An intrauterine device (IUD) is a small, T-shaped form of long-acting reversible contraception inserted into the uterus by a healthcare provider. IUDs are highly effective, providing over 99% protection against pregnancy for several years. The lifespan varies by type: hormonal models typically last three to eight years, and the non-hormonal copper IUD lasts up to twelve years. Once the recommended period passes, the device is considered expired, losing the manufacturer’s guarantee for its original function. Leaving an IUD in place past its expiration date raises concerns about potential health risks and a loss of contraceptive reliability.
The Decline in Contraceptive Reliability
The primary function of an IUD is to prevent pregnancy, but once the device is past its expiration date, this protection diminishes significantly. The drop in effectiveness varies based on whether the IUD is hormonal or copper-based, as their mechanisms of action differ.
Hormonal IUDs, such as Mirena or Kyleena, contain levonorgestrel, a form of progestin. This hormone is released daily to thicken cervical mucus, inhibit sperm movement, and sometimes suppress ovulation. When the IUD expires, the internal supply of levonorgestrel is largely depleted, and the rate of hormone release drops considerably. This cessation of contraceptive action leads to a rapid return of fertility.
Copper IUDs, like Paragard, continuously release copper ions into the uterine environment. These ions create a localized, spermicidal effect that is toxic to sperm, preventing fertilization. While the structure remains in place, effectiveness declines over time as the copper ions may slowly erode. Although some studies suggest a copper IUD may retain some efficacy beyond its official lifespan, it should no longer be relied upon for pregnancy prevention once the approved duration is reached.
Regardless of the IUD type, the risk of unintended pregnancy increases the longer the device stays past its approved time frame. If conception occurs with an expired IUD present, there is a higher risk of complications, including ectopic pregnancy and spontaneous abortion. Since the device’s original effectiveness is no longer guaranteed, supplementary contraception is necessary for anyone who remains sexually active.
Increased Risks to Uterine Health
Leaving an IUD in the uterus for an extended time introduces physical and biological risks to the uterine environment. One significant concern is the potential for the device to become embedded in the uterine wall, where the IUD material integrates into the myometrium, the muscle layer of the uterus. This can cause localized discomfort or pain and makes the eventual removal procedure more complex.
While the risk of pelvic inflammatory disease (PID) is low after initial insertion, prolonged retention may slightly increase the long-term risk of localized infection. Symptoms such as abnormal vaginal discharge, pelvic discomfort, or fever should prompt immediate medical evaluation. In rare cases, the device material could degrade or fragment over many years, causing chronic irritation to the uterine lining.
Potential Complications During Removal
The mechanical challenges associated with removing an expired IUD are distinct from the general health risks of retention. The most frequent complication is the inability to locate or grasp the retrieval strings, which may have retracted into the cervical canal or broken off due to material degradation. If the strings are not visible, the healthcare provider must use specialized instruments or techniques to retrieve the device.
The embedding of the IUD into the uterine muscle, a risk that increases with prolonged duration, directly complicates removal. An IUD integrated into the uterine wall cannot be removed with a simple pull on the strings. This situation may require a hysteroscopy, which involves inserting a small camera and instruments through the cervix to visualize and safely detach the device.
If the IUD’s exact location is uncertain, possibly due to migration or perforation, medical imaging such as an ultrasound or X-ray is often necessary before removal can be attempted. The need for these preparatory procedures highlights why leaving the IUD past its expiration date transforms a typically simple, in-office procedure into a potentially more difficult or time-consuming one.
Immediate Action and Next Steps
If your IUD has passed its expiration date, assume the device is no longer providing reliable contraception. Contact a healthcare professional, such as a gynecologist or family planning clinic, immediately to schedule an evaluation and removal. While waiting for the appointment, use a reliable barrier method of contraception, such as condoms, during sexual activity to prevent pregnancy.
If unprotected intercourse has occurred since the IUD expired, taking a pregnancy test is advisable. Emergency contraception, such as the copper IUD itself if inserted within five days, may be an option to discuss with the provider. The risks associated with an expired IUD are manageable, and removal is typically straightforward, even if it requires additional steps like imaging or a more complex procedure. The healthcare provider can remove the expired device and, if desired, insert a new IUD or initiate an alternative birth control method during the same visit.