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My Mirena IUD strings were cut too short. Will it be difficult for my IUD to be removed? #1003/8
At my 6 week checkup after insertion, the doctor realized the strings of my Mirena IUD were cut too short. At my one-year checkup, they told me that it might be difficult to remove. How would they remove it if they can't get to the strings?

Usually it is not very difficult to remove an IUD in this situation.  And the strings may reappear over time.  The strings are usually very close to the opening of the cervix into the vagina.

 

Below are several paragraphs by Dr. David Grimes from his chapter on IUDs in the 19th edition of Contraceptive Technology.

 

 String Problems

Missing strings may signal an unsuspected perforation or spontaneous expulsion; alternatively, some strings ascend into the endometrial cavity and descend without known explanation. Ultrasound examination can quickly confirm the presence of an IUD within the endometrial cavity. Should the device be present but no strings visible and should the woman request its removal, a cotton swab or endometrial biopsy instrument can sometimes tease the strings from the endometrium to the endocervix.

 

Removal of a T-shaped device without visible strings has two prerequisites: the patient’s comfort and cervical dilation. A paracervical block or intrauterine instillation of anesthetic administered before manipulation, supplemented by an oral analgesic, can decrease the pain associated with the procedure. Second, osmotic dilators left in the os overnight, or misoprostol 400 mcg (vaginally or orally), will dilate the cervix. Gentle exploration with an alligator forceps usually yields the device quickly; if not, ultrasound guidance may be helpful. Rarely are the expense and inconvenience of hysteroscopy required for IUD removal.

 

Several mechanical problems relate to string length. If the male partner complains of penile discomfort from the string being cut too short, one option is to cut the strings off even shorter within the endocervical canal. This may eliminate the barb-like sensation and obviate the need to replace the IUD. If the strings initially are too long, simply trim them. If the strings become longer at a later time, check for partial expulsion of the IUD.

 

  

Key Words:  6 week checkup, Mirena IUD, strings, cut too short, difficult, remove, reappear, cervix, vagina, Dr. David Grimes, Contraceptive Technology

 

Reference:

Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J, Nelson AL. et al Contraceptive Technology 19th edition: page 125: Ardent Media Inc. 2008

 

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2008-10-9


Managing Contraception for Your Pocket 2013-2014
  


Managing Contraception for Your Pocket 2013-2014
  

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