An intrauterine device (IUD) is a highly effective, long-acting form of reversible contraception placed inside the uterus. While this T-shaped device is one of the most reliable methods available, complications can occur. Embedding is a rare but serious event involving the device shifting from its intended placement within the uterine cavity.
Defining an Embedded IUD
An embedded IUD describes a situation where a portion of the device, usually one of the arms, has penetrated the muscular wall of the uterus, known as the myometrium. The device is not simply misplaced or low-lying; it is partially grown into the uterine tissue. This penetration occurs without the device fully passing through the entire uterine wall to exit into the abdominal cavity.
It is important to distinguish embedding from complete uterine perforation. Perforation means the IUD has gone entirely through the uterus and is lying outside the organ. In embedding, the IUD remains partially contained within the uterine muscle layers and is firmly lodged, meaning it cannot be removed with a simple pull on the strings.
Recognizing the Signs
The presence of an embedded IUD can manifest through several symptoms. One of the most common indicators is the inability to feel the IUD’s retrieval strings or noticing they feel significantly shorter or longer than usual. This change occurs because the device has shifted its position within the uterine cavity.
Patients frequently report chronic or severe pelvic pain, often caused by the IUD irritating the uterine wall. Abnormal bleeding is also a frequent symptom, presenting as heavy, prolonged, or irregular bleeding patterns. Pain during intercourse, medically termed dyspareunia, can also occur.
Diagnosis and Confirmation
If an embedded IUD is suspected based on symptoms or the inability to locate the strings, a healthcare provider will use diagnostic imaging to confirm the device’s exact location. The primary tool for this confirmation is a transvaginal ultrasound (TVUS). This technique provides a clear, high-resolution view of the uterus and the IUD’s relationship to the uterine walls.
The ultrasound allows the provider to measure the distance between the IUD and the outer wall of the uterus, visually confirming if any part is penetrating the myometrium. Specialized 3D transvaginal ultrasound can offer a more detailed, three-dimensional reconstruction, which is particularly helpful in visualizing the arms of the IUD. If the ultrasound cannot locate the device, or if complete perforation is suspected, an X-ray or computed tomography (CT) scan may be used to confirm its location within the pelvic or abdominal area.
Treatment Methods for Removal
Removing an embedded IUD typically requires a specialized procedure. The preferred method for removal is operative hysteroscopy. This minimally invasive procedure involves inserting a thin, lighted tube with a camera, called a hysteroscope, through the cervix and into the uterus.
Hysteroscopy provides the physician with a direct, magnified view of the uterine cavity and the embedded portion of the device. Specialized instruments, such as grasping forceps, are passed through the hysteroscope to carefully disengage the IUD from the myometrial tissue. The procedure is usually performed under general or local anesthesia to ensure patient comfort and allow for the precise work required to free the device.
In cases where the IUD is deeply embedded or has migrated through the uterine wall, the hysteroscopic approach may not be sufficient. For these complex or perforated cases, a laparoscopic procedure may be necessary. Laparoscopy involves making a small incision in the abdomen to insert a scope and instruments to retrieve the device from the abdominal cavity. Open abdominal surgery is reserved for rare instances where the IUD has caused damage to surrounding organs or cannot be safely removed using less invasive techniques.
Potential Health Consequences
An embedded IUD that is not diagnosed and removed can lead to several medical complications. Chronic pain is a persistent issue, often caused by irritation and inflammation of the uterine muscle where the device is lodged. Continued abnormal bleeding and cramping may also persist as long as the device remains out of its correct position.
The most immediate medical risk of any malpositioned IUD is a failure of contraception, which significantly increases the risk of unintended pregnancy. Furthermore, while the general risk is low, an embedded IUD can create a pathway for infection, potentially leading to Pelvic Inflammatory Disease (PID). Prompt removal is necessary to alleviate these symptoms and eliminate the potential for more serious long-term complications.