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Contraception - Management
What should I do if the woman cannot feel the thread(s) of her intrauterine device (IUD)?

  • Confirm the location of the copper intrauterine device (IUD) by history, clinical examination, ultrasonography and radiography:
    • Assume expulsion until proved otherwise.
    • Ask the woman whether she thinks that the device has been expelled.
    • If there is no definite evidence of expulsion:
      • Perform a vaginal examination.
    • If no threads are visible on speculum examination and uterine placement of the copper IUD cannot be confirmed clinically:
      • Clinicians may prefer to refer women immediately for ultrasonography to locate the device.
      • Experienced clinicians may use an IUD thread retriever, Spencer Wells forceps, or uterine sonography to identify and retrieve the threads.
    • If the copper IUD is not visible on ultrasonography, arrange abdominal radiography to definitively confirm the presence of the IUD. Further imaging may be necessary to establish whether or not the IUD is extrauterine.
  • Expelled copper IUD:
    • Arrange for the woman to resume regular contraception.
    • Consider whether emergency contraception is indicated (see the CKS topic on Contraception - emergency).
  • Intrauterine copper IUD:
    • The options are conservative management (leaving the device where it is) or replacement.
    • Refer if partial perforation or embedment into uterine wall is suspected.
  • Extrauterine IUD or IUD embedded in uterine wall:
    • Refer for specialist management.
Basis for recommendation
  • These recommendations are based on guidelines published by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2004a].

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