Removal of an Intrauterine Device (IUD) is a routine procedure, and for those who are currently using IUDs, it may help to know that removal is usually faster and less painful than insertion. Some people develop anxiety about IUD removal because the insertion process was unpleasant or because they have heard that IUD removal is painful, but this is not generally the case. In the hands of a competent gynecologist, this procedure is fast and relatively uncomplicated.
IUDs are designed to prevent pregnancy. They are often recommended to women in long-term relationships who are at low risk for sexually transmitted infections, because they are easier to manage than many other forms of birth control, and because they tend to have minimal side effects. There are two types of IUDs: copper IUDs, which prevent pregnancy by slowly secreting copper, and hormonal IUDs, which release hormones. Copper IUDs last around 10 years, while hormonal IUDs last for five years.
There are several reasons for IUD removal. When an IUD expires, it needs to be removed, and a woman may request replacement at the same time. IUDs can also be removed from women who want to get pregnant, or women who are experiencing unpleasant side effects. IUDs are also typically removed after the first year of menopause.
The procedure starts with a routine gynecological examination, in which the doctor first ascertains the position of the uterus by inserting his or her fingers into the vagina and palpating the abdomen with the other hand. This examination also tests for tenderness or physiological changes, which can indicate a medical problem. At the same time, the doctor locates the IUD strings to confirm that the IUD is still present. Next, a speculum is inserted to make it easier for the doctor to see, followed by a tenaculum, a special medical device which stabilizes the uterus. At this point, the doctor grasps the IUD strings with forceps or clamps, and gently pulls the IUD out of the uterus. As the IUD emerges, the arms of the IUD retract, allowing it to slide out.
If the IUD does not appear to be moving, the doctor may ultrasound the area to see why the device is not coming out. The doctor may need to change the angle of the clamps, or the IUD may be embedded in the uterine wall, in which case the patient will be given an anesthetic so that the doctor can insert forceps into the uterus to grasp the IUD and remove it. Sometimes, a surgical procedure may be required to free an embedded IUD, and this is the most serious potential complication of IUD removal. An ultrasound may also be performed if the doctor cannot feel or see the strings, in case the IUD has accidentally come out. If the strings have retracted into the uterus, clamps will be used to grasp them, allowing the doctor to pull the IUD out.
Some cramping and bleeding can be expected during and after IUD removal. Some women like to take aspirin or another mild analgesic before the procedure to minimize pain. Some doctors also recommend abstaining from unprotected intercourse for a week before a scheduled IUD removal, as ovulation after a removal could result in pregnancy if sperm are present, and sperm can last up to five days.
As with going to the dentist, an IUD removal tends to seem more scary when one is scheduling it (and putting it off). Once in the office, the procedure is usually very quick, and a minimum of pain is involved. It's important to remove and replace IUDs after they expire, if one does not want to get pregnant, and for women pursuing pregnancy, IUD removal is obviously the first step. If you had an unpleasant insertion experience which is causing you to delay IUD removal, you may want to make an appointment with a different doctor; consider asking your friends if they have any recommendations.