUD or its low position, leading to uterine contractions. Antispasmodic drugs can be tried first. If they are ineffective, the IUD can be replaced with a new one.
3. Infection
In rare cases, improper disinfection or sterile procedures can lead to ascending infection. If an infection occurs, the IUD should first be removed, followed by appropriate treatment.
4. IUD Implantation
In some cases, the IUD may become embedded in the uterine wall. If it is relatively shallow, it can still be removed with an IUD removal hook. If it is deeply embedded, the cervix must first be dilated to sizes 6–7, and the IUD loop should be brought to the cervix. The IUD wire should then be straightened with two hemostatic forceps and cut before being removed. The procedure should be performed slowly and gently. If necessary, ultrasound guidance can be used to reduce the risk of blind manipulation. If the IUD is very deeply embedded, it may even have protruded out of the uterus.