IUD Complications & Considerations

An IUD, or intrauterine device, is a T-shaped plastic or copper contraception device that a healthcare provider places inside a patient’s uterus. IUDs have become one of the most popular birth control methods worldwide, with the National Institutes of Health reporting that global use in reproductive-aged persons is 14.3 percent.

IUD use by United States individuals using contraception was reported at 6.5 percent. Those numbers are on the increase, and the Centers for Disease Control and Prevention estimated that IUD use in the U.S. had jumped 83 percent between 2006 and 2013.

IUDs have numerous advantages: They’re very effective at preventing pregnancy, with less than a 1 percent chance of becoming pregnant; they are long acting; they don’t require daily action like taking a pill; and IUDs can be easily inserted and removed in a short office visit.

While IUDs are becoming more popular, there remains some public skepticism in the U.S. due to problems with the devices in the 1970s and ’80s. The Dalkon Shield IUD was found to cause high rates of infection, failure to prevent pregnancy and other problems, resulting in lawsuits and considerable negative media attention about IUDs.

But IUDs have long since been improved. OB-GYNs have become more knowledgeable about them, while helping patients better understand their proper use. The Comprehensive Women’s Health Center endorses IUD use as safe and effective for most patients when prescribed and inserted by a well-trained and experienced provider. All of our physicians are highly qualified in IUD application.

Are IUDs a safe form of birth control?

IUD considerations, side effects & possible complications

Patients should weigh the advantages and risks of having an IUD in a discussion with their physician. A patient’s medical history and goals can help their provider determine whether an IUD or an alternate form of birth control is more suitable.

Before placing your IUD, your provider will confirm that you are not pregnant and that you do not have any medical conditions that make it unsafe for you to use an IUD. IUD users should also consider that while an IUD will protect them from becoming pregnant when in proper position, it will not prevent a sexually transmitted disease.

Some patients who are considering an IUD express concern over complications associated with their use. As with many medical procedures and devices, there can be side effects and complications from IUD use.

Side effects

One side effect of IUD use is the pain or discomfort some patients experience during the insertion process. Patients concerned about pain from the insertion should talk to their doctor about including nonsteroidal anti-inflammatory drugs. Patients experiencing severe pain after IUD insertion should notify their physician.

Patients may experience other side effects listed below after the IUD is placed. These side effects typically improve over time, but may last throughout use of the IUD. If the side effects are unacceptable or worsening, the patient should consult their doctor.

Cramps or a backache a few days after insertion
Irregular periods (hormonal IUD)
Spotting between periods
Heavier periods with stronger cramping (copper IUD)

Possible complications from IUD use

More serious complications are rare. The chance of these can often be reduced by selecting an experienced physician and understanding the proper use of the IUD. Complications that do occur will vary for individual patients. Pregnancy occurring with an IUD is very rare, but if pregnancy occurs, it is more likely to be an ectopic pregnancy (which implants outside of the uterus and can be dangerous).

Lost strings. The IUD strings, which hang from the bottom of the IUD, protrude from the cervix into the vagina. These strings are left in place when the IUD is inserted, but they can sometimes work their way up into the uterus. “Missing” or “lost” IUD strings are known as nonvisualized strings.

Lost strings can mean a couple of different things. Sometimes the missing strings are merely hidden higher inside of the cervix. An X-ray or ultrasound may ultimately locate the missing strings and allow the physician to remove and/or replace the IUD. It’s important to visit a doctor if the strings are lost in order to confirm that the IUD is in the proper location. Most of the time, the IUD is in the right place in the uterus and is still effective. It could also mean there is a larger issue such as expulsion, or perforation. (see below).

Infection. One of the most serious complications that can arise because of an IUD is infection. IUD infections are generally a result of the insertion process. The risk of infection is very minimal, and if an infection occurs, it can be treated without removing the IUD. If an infection does occur, it can lead to pelvic inflammatory disorder.

Expulsion. Expulsion occurs when the IUD has moved from its intended position at the top of the uterus. This is one of the more common complications and occurs in 2-3 percent of patients using an IUD. The two types of expulsion are complete and partial. A complete expulsion occurs when the IUD is pushed out of the uterus and into the vagina. A partial expulsion is when the IUD moves out of its normal position at the top of the uterus. A partial expulsion might cause cramping and the patient might feel the strings are lower than they should be. Many doctors recommend checking strings on a regular basis to ensure proper position. Both complete and partial expulsion affect the contraceptive effectiveness of the IUD, and sometimes the patient is not aware that it is out of position.

Perforation. Perforation (the IUD pushing into or through the muscle of the uterus) is rare, occurring in 1–2 per 1,000 IUD insertions. This typically occurs during the insertion process. If the provider inserting the IUD recognizes a perforation, they will stop the procedure and remove the IUD. If a perforation is not recognized, the IUD’s effectiveness decreases. After a perforation, it is possible that the removal process may be more complicated and take longer.

As a result of perforation the IUD can pass through the uterine wall; this is the rarest and most dangerous of all IUD complications. There have been cases where an IUD has migrated to areas of the pelvis, abdominal cavity, gastrointestinal tract and bladder. If the IUD does move outside the uterus, the IUD must be surgically removed.