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 because she had a cesarean section 22 years ago and once miscarried, it seemed impossible to remove. It grew 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, and others said that after menopause, the uterus may shrink, which 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:
(1) Women who have had the IUD for 5–10 years or longer and require its replacement;
(2) Women with irregular vaginal bleeding or other symptoms that persist despite treatment;
(3) Women who wish to conceive again, or those who have been sterilized for 1 year;
(4) 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
It is currently believed that the IUD increases the activity of fibrinolytic enzymes, which is the primary cause of bleeding. Antifibrinolytic drugs like tranexamic acid can reduce bleeding. Mild, irregular vaginal bleeding often does not require treatment; however, heavy bleeding may necessitate medication to stop it. If bleeding persists despite treatment, the IUD may be removed. Prolonged bleeding may require antibiotic treatment.
2. Lower Back Pain and Abdominal Discomfort
This may be caused by an oversized IUD or its low position, leading to uterine contractions. Antispasmodic medication can be tried first. If ineffective, the IUD may be replaced with a new one.
3. Infection
In rare cases, improper sterilization or non-sterile procedures can lead to ascending infection. If infection occurs, the IUD should be removed first, followed by appropriate treatment.
4. IUD Implantation
In some cases, the IUD may become embedded in the uterine wall. If embedded superficially, it can still be removed with an IUD removal hook. If deeply embedded, the cervix must be dilated to sizes 6–7, and the IUD loop should be brought to the cervix. The loop wire should then be straightened with two hemostats 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 (blindness) in the operation. If the IUD is very deeply embedded, it may even have pierced the cervix.