An intrauterine device (IUD) is a highly effective, small, T-shaped form of long-acting reversible contraception that a healthcare provider inserts into the uterus. These devices are approved by the U.S. Food and Drug Administration (FDA) for a set lifespan, which can range from three to ten years, depending on the specific product. Once an IUD reaches this recommended expiration date, its integrity and intended function begin to diminish. Leaving an IUD in place beyond its approved lifespan can compromise its primary function and lead to potential health and procedural complications.
Loss of Contraceptive Effectiveness
The most immediate and concerning consequence of an overdue IUD is the failure to prevent pregnancy. The specific mechanism of failure differs significantly between the two main types of IUDs.
Hormonal IUDs, such as those releasing the progestin levonorgestrel, are designed to maintain a consistent hormone release rate over their approved duration. This hormone works primarily by thickening the cervical mucus to block sperm and thinning the uterine lining to prevent implantation. Over time, the hormone reservoir within the device becomes depleted, causing the localized progestin concentration to drop below the level needed to ensure contraceptive effects. As the hormone effect fades, the cervical mucus thins, and the uterine lining may return to a state that supports a pregnancy.
The copper IUD, which is non-hormonal, functions by continuously releasing copper ions into the uterine environment. These ions create a sterile inflammatory reaction that is toxic to sperm and eggs, effectively preventing fertilization. The copper wire wrapped around the device’s stem is subject to degradation and corrosion within the body’s saline environment. Once the device exceeds its 10-year approved lifespan, the concentration of active copper ions may fall below the threshold required to maintain the spermicidal environment, leading to a reduction in its contraceptive efficacy. The risk of unintended pregnancy begins to climb steadily once the device is past its expiration date.
Increased Risk of Physical Adverse Effects
The prolonged presence of any foreign medical device in the body can lead to physical changes, which becomes a concern when an IUD is left in place too long. One serious risk is uterine embedding, where a portion of the IUD, often one of the arms, slowly penetrates the myometrium, the muscular wall of the uterus. This is distinct from a full uterine perforation, which is the device passing completely through the uterine wall. Embedding can increase the risk of a late or secondary perforation through gradual erosion. This deep penetration can cause localized inflammation and discomfort.
The risk of Pelvic Inflammatory Disease (PID) is another consideration, though the greatest risk occurs in the first 20 days after initial insertion. While modern IUDs have a very low long-term PID rate, the sustained presence of a device beyond its approved term introduces a prolonged low-level risk. The IUD’s plastic frame and components can also become brittle or degrade over many years. This material breakdown could lead to fragmentation, where small pieces of the device separate inside the uterus, complicating the eventual removal process.
Potential Difficulties During Removal
When an IUD is removed on schedule, the procedure is typically quick and straightforward, performed in an office setting. However, an overdue IUD can introduce significant procedural difficulties. The retrieval strings attached to the IUD, which a provider uses to pull the device out, may degrade, become brittle, or retract completely up into the cervical canal or uterine cavity. If the strings are not visible, the provider must use specialized instruments, such as a narrow hysteroscope or biopsy brush, to grasp the device, which makes the procedure longer and more uncomfortable.
Complications are further compounded if the device has become embedded in the uterine wall. An embedded IUD resists the gentle traction required for a standard removal, often necessitating a more involved procedure. In these cases, the provider may need to use a hysteroscopy, a procedure using a small camera inserted through the cervix, to directly visualize the device and carefully detach it from the uterine tissue. Although rare, a deeply embedded or fragmented device may require surgical removal under general anesthesia, transforming a simple office visit into a minor operation.
Immediate Steps If Your IUD is Overdue
If you realize your IUD has passed its expiration date, the most important step is to contact your healthcare provider immediately to schedule a consultation and removal appointment. Do not attempt to remove the device yourself, as this can cause injury, fragmentation, or partial removal. The provider will assess the device’s condition, discuss the risks, and plan the safest method for removal.
Because the contraceptive effectiveness of the device is questionable once it is overdue, you should immediately begin using a backup form of contraception, such as condoms or other barrier methods. This precautionary step is necessary until the expired IUD is replaced with a new device or another birth control method is initiated. While awaiting your appointment, monitor your body for signs of potential complications. Watch for symptoms such as fever, persistent pelvic pain or cramping, or unusual or foul-smelling vaginal discharge, and report any of these immediately to your healthcare provider, as they may indicate an infection.