Unbeknownst to many women, there is a chance that once placed, your intrauterine device (IUD) might not stay put. Some of the ways women may experience complications with movement of their IUDs are IUD expulsion, IUD migration, and uterine or organ perforation by their IUDs.
An IUD can be expelled from the uterus entirely (expulsion), or move within the uterus itself (migration). In the process of migration, an IUD can puncture (perforate) the wall of the uterus, and even become embedded in other abdominal or pelvic organs and structures. A woman’s chances of experiencing IUD expulsion and/or perforation may be higher postpartum.
Periodically, clinical case reports are published in medical journals, detailing the cases of women who have experienced perforation with their IUDs. IUDAlert hears directly from women around the world who have experienced IUD perforations. We publish their firsthand accounts so that other women can be informed about the real risks associated with IUD use. After all, it is women’s experiences that provide the “real” data in terms of how these complications truly affect the health and lives of women.
In a 2016 article in Self titled, “How To Know If Your IUD Is Falling Out,” executive editor Zahra Barnes tells us: “Reported expulsion rates [of IUDs] are around 3 to 5 percent, according to the American College of Obstetricians and Gynecologists.”
“Experts still aren’t sure of the medical reason behind [IUD] expulsion,” says Barnes. “It’s more common during your period and also more likely to happen in the first few months after insertion.”
For the article, Barnes interviewed Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology at Yale Medical School, and Jamil Abdur-Rahman, M.D., board-certified OB/GYN and chairman of obstetrics and gynecology at Vista East Medical Center in Waukegan, Illinois. In the article, Dr. Minkin explains that sometimes “your uterus says, ‘I’m tired of having this in here’ and spits it [the IUD] out.” Dr. Abdur-Rahman adds “It might just be a factor of having a foreign body in there.”
Uterine perforation can happen when your IUD is misplaced upon insertion or moves within the uterus, but is not fully expelled out of the cervix.
On the frequency of perforations, Barnes says in the Self article: “It only happens in 1 out of every 1,000 insertions, according to ACOG, and it’s most common around the time of insertion. That’s because perforation often happens due to improper placement, says Abdur-Rahman MD. Insertion is a ‘blind procedure,’ he explains, meaning doctors don’t get to see what they’re doing.”
The Self article continues:
“When you’re inserting an IUD, you push it [past the cervix] through a tube that’s like a narrow straw. It squirts out into the uterus and the arms pop open,” says Mary Jane Minkin, MD. The thing is, around one in four or one in five women has a retroverted, or tilted, uterus, says Abdur-Rahman. That’s when the uterus is tipped backward instead of forward, meaning an IUD’s wings can more easily wind up where they shouldn’t.”
IUD perforation can be “partial” or “complete”
A perforation with an IUD may be “partial” or “complete.” Perforation is often suspected or diagnosed when the IUD string is no longer visible at the external os (opening to the cervix), especially if other symptoms are present.
- A partial perforation is when only a part of the IUD becomes embedded in the uterus—or the uterine wall.
- A complete perforation is when an IUD completely punctures through the uterine wall, and moves or migrates into the abdomen. When a complete perforation happens, it poses a risk to other organs in the abdomen and pelvis, as well as the abdominal wall.
IUD perforation: Testimonies
Jessica, who experienced a complete IUD perforation and submitted her story to IUDAlert last month, wrote:
“I had mine put in and not a month later it had broken through my uterine wall and attached itself to my colon. I had to go under to have surgery to remove it. I’ve had constant back pain and hip pain for months now. Oh also it took 4 months for them to listen to me and do ultrasounds and X-rays. I have had unbearable back and hip pain since getting my IUD. Even now with it out. I’m now in physical therapy.”
Similarly, a woman named Pauline recently shared with us her experience with an IUD that perforated her bowel:
I had it for HRT and this happened……Had mirena inserted aug 11 and by week two had bad bloating and sharp pain I put up with it for two more weeks I’m a nurse and popped into see my Dr who decided to take me to theatre the next day as he couldn’t see the strings..the next day I went down for surgery they couldn’t find the coil..they woke me up had an xray..they said it wasn’t in my uterus but in my abdomen back to theatre same day and yes it had perforated my uterus and had to be cut from my bowel…traumatised is an understatement two anaesthetics and two surgeries in one day…this thing is a danger it nearly cost me my life….
IUD perforation: Clinical case reports
Case reports in medical journals underscore the reality of Jessica and Pauline’s experiences with IUD perforation and migration. A recent case report was published in BMC Women’s Health in August titled, Intrauterine devices migrated into the bladder: two case reports and literature review.
The BMC Women’s Health Study refers to two case presentations where the IUD migrated and became embedded in the bladder.
“…a 37-year-old female who presented lower urinary tract symptoms for a year. Cystoscopy showed that a strip of metal penetrated into the bladder, and the surface was covered with stones.”
“A 46-year-old woman was referred to our hospital complaining of “frequent urination, urgency and pain for over 10 days”. The patient had a history of three vaginal deliveries and no C-sections. She was previously placed an Intrauterine device in a local hospital in 1998, but she had an unexpected pregnancy in 1999. As no indication of a residual IUD was found in the uterus on ultrasonography, her doctor believed that “the IUD had spontaneously expulsed and a new IUD was inserted…”
In both cases, the IUD was removed.
What stands out in these case reports is the lack of attention paid to the mental and emotional effects these women likely endured during their ordeals with their wandering IUDs. We see in Pauline and Jessica’s stories (and in the hundreds of others submitted to the IUDAlert site), the complete picture of the trauma caused when IUDs don’t stay put. Women who are uninformed of these risks feel the additional horror of being blindsided when issues arise, and angry that their ability to give informed consent was withheld from them by their medical providers.
How do you know if your IUD has been expelled from, or perforated, your uterus?
First and foremost, if you or your partner can no longer feel the strings of your IUD, it may be a signal that the device has moved within (or out of) the uterus.
Other symptoms include:
- Pelvic pain, ranging from severe to extreme
- Pain in the lower abdomen
- Unintended pregnancy (displaced IUDs no longer prevent a woman from pregnancy since they are no longer fully functional)
- Nausea or vomiting
- Fever or chills indicating an infection
- Irregular periods or heavy menstrual bleeding
- Rapid heartbeats
If all of this is not enough to endure, one or more surgeries may be needed to locate and remove the device if it migrates and/or perforates the uterus or other organs.
Uterine perforation complications
Complications from uterine perforation, or from any surgical procedures needed to remove the IUD from the uterus or other abdominal or pelvic organs may include:
- Scarring of the uterus
- Surgical tears in the uterus
- Scarring and perforation of other organs in the abdominal cavity
- Excessive bleeding or hemorrhaging
- Hysterectomy and/or infertility
Although IUD perforation is considered a rare occurrence, it can happen. The possibility of perforation—and its warning signs—should be part of the discussion between a patient and medical professional prior to consent and insertion of these devices.
Natural Womanhood, a non-profit organization dedicated to truth in women’s health, is calling on the FDA to update the risks and side effects of contraception in prescribing information and patient inserts. If you believe that women deserve better information when it comes to hormonal contraception, we encourage you to sign this petition today.