IUD Removal: What to Expect Before, During, and After the Procedure

How is an IUD removed? Here’s why it may need to be removed and what to expect before, during, and after the removal.

Holding an IUD birth control copper coil device in hand
Photo: Adobe Stock

An intrauterine device (IUDs) is a type of birth control that is inserted into the uterus —but it's not meant to stay there forever. The IUD is a small, T-shaped device that has a 99% chance of preventing pregnancy. By design, it has a tail of plastic strings that help with removal.¹

Two different types of IUDs are available in the U.S.: a hormonal IUD which releases progestin—a type of progesterone (a sex hormone)—into the uterus, and a copper IUD that contains no hormones but releases copper into the uterus. Both IUDs prevent sperm from entering the uterus and reaching the egg.² From 2017–2019, the CDC estimates that among U.S. women aged 15–49, about 8% use IUDs.³

An IUD is a long-acting reversible contraceptive, meaning it lasts for several years and will be removed at some point. How is an IUD removed? A healthcare provider can perform a simple procedure to remove it at any time.²

Here are some important things to know about how an IUD is removed, and what to expect before, during, and after the procedure.

Why Would an IUD Need to Be Removed?

You can request an IUD removal at any time if you want to switch birth control methods or are trying to get pregnant. There are, however, several instances in which your doctor will recommend an IUD removal.

The most common reason is that the IUD has expired. IUDs are effective for several years, but the exact expiration date depends on the brand. Hormonal IUDs can last from 3–7 years, while the copper IUD lasts for 10 years.⁴ Consult with your OB-GYN about the specific expiration date for your IUD.

You may want to remove an IUD if:

  • You experience prolonged discomfort or painful side effects, such as heavy bleeding, fever, and headaches.²
  • You have pelvic inflammatory disease (PID), an infection in your reproductive organs, usually caused by bacteria from a sexually transmitted infection (STI).⁴,
  • Your IUD has moved into the wall of your uterus or to other organs.⁴,
  • You got pregnant while the IUD was in place.²

However, displacement of IUDs, as well as pregnancy or developing PID with an IUD in place, are all rare complications.²

Using an IUD doesn't protect against STIs, but it also doesn't increase your risk of developing an STI.² In most cases, a healthcare provider can treat an STI by prescribing antibiotics, without removing the IUD, but may consider removal if your condition does not improve in 48–72 hours after starting antibiotics.⁷

How to Prepare for the Removal

You can schedule your IUD removal with the healthcare provider that inserted the IUD, or any Planned Parenthood health center, family planning clinic, or private gynecologist office that inserts IUDs.⁸

Before the procedure, meet with a doctor or nurse to discuss your medical history and why you're getting your IUD removed.¹ They can share any relevant information, including:⁷,

  • How to manage side effects of IUD complications
  • A treatment plan for any STIs
  • Alternative types of birth control
  • Risks to a pregnancy
  • Post-IUD fertility

Depending on your condition, your provider can replace your IUD with a new one on the same day as a removal. The contraceptive protection from your IUD stops working once it is removed.² Talk with your provider about whether you need to avoid sex in the week before or after the IUD removal, take emergency contraception pills, or use an additional type of contraceptive for a week after the IUD removal—all options to prevent pregnancy during the IUD replacement. This will depend on whether you are switching to a hormonal or copper IUD and what day you are in your menstrual cycle.⁷

How Is an IUD Removed?

A standard IUD removal is similar to a routine pelvic exam, and as simple as one too. After lying on your back and propping your legs up, as if in a sitting position, your healthcare provider will insert a speculum—a duck-bill-shaped device—into your vagina. This is the same tool used during IUD insertion and allows the provider to locate your cervix and uterus.¹

Once they have located the IUD strings, your provider will steadily pull them using a pair of forceps (like tweezers) to remove the IUD.¹ If they aren't visible, your provider can insert a thin brush (cytobrush) through your cervix to help retrieve the strings.⁹ This process should take a few minutes—usually less time than it takes to insert the IUD.²

Side effects during a standard IUD removal

For most people, the pain experienced during a standard IUD removal is minimal. At most, you will have mild cramping as the device is removed.⁸ Some people who experience more pain during IUD insertion and removal might also faint during the procedure.¹

If the IUD is difficult to remove

In rare cases, a standard IUD removal might not be enough to take out the IUD. If the IUD has moved and still can't be pulled out, your provider will perform an ultrasound to help locate its position in the body. Your provider may also ask you to take a pregnancy test, as pregnancy could be a reason for missing strings.⁹

After the ultrasound, if the IUD appears in the uterus, your provider might use other tools to help remove the device. This includes alligator forceps—a long surgical tool with a scissor-like grip and a jagged, tweezer-like tip.⁹

If the IUD is stuck in the wall of the uterus or has moved outside the uterus, your provider will refer you to a gynecologic surgeon—a specialist of the reproductive system.⁹ This specialist can perform either a minimally invasive procedure or a surgery to remove the IUD.¹⁰,¹¹

What to Expect After an IUD Removal

Side effects from a standard IUD removal are generally minimal.

You may experience cramping in the first few hours or days after a removal. Pain from the IUD removal or replacement can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.¹,⁷ You may also notice some light bleeding from your vagina in the following days or weeks.¹²

There are times, however, when you may experience more severe side effects after removal—though these are likely not from the IUD removal itself, but due to existing IUD complications or from a new IUD insertion. Visit your healthcare provider if you experience any of the following:⁷

  • Severe pain or cramps
  • Fever
  • Heavy vaginal bleeding
  • Unusual discharge from the vagina

If you had your IUD removed and not replaced, your body will eventually stop experiencing any side effects from the IUD. Your menstrual cycle will return to its regular flow, which could come back immediately after a copper IUD or in a few months after a hormonal IUD.¹²

If you want to get pregnant after an IUD removal, there's good news. Research suggests your fertility should return to its pre-IUD state, meaning you could get pregnant right after the IUD is removed.¹³,¹⁴

Can You Remove an IUD At Home?

Though the removal process may seem simple, it is important to have your IUD removed at a medical office rather than at home. In trying to pull out the IUD yourself, you may reposition it rather than remove it. This not only causes cramps and pain, but can make the IUD ineffective.⁸

Summary

IUDs may be removed for a variety of reasons and can be done at any time. Because of the simplicity of the procedure, which is similar to a routine pelvic exam, it can be completed in a matter of minutes and involve minimal pain. If complications arise, which are rare, there are non-invasive ways to deal with them. You can even have a new IUD inserted that same day.

If you think an IUD removal may be necessary, whether it's because you want to get pregnant or are experiencing unpleasant side effects, schedule an appointment with your gynecologist or at a medical clinic to discuss next steps and possible outcomes.

Sources

  1. Lanzola EL and Ketvertis K. Intrauterine device. StatPearls. 2022.
  2. American College of Obstetricians and Gynecologists. Long-acting reversible contraception (LARC): Intrauterine device (IUD) and implant
  3. Centers for Disease Control and Prevention. Data brief 388. Current contraceptive status among women aged 15–49: United States, 2017–2019. National Center for Health Statistics.
  4. American College of Obstetricians and Gynecologists. Long-acting reversible contraception: implants and intrauterine devices.
  5. Office on Women's Health. Pelvic inflammatory disease.
  6. Uysal G, Nazik H, Okçu NT, Seyfettinoglu S, Kazgan H. Surgical removal of an extrauterine device migrating to appendix. Case Rep Med. 2016;2016:4732153. doi:10.1155/2016/4732153
  7. Centers for Disease Control and Prevention. U.S. selected practice recommendations for contraceptive use, 2016: Intrauterine contraception.
  8. Planned Parenthood. How does IUD removal work?
  9. Prine L, Shah M. Long-acting reversible contraception: Difficult insertions and removals. Am Fam Physician. 2018;98(5):304-309. PMID: 30216029.
  10. Asto MRD, Habana MAE. Hysteroscopic-guided removal of retained intrauterine device: Experience at an academic tertiary hospital. Gynecol and Minim Invasive Ther. 2018;7(2):56-60. doi:10.4103/GMIT.GMIT_11_18
  11. Sarver J, Cregan M, Cain D. Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: A case report. Case Rep Women's Health. 2021;29:e00287. doi:10.1016/j.crwh.2021.e00287
  12. Planned Parenthood. What are the side effects of IUDs?
  13. Dinehart E, Lathi RB, Aghajanova L. Levonorgestrel IUD: Is there a long-lasting effect on return to fertility?. J Assist Reprod and Genet. 2020;37(1):45-52. doi:10.1007/s10815-019-01624-5
  14. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF. Fertility after intrauterine device removal: A pilot study. Eur J Contracept Repro Health Care. 2015;20(3):223-230. doi: 10.3109/13625187.2015.1010639
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