What Is an Intrauterine Device?
An intrauterine device, or IUD, is a birth control device. It is a small, plastic, T-shaped device inserted into the uterus by a medical provider to prevent pregnancy or for other issues such as heavy menstrual periods. They are the most cost-effective and often used long-acting reversible contraception (LARC). Depending on the type of IUD used, its action can last 3 to 12 years. When the device is inserted, women need not worry about birth control until it is time to replace it. If the person wants to become pregnant between periods, the healthcare professionals can remove the IUD. However, IUDs do not prevent sexually transmitted infections (STIs). Condoms should be used along with an IUD to prevent the risk of contracting an STI. There are two types of IUDs, copper IUDs and hormonal IUDs. They have plastic frames that open into a T shape inside the uterus. A string attached at the bottom of the IUD extends into the vagina so that the healthcare provider can remove the IUD whenever needed.
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Copper IUDs: They are small, T-shaped, plastic, and copper devices. A thin copper wire coils around the stem part of the “T.” The end of the stem is like a smooth ball that prevents any punctures to the cervix when inserted by a healthcare professional. Copper IUPs constantly release a small quantity of copper into the uterus. The device can also be used for emergency contraception within 5 days of unprotected sex.
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Hormonal (levonorgestrel) IUDs: It is a small, T-shaped, plastic device that contains the progestin hormone levonorgestrel flowing through the stem. Progestin is an artificial version of progesterone, a hormone produced naturally in the ovaries. They are available under Mirena, Liletta, Kyleena, and Skyla.
How Does an Intrauterine Device Get Retained in the Uterus?
Intrauterine devices are considered safe and effective birth control methods, and the risk of displacement or retention is relatively low. However, in certain cases, complications might lead to IUD displacement or retention. Regular check-ups and follow-up appointments will help ensure the IUD is in its original position and functioning effectively. It is essential to seek medical attention if any unusual symptoms are experienced, such as severe pelvic pain, unusual bleeding, or discomfort.
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Incorrect Insertion: During the insertion of an intrauterine device, if it is not properly placed in its exact location within the uterus, it might not be securely in its position and could become displaced later.
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Expulsion: The body might naturally push the IUD if it is not positioned properly or due to anatomical variations. This commonly occurs shortly after insertion. However, it can happen at any time during use. There are two types of expulsion: complete and partial. When the IUD is expelled from the uterus and into the vagina, it is called completed expulsion. When the IUD moves out of its position at the top of the uterus, it is called partial expulsion. This is more common shortly after insertion, but it can happen anytime during use.
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Uterine Shape and Size: The size and shape of the uterus can also affect the IUD placement, as they are different for each person. If the uterus is smaller or unusually shaped, the IUD might not sit properly in its position and could be more prone to displacement.
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Uterine Contractions: In cases of strong uterine contractions during menstruation, there are chances for the IUD to get displaced or pushed out of its intended position.
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Infections: Infections or inflammation is one of the most serious complications, most commonly occurring due to improper insertion, which could lead to the IUD being displaced or retained.
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Trauma or Injury: An injury or trauma to the abdominal or pelvic area may dislodge the IUD from its actual position.
What Are the Symptoms of Retained Intrauterine Devices?
Women may present with various symptoms if there is displacement or retention of the IUD. And the IUD has only displaced slightly; there might not be any noticeable signs. The most common sign of IUD retention or displacement is pelvic pain. This pain can range from mild to severe and may be intermittent or constant.
Other symptoms include:
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Abnormal vaginal bleeding.
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Persistent pressure or feeling of fullness in the pelvic region.
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Irregular menstrual cycle.
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Severe cramping during periods.
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Discomfort or pain during sexual intercourse.
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Increased vaginal discharge.
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Lower abdominal pain.
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Unable to feel the IUD strings with the fingers.
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Fever or chills.
How Is Retained Intrauterine Device Diagnosed?
The diagnosis of a retained intrauterine device is a challenging task. Initially, a clear history, presentation of complaints, and physical examination are carried out. Imaging techniques help identify the exact location of the IUD.
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X-ray - It is commonly used as an imaging technique to identify IUDs. However, some IUDs may not be visible on X-ray images, so other diagnostic approaches must be chosen.
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Transvaginal Ultrasound - This imaging technique is commonly used to locate and determine the position of IUDs within the uterus with better visualization of the IUD and pelvic organs. If the IUD is embedded in the uterine wall or overlapped by other structures, it may be difficult to locate it.
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Magnetic Resonance Imaging (MRI) - This provides more detailed information about the location and position of the IUD.
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Hysteroscopy- When all other methods are unsuccessful, hysteroscopy is a valuable diagnostic tool for identifying lost IUDs. In this procedure, a thin, lighted tube attached to a small camera called a hysteroscope is inserted through the cervix into the uterus to visualize the IUD and uterine cavity directly. Hysteroscopy also aids in the removal of lUD.
What Is the Treatment for Retained Intrauterine Devices?
The treatment for removing retained IUDs depends on many factors, like the patient's symptoms, the location of the IUD, and any associated complications.
There are several ways to remove an IUD:
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If the string of the IUD is visible, the healthcare provider may carefully pull it to remove the device.
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In cases where an IUD is easily accessible, it can be removed with the help of a hysteroscopy. Specialized instruments are used to grasp and remove the IUD safely.
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Laparoscopy is a minimally invasive surgical approach to remove the IUD if it has displaced outside the uterus or perforated adjacent structures.
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Laparotomy is a surgical procedure performed if there are severe complications or if the IUD has caused severe damage.
Conclusion
Intrauterine devices are the most effective method of birth control. In rare situations, it can get displaced and retained in the uterus, leading to complications and difficulty in diagnosis as the symptoms are nonspecific and due to the limitations of certain diagnostic methods. Prompt diagnosis and suitable management are very important to prevent potential complications. So, regular follow-up visits are necessary for identifying and preventing retained IUDs.
