Steps to Remove Device

When to remove an IUC

• At the end of the recommended duration of use
• When fertility is desired, or contraception is no longer required
• At the time of treatment for cervical or uterine malignancy
  • A cervical diagnostic excision, such as a LEEP, can often be performed with the IUC in place, but inadvertent removal may occur
  • An endometrial biopsy can be performed with an IUC in place, but removal is possible
• Breast malignancy sensitive to progesterone (LNG-IUS only)
• Confirmed pregnancy: with ectopic pregnancies, removal of IUD is not mandatory if treatment occurs and the woman still wishes to keep the IUD
• Current PID not responding to treatment after 48 hours
• Pelvic tuberculosis
• Ongoing symptomatic uterine fibroids or other gynecological problems that are exacerbated or not improved by an IUS
• New onset of significant vaginal bleeding that is unacceptable

At the end of the approved duration of use, an IUC does not need to be replaced urgently. A woman should be reassured if there is a waiting list to see a clinician. In the meantime, the IUC will still provide reliable ongoing contraception. The IUC can be removed and replaced at the same visit.

Bridging devices

If the woman wants to switch to another form of contraception, bridging may be required. Recommended contraception change strategies are listed below:

IUC Removal

• Women who desire ongoing contraception (e.g. bridging to another method) should abstain from intercourse or use condoms for the week prior to removal since fertilization may be possible.
  • Does not apply to women who are removing their IUC in order to get pregnant
• Grasp threads with forceps and apply steady traction.
• If performed in the operating room (example at time of tubal sterilization), ensure documentation of removal is in OR report.
• If there is excessive resistance, and the IUC cannot be easily removed a paracervical block may be helpful. If unsuccessful, attempt should be abandoned and referral to an expert should be considered.
• If PID is suspected, the woman should be treated with antibiotics prior to removal.

Difficult Removal

• If the IUC strings are not visible, a cytobrush or small hook may be helpful to bring the strings lower and into view.
• If the strings cannot be located, alligator forceps (image below) or an IUD hook may be used to attempt removal of the IUC.
• If the IUC cannot be located, a pregnancy test and ultrasound should be obtained. If the IUC is not located on ultrasound, an X ray should be performed up to the diaphragm.
• If the IUC is in the abdomen or embedded in the myometrium, refer for ongoing management on a semi-urgent basis.
• If after X-Ray the IUC is not seen, expulsion has occurred.

An alligator forceps is used if no string is visible

Black D. and Waddington A. et al. Build Your Expertise: IUC slide deck: 93.
Costescu D. and Guilbert E. et al. Preceptorship Program on IUC insertion - Modules 3-4.