IUD Removal and Replacement
IUD removal takes the device out of the uterus when it has expired, when the patient asks, or for a medical reason. Replacement inserts a new device during the same visit. Removal can be done at any time of the cycle by a trained provider and is usually quick and simple.
Indications for removal.
Patient request at any time, for any reason.
Expiry of the device: copper T 380A at 12 years, other copper devices at 3 to 8 years, levonorgestrel 52 mg device at 5 years, levonorgestrel 19.5 mg at 5 years and 13.5 mg at 3 years.
Wish for pregnancy.
Complication: pelvic infection not responding to treatment, partial expulsion, embedded or malpositioned device, perforation, unacceptable bleeding or pain.
Pregnancy with the device in place and strings visible.
Menopause: 12 months after the last menses at age 50 or over, or 24 months at under 50.
Counselling. Ask the reason, offer treatment for problems, and plan the next method. Explain that fertility returns immediately after removal.
Timing and protection.
Removal can be done at any time; it is often easier during menses.
For a patient who does not want pregnancy and is not replacing the device, advise condoms or abstinence for 7 days before removal, because sperm survive up to 5 days, or begin another method before removal.
If replacing the device, insert the new one at the same visit with no gap.
Provider and equipment. Trained provider; sterile gloves; speculum; antiseptic; long artery or ring forceps; sterile scissors; new device and equipment if replacing; local anaesthetic if needed.
