Intrauterine Devices (IUDs) are one of the long-acting reversible contraception (LARC). However, it is not 100% foolproof and while you still have an IUD inserted in place, an unplanned pregnancy can take place. If you decide to go through a medical abortion for the pregnancy, you may wonder if the IUD can stay in or should be removed.
To answer this, yes, it is mandatory to remove the intrauterine device for birth control before you start with medical abortion. In this blog, we will explore the reasons why IUD should be removed before a medication pregnancy termination, the process of removal, and expectations for safety and wellness.
Why to Remove the IUD Before Medical Abortion?
You may use a combination of Mifepristone and Misoprostol pills or the MTP Kit to begin with a medical abortion. The pills cause uterine contractions, ripen the cervix, and bring some biological and hormonal changes that expel the pregnancy tissues. The IUD is a T-shaped and thin plastic or copper contraceptive device.
So, an IUD is a foreign object that if left inside the uterus during the abortion may cause health and medical risks as follows:
1) Risk of Uterine Perforation
In a medical abortion, Misoprostol pills cause uterine contractions frequently. With the IUD inside, the muscle movements may push the device on the uterus wall, causing perforation and injury. This can lead to organ damage as well as internal bleeding.
2) Interference with the Process
The shedding of uterine lining happens through the antiprogesterone activity of Mifepristone pill. However, with an inserted IUD, the passage of endometrial lining, pregnancy tissues, and blood clots becomes harder. Also, the uterine muscles do not contract uniformly, increasing the risk of an incomplete termination.
3) Infection (Pelvic Inflammatory Disease)
IUD during a pregnancy may raise the risk of pelvic infection. Plus, if you induce an abortion with MTP Kit pills, an IUD within the womb may increase the risk of PID or Pelvic Inflammatory Disease, impacting future fertility until timely treatment happens.
4) Ectopic Pregnancy Screening
If a pregnancy occurs with an IUD already active in the uterus, the risk of an extrauterine pregnancy or an ectopic pregnancy also increases. Here, the implantation happens outside the uterus, mostly in the fallopian tubes. So, an IUD removal can help detect the pregnancy location as well via an ultrasound, checking for an ectopic pregnancy.
The Intrauterine Device Removal Process: Step-by-Step
It may take five minutes and a clinical procedure to remove the IUD. This is how the removal procedure for an intrauterine birth control device may seem like:
1) Confirmation and Ultrasound
Before removal begins, the physician will conduct an ultrasound. The scan reveals the gestational age and the pregnancy location, along with the IUD location in relation to the implanted embryo.
2) The Removal
During the IUD removal, you lie down on the examination table. The healthcare professional will see the cervix using a speculum to understand where the IUD strings are. Then a special tool is used to apply gentle pressure on the strings. This allows the IUD to come out easily from the cervical canal.
3) Determining the Pregnancy
The process of removing the intrauterine device may sometimes result in a miscarriage. So, the doctor will keep you under observation for a few minutes to check if the vaginal bleeding starts. In case the pregnancy remains as it is after the IUD is removed, then you may go ahead with the Mifepristone dose and follow the other pills as indicated by the physician.
What If the IUD Strings Are Missing?
Especially if you are pregnant or otherwise, never pull out the IUD yourself. Here is what can happen in certain instances:
→ The IUD strings may coil up in the uterus or cervical canal. This makes it hard to see the IUD or the removal strings during the routine examination.
→ In case the doctor is unable to find the strings, they may use a string hook or a small brush to retrieve them.
→ If the IUD moves from its original position, then a small surgical procedure needs to be done before the beginning of a medical abortion.
Pain and Physical Sensations
Most women may experience a momentary sharp pain or pain, or a sensation of a heavy tug and mild cramping when the IUD removal is under process. However, if the removal is done during a pregnancy, the cervix is softer than before, and that reduces discomfort compared to the insertion time. If there is any cramping, expect relief within 10 to 15 minutes.
Timing the Medical Abortion After IUD Removal
When the intrauterine device for contraception is finally removed, you can begin with the medical abortion with MTP Kit medicines as asked by your doctor. Here is how to go about with the abortion pills:
→ Take Mifepristone 200mg orally with water at the clinic or home. This causes the endometrial lining to disintegrate and prepare the reproductive organs for the next step of the abortion by detaching the fertilized egg from the implantation tissue.
→ After 24 to 48 hours, you may use 4 x Misoprostol 200mcg pills buccally or sublingually, avoiding vaginal use especially if the IUD is removed recently. The pills result in cervical dilation and uterine contractions via the prostaglandin mechanisms.
→ The pregnancy tissues are expelled. The contractions may cause abdominal cramps, pain, and heavy vaginal bleeding to facilitate the MTP Kit aided abortion. You may take over-the-counter medicines to manage side effects such as the pain, nausea, vomiting, dizziness, stomach upset, etc.
Frequently Asked Questions (FAQs)
Here are some common queries about IUD removal before a medical abortion:
1) What is the risk if I leave the IUD in during the abortion?
If the IUD stays within the uterus and you begin using abortion pills, the risk for intense pain, uterine performance, heavy bleeding, life-threatening infections such as PID, and an incomplete abortion highly increases.
2) Can I have a medical abortion if my IUD strings are not visible?
The doctor must locate the IUD strings and remove the device before you can begin with the medical abortion. If the strings are not visible or missing, the physician will use a special hook or tool along with an ultrasound for guidance, to retrieve this birth control device.
3) Does removing the IUD cause a miscarriage automatically?
Not always, but removing the IUD at times may trigger a spontaneous abortion due to pressure or irritation of the uterus or cervix during the process. However, you may still need to take abortion pills if the doctor recommends.
4) Is IUD removal more painful when you are pregnant?
Due to hormonal changes in pregnancy, the cervix is mostly softer and ripened than when you are not pregnant. Thus, the removal process of an IUD is usually less painful than otherwise.
5) How soon after IUD removal can I take the abortion pill?
After removal of the IUD, which usually takes only a few minutes in a clinic, you can start with Mifepristone the same day if the doctor gives approval.