IUDs are typically removed by clinicians during a pelvic exam in the office. There can be numerous barriers to this arrangement, such as difficulty scheduling an appointment, concern about appointment cost, and clinician refusal of patient’s request for removal. Unsurprisingly, these barriers can raise patients’ concerns about ability to retain control over their own reproductive health. Additionally, patients may hesitate to choose a contraceptive option that requires not one, but two pelvic exams.

IUD self-removal by the patient is a safe alternative to the usual office removal. Clinicians should leave strings relatively long for patients who want the option of self-removal. The most effective position for self-removal is squatting or lying down. The patient uses their fingers to feel for the IUD strings. Exam gloves can help improve traction on the strings, but are not essential. The patient grasps the IUD strings and pulls firmly towards the opening of the vagina. As the IUD moves out of the uterus, the patient likely will feel cramping.

Once the IUD is removed, it should be checked to ensure that it has no parts missing. Patients can find pictures of the type of IUD they have on the RHAP IUD Facts patient hand-out or by using a search engine such as Google. Most patients have some spotting and cramping for up to a few days after removal, and they may get pregnant immediately after the IUD is removed if they have unprotected sex.

Patients should call their clinician if they can’t feel strings, if the IUD can’t be easily removed from the uterus with gentle traction, or if the IUD is not removed in its entirety. Additionally, patients should reach out for heavy bleeding, foul smelling vaginal discharge, or fever/chills after IUD removal.

Resources

RHAP IUD Fact Sheet

Sources

Amico JR, Bennett AH, Karasz A, Gold M. Taking the provider “out of the loop:” Patients’ and physicians’ perspectives about IUD self-removal. Contraception. 2018 Oct 1;98(4):288-91.

Foster DG, Grossman D, Turok DK, Peipert JF, Prine L, Schreiber CA, Jackson AV, Barar RE, Schwarz EB. Interest in and experience with IUD self-removal. Contraception. 2014 Jul 1;90(1):54-9.

Raifman S, Barar R, Foster D. Effect of knowledge of self-removability of intrauterine contraceptives on uptake, continuation, and satisfaction. Women’s Health Issues. 2018 Jan 1;28(1):68-74.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.