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My doctor cannot locate my Mirena IUD, what should I do? #503/13

Hello, I had a hysteroscopy to remove an IUD a couple of weeks ago, but the doctor did not see anything.  So, I am thinking that the IUD had to have expelled itself. Should I spend the extra money to have the CT scan done?  Wouldn’t the doctor have been able to see something, even if it was embedded in my uterus?



Good afternoon!


Before I answer more fully, please tell me:

1.      What has your doctor said about the location of your IUD?

2.      When ws this IUD inserted?

3.      What kind of IUD is/was it?

4.      Describle in detail the moments during which your IUD was inserted.  How much pain was there?  Was it ever what you might call sharp pain?  Did you scream out?

5.      How often and for how long after insertion were you able to feel the strings of your IUD?

6.      How old are you?

7.      What is your pregnancy history and do you plan to become pregnant in the future?

8.      Finally, and perhaps most important, what else do you want me to know about you?


Please send me these answers to my questions and I will be able to give you some thoughts.


Her email reply on 5-3: “I had the Mirena inserted in 2010, so I have had it in 3 and a half years.    When I had it inserted it was painful, mostly crampy, but some sharp pain here and there (nothing to make me yell out though).  I was almost ready to just go on the pill, because the doctor seemed to have a hard time getting it in, but he finally got it.  So yes, I would use the word painful! 


I am 32 years old.  I have had two pregnancies.  I decided to have the Mirena put in after my second pregnancy.  I went in a couple months ago to have it removed because we want to have another child now.   The doctor could not find it, so I had an ultrasound done.   All we could see was a shadow.  Could not see a clear picture of the IUD.  The doctor said where the shadow was it looked to be where it should.  I went in to have a hysteroscopy a few weeks ago to have it removed and the doctor did not see anything.  Now I have a CT scan scheduled for next week to see if it’s even in there.  I have just been bothered by the fact that even I saw the shadow in the ultrasound, so I was confused when he couldn't find it with the hysteroscope. 


 No, I have never been able to feel my strings.  I remember checking after I got home from having it put in and I could not feel anything.  I heard that the doctor that put it in tends to cut the strings short when he inserts IUDs. 


I know you cannot give me an actual diagnosis.  I am just wondering if the chances of the IUD being expelled at some point are more likely than it being embedded. Do you think I should go back and pay the money to discuss this with my doctor?   I am paying for the CT scan out of pocket and just wondering if it’s even worth having done. 


I do have a heavy period that lasts one day each month, but my period never went away completely after I had the Mirena put in, although it did lighten up. Recently I noticed it has been heavier, but still only lasts one day whereas before I had the Mirena put in, my periods lasted 4 days. 


Thank you for your time!”


Several things suggest that there is a possibility that your IUD was placed though the uterine wall in the process of insertion.  You experienced sharp pain – enough to almost go to the pill rather than to complete insertion.  Then you never felt the strings.  Now the IUD has not been found at hysteroscopy or ultrasound.


You could however, have expelled your IUD, in which case it will not show up on the CT scan.


Please keep me posted after the scan.

What is your status today, May 24th?


Her email reply on 5-25: “Hello!  I had the CT scan done and it did perforate the uterus.  The doctor said it looks to be behind the bladder somewhere.  Now I am waiting to have a laproscopy done to find and remove it.”


To learn more about the advantages and disadvantages of the Mirena IUD, go to:

www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?


Key words: hysteroscopy, IUD, expelled, CT scan, embedded, uterus, pain, cramps, strings, pregnancy, Mirena (levonorgestrel) IUD, pills, removed, ultrasound, shadow, heavy periods, uterine wall

Posted 5-12-2013, Updated 5-18-2013, May 25, 2013

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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