Leaving an IUD in past its approved lifespan won’t cause an immediate medical emergency, but it does carry real risks that increase over time. The most common concern is reduced contraceptive effectiveness, especially with hormonal IUDs, where the hormone supply gradually runs out. Beyond that, an IUD left in for many years can become physically harder to remove and, in rare cases, embed into the uterine wall.
How Long Each IUD Is Approved to Last
Different IUDs have different lifespans, and some have evidence supporting use beyond their official FDA approval:
- Paragard (copper IUD): FDA-approved for 10 years, with studies supporting effective use for up to 12 years
- Mirena: FDA-approved for 6 years, with studies supporting use for up to 7 years
- Liletta: FDA-approved for 6 years, with extended use extrapolated from Mirena data to about 7 years
- Kyleena: FDA-approved for 5 years, with no extended use data available
- Skyla: FDA-approved for 3 years, with no extended use data available
Those extended-use timelines come from clinical studies, not from the manufacturer’s label. Some providers will discuss keeping a device in beyond its official window based on this data, but it’s worth understanding what changes as the device ages.
Pregnancy Risk Goes Up Over Time
Hormonal IUDs work by releasing a small daily dose of a synthetic hormone that thins the uterine lining and thickens cervical mucus. Mirena, for example, starts at about 20 micrograms per day and drops to roughly half that by year five. Eventually, the hormone reservoir runs low enough that contraceptive protection weakens. Once you’re past the supported window, you’re essentially relying on a device that may no longer be doing its job.
The copper IUD works differently. It doesn’t release hormones at all. Instead, copper ions create an environment that’s toxic to sperm. That mechanism is more durable, which is why Paragard lasts longer and has evidence supporting 12 years of use. But even copper IUDs lose effectiveness eventually as the copper corrodes and the device degrades.
During their approved lifespan, IUDs are among the most effective forms of birth control: the copper IUD has a first-year failure rate of about 0.8%, and hormonal IUDs about 0.2%. Those numbers climb once the device is past its effective life, though there isn’t a clean data point for exactly how much. If you’re relying on an expired IUD as your only contraception, you’re taking a gamble without knowing the odds.
The IUD Can Become Embedded
The longer an IUD stays in your uterus, the greater the chance it partially embeds into the uterine wall. Embedment means the device has started to sink into the muscle layer of the uterus without poking through to the outside. This is more common in postmenopausal women whose uterine tissue has thinned and changed, but it can happen to anyone with a long-retained device.
You might notice this as persistent lower abdominal discomfort, unusual bleeding, or the inability to feel the IUD strings at your cervix. Some women have no symptoms at all and only discover the problem when they finally go in for removal. A partially embedded IUD can also shift position over time, and in rare cases, it can migrate partially outside the uterus, which creates a potential pathway for infection.
Removal Gets Harder the Longer You Wait
A standard IUD removal takes about a minute. Your provider pulls on the strings, the arms of the device fold up, and it slides out. When an IUD has been in place for many years, especially a decade or more, that simple process can become complicated. The strings may retract or dissolve. The device may be partially embedded. Scar tissue or calcium deposits can form around it.
In a study at a tertiary hospital, the average duration of IUD use among menopausal patients who needed hysteroscopic removal (a procedure using a small camera inserted through the cervix) was 22 years. One patient had forgotten about her IUD entirely and had it in place for 40 years. These cases required specialized procedures rather than a simple office visit. The longer you wait, the more likely you’ll need something beyond a routine removal, which means more time, more cost, and potentially sedation or anesthesia.
Infection Risk Is Lower Than You Might Think
One common worry is that an old IUD will cause a serious pelvic infection. The data is actually reassuring on this point. The highest risk of pelvic inflammatory disease (PID) with an IUD comes in the first 20 days after insertion, when the rate is about 9.66 per 1,000 women per year. After that initial window, the rate drops to 1.38 per 1,000 women per year, which is similar to the rate in women who don’t have an IUD at all.
This means an overdue IUD isn’t sitting in your body brewing an infection. The risk of PID is tied to the insertion process and exposure to bacteria at that time, not to how long the device has been in place. That said, an embedded or displaced IUD is a different situation. If the device has shifted or partially migrated, the disrupted tissue could be more vulnerable to bacterial colonization.
Copper Toxicity Is Unlikely
Some women with an overdue Paragard worry about copper building up in their system. Research on long-term copper IUD users found no change in blood copper levels over time. The mean copper levels and urinary copper excretion in IUD users were the same as in the general population. The copper released by the device appears to stay local to the uterus and isn’t readily absorbed into the bloodstream. So while the copper IUD does release copper continuously, it doesn’t accumulate systemically in a way that would cause toxicity.
Your Fertility Won’t Be Permanently Affected
If you’re worried that leaving an IUD in too long will hurt your chances of getting pregnant later, the evidence is clear: it won’t. A large systematic review found that about 83% of women conceived within 12 months of stopping any form of contraception, and IUD users were no different from those using other methods. The return-to-fertility rate after IUD removal ranged from 71% to 96%, with an average around 85%.
Neither the type of IUD (copper or hormonal), the duration of use, nor the addition of hormones to the device had any measurable impact on future fertility. The concern about impaired fertility from contraceptives is largely a holdover from the era of high-dose birth control pills and has not been borne out in modern research.
What You Should Actually Do
If your IUD is past its expiration date by a few months and you’re trying to schedule a removal, there’s no reason to panic. The risks described above develop gradually, not overnight. But if your IUD has been in for years beyond its approved lifespan, especially if you’re approaching or past menopause, getting it removed sooner rather than later reduces your chance of needing a more complex procedure. Use backup contraception in the meantime if you’re sexually active and don’t want to become pregnant, since you can’t know exactly when a hormonal IUD stops providing reliable protection.