How Is an IUD Removed and What Side Effects Can You Expect?

The contraceptive expectations of women across the globe are similar: easy to apply, minimal side effects, effective protection, and the ability to return to fertility when desired. Intrauterine devices (IUD) satisfy many of these criteria. But how much do we know about the removal of an IUD? Is it possible to make this step more accessible?

How is an IUD removed?

IUD is a T-shaped tool placed inside the womb. When inside, the "arms of the T" are directed toward the uterine tubes. Also, IUDs have a string on the "bottom end of the T", which could be found in the vagina. This string is the primary tool for removal.

During your appointment, the healthcare provider will examine the presence of the string in the vagina. If in place, they will grasp the string with a clamping tool and gently pull it out. During the procedure, the arms are coming closer to each other on the top end, which helps with easy removal. The method is fairly easy, lasting for a couple of minutes. You may experience mild discomfort or pain in the lower belly, similar to menstrual cramps. Mainly, it doesn't require anesthesia, and painkillers are sufficient to manage the period.

Sometimes, the string could be missing. It might be associated with several reasons.

• Short-cut string. After an IUD placement, the string is cut to a certain length, and the length is adjusted based on the individual's needs. If it was cut too much, then the remaining end may slip into the cervix or uterus.
• IUD expulsion. In 5–14% of cases, the IUDs might be discharged from the womb. In women, especially with heavy menstrual bleeding, it is possible that the expulsion would go unnoticed.
• IUD displacement. IUDs may change their place over time. If they move upper, towards the womb, then the string may also enter the cavity. In 0–5% of cases, the IUD may pierce and attach to the womb wall.

Depending on the situation, the cases with lost strings could be managed by a trained professional.

Can you remove your own IUD?

There is an increasing number of online posts and 'tutorials' discussing the removal of IUDs on your own. A 2022 study reported that more than a thousand users describe their experiences as mainly positive in their online posts. Analyses show that the main reasons for self-removal motivation are to have more control over one's contraception, financial barriers, and difficulty in securing an appointment.

The COVID-19 pandemic was a crucial period in investigating the safety and success rates of IUD self-removal. During this period, under self-removal guidance, the level of self-management increased by threefold. The study's authors concluded that self-removal guidance might be a helpful approach during public health emergencies.

The success rate of IUD self-removal attempts is 20% to 30%. Copper IUDs are easier to remove than the hormonal ones. Also, longer string, squatting or lying down, and use of gloves were among the helping factors.

The use of a guide increases the success rate. Despite a 'wealth of information' on the internet and social media, it is recommended to use scientifically trusted guides. Clinicians work on improving self-management knowledge and testing their effectiveness. One such guide was presented by the University of Washington. Also, it is highly recommended that counseling and clinician perspectives be considered before proceeding with self-management.

What to expect after an IUD removal?

After the procedure, some mild symptoms, such as vaginal bleeding and pain, might be observed.

Bleeding

The intensity and duration of vaginal bleeding may vary. However, in general, it is spotting-like and light, lasting for a few days. If you experience heavier-than-period bleeding, especially if you removed the IUD on your own, it is recommended to contact a healthcare provider.

Cramping

The level of pain following the procedure may also be subjective. Generally, it would be felt in the lower belly as discomfort or mild period cramps. Painkillers, such as paracetamol or ibuprofen, might be helpful in alleviating the symptoms.

Possible period changes

While using an IUD, spotting between periods or increased or decreased menstrual flow might be observed. However, after uncomplicated IUD removal, the frequency or intensity of periods are not expected to change. In some cases, if an infection of the womb cavity is experienced, this, in the future, may lead to reduced menstrual bleeding. However, in general practice with hygienic management, the chances of such complications are very low.

Also, it is expected to get your periods within the expected time of your cycle. However, especially if you used a hormonal IUD, after removal, it may take up to three months to resume menstrual cycles.

Fertility restoration

Generally, it is safe to have intercourse before or after an IUD removal. However, it should be remembered that after removal, fertility might be restored immediately. Therefore, you should plan this period carefully if you don't want to conceive and are planning to replace the IUD later or switch to another contraceptive method.

Weight loss or gain

Generally, IUDs are not associated with weight changes. There is a high perception that hormonal IUD causes weight gain. According to a survey of 2,300 women, 38.2% believe that IUD use would increase their weight. A study testing progestin-only contraceptive methods showed that levonorgestrel-containing IUDs (LNG-IUD) users gained an average of 1 kg over 12 months. This number was 200 grams for copper IUD users.

Given these findings, the body weight is also not expected to be affected by the IUD removal.

IUD removal side effects

Generally, when all recommendations are followed, no major side effects during the IUD removal are expected. In some cases, women may experience vasovagal symptoms, which is a reaction to cervical handling, and women may feel dizzy and faint. Usually, it lasts very briefly and is managed by stopping cervical manipulation, using the correct position, and taking relevant measurements depending on the symptoms.

In cases when the IUD is misplaced and is found attached to the womb wall or in the abdomen, the possibility of side effects should be discussed with a professional.

When should you remove your IUD?

The main reason for IUD removal is the desire to stop contraception or renewal of the device after the recommended period of use. This period is 3–5 years in levonorgestrel-containing IUDs (LNG-IUDs) and up to 10 years in copper-containing IUDs (Cu-IUDs).

Also, there are several medical reasons when the removal might be considered:

• Irregular and heavy bleeding. IUDs may lead to spotting or changes in menstrual flow. Generally, it is more likely to experience heavy bleeding with copper IUDs than hormonal ones. If these symptoms affect the quality of life and alternative methods are available, removal might be considered.
• Discomfort or pain. This might be a sign of IUD misplacement, and with the examination findings, removal might be discussed.
• Intrauterine pregnancy. Although an IUD is considered an effective contraceptive method, in 0.2% (hormonal IUDs) to 0.8% (copper IUDs) of cases, it is possible to experience unintended pregnancy during the first year of use. When pregnancy is discovered, it is recommended to remove the IUD, as the device increases the risk of spontaneous abortion and preterm delivery.
• Cervical and uterine malignancies. Due to the hormonal content, it is recommended to remove levonorgestrel-containing IUDs if the malignancy is diagnosed.

How much does IUD removal cost?

The expenses related to the procedure might differ from country to country, as well as access to medical insurance. A 2015 study from the University of Miami showed that ultrasound-guided IUD removal costs $465, while the expenses might increase up to $3,562, depending on the need for operating room use. In another 2020 study in the USA, the median cost of IUD removal was $262, ranging between $50–1,000.

How soon can you get a new IUD?

If you intend to continue IUD use and there are no contraindications for so, then you may get a new IUD in the same session. Concerns might be associated if you have heavy bleeding at the time of the placement, as a heavy flow could remove it. In such cases, individual assessments might be helpful. Also, if an IUD is desired after giving birth, it is recommended to wait until 6–14 weeks after delivery to reduce the chances of expulsion.

IUD alternatives

After removal, if you don't want to replace the IUD and would like to use another contraceptive method, there are several hormonal and non-hormonal alternatives.

• Non-hormonal. Barrier methods (diaphragm or cervical cap, sponge, male and female condoms, spermicides), permanent sterilization (females-tubal ligation, males-vasectomy).
• Hormonal. Implant, injection or 'shot,' pills, patch, hormonal vaginal contraceptive ring.

To find the ideal choice for you, discuss your options with your physician.

In summary, IUD removal is a simple procedure, and if performed as recommended, no severe side effects are expected. It is always recommended to discuss the timing, removal method, and future contraceptive plans with your healthcare provider to prevent undesired effects associated with IUD removal.