Step One: Deciding To Remove Your IUD
While the IUD is removed after its designated time is up, that’s not the only reason a patient might decide to have their’s taken out.
“Women will choose to remove their IUD for any number of reasons,” explains Yesmean Wahdan, MD, practicing Ob/Gyn and associate medical director at Bayer Women’s Healthcare. “Whether they’re having a complication with it or if it’s a product like Mirena which lasts for five years, but she decides after two years she wants to get pregnant, she can go in and get it removed.”
Usually, a complication with the IUD makes itself known fairly quickly after insertion through pain or discomfort, which is why a patient would want to get theirs removed ASAP.
“I got my first one two years ago, so January of 2015,” says Ashley, 24. “My gyno was amazing about inserting it… however, the afternoon after up until two weeks after, I was in a lot of pain. So, during my next check-up, she checked its placement with the ultrasound again and discovered it moved slightly and decided to remove it.”
Step Two: Prepare For The Appointment
Just like getting an IUD inserted, getting an IUD removed can cause cramping. “Usually, we would have told the patient to take Motrin a half hour before,” says Dr. Carolyn Alexander, MD, practicing Ob/Gyn at the Southern California Reproductive Center. “If a patient has a very large uterus, then… we usually explain to them that sometimes it can be difficult to get the IUD out.”
A lot of what to expect depends on your individual body and what the provider feels is best, so ask questions to ensure you’re doing what you can to make the process as smooth as possible.
Step Three: Actually Go To The Appointment
A quick Google search reveals that people often take matters into their own hands and remove their IUDs themselves — but do not do this. “We don’t generally recommend that,” says Dr. Wahdan. “Because we don’t want you to run into any snags.”
There’s a lot of information about your uterus that your provider knows which impacts how the device is removed. If there’s any kind of anomaly, especially if your uterus is not directly in line with your body, removing an IUD takes the technique and skill of a medical professional, without which the process could end up causing harm, like scratching and injuring the uterine wall or the cervix.
Plus, the appointment is a good time to ask your provider questions.
“If you go into the provider to remove your IUD, you then need to have a conversation with your provider about what your plans are,” Dr. Wahdan continues. “If your plans are to get pregnant, then great, you can talk to your provider about how to prepare yourself for the pregnancy.”
She adds: “But if you just don’t want the IUD for one reason or another, and you want a different contraceptive option, then that would be a great time to talk to your provider about what’s available for you.”
Step Four: The Procedure
As Sam, 25, put it: “Fortunately, there weren’t any issues with taking it out. I was on the table as I would be for a normal exam, speculum in, ultrasound on my lower abdomen, and they basically just yanked it out.”
That’s not too far off from how doctors describe it, either.
“Usually we put in the little speculum to open up the walls of the vagina,” explains Dr. Alexander “And then we would want to know the position of the uterus (meaning, if it’s anteverted or anteflexed or retroverted), because it might influence the way you pull on the strings. Then, once the speculum’s in, we take forceps to… get a firm grasp on the strings to carefully pull it out.”
And provided there aren’t any issues, the procedure is short and sweet. “Preparation and setting up for the process takes longer than the actual removal,” says Dr. Wahdan. “Based on personal experience, as long as everything goes as planned, it literally takes two minutes.”
The pain can vary, but Dr. Alexander says that people often say it’s less painful than getting an IUD put in, but that really depends on the circumstances.
“Getting it out hurt so much worse than having it put in,” Sam remembers. “But I suspect that was due to the fact that it was crooked, bent, and stuck.”
On the other hand, Hannah, 27, had no issues: “The removal was the least bad part, in my opinion!”
Step Five: Deal With Any Possible Complications
So we keep hearing about “things going smoothly,” but what if they don’t? There are a few complications that can arise, the most basic being that the provider can’t find the strings used to pull the device out.
“If the strings are really short, then we have a little hook,” says Dr. Alexander. “It’s teeny and it goes in, and you can actually kind of swivel in there and the strings can come out so that we can get a better grasp on the strings.”
If the complications are a little more, well, complicated, then Dr. Wahdan says that there are a couple red flags that providers are trained to recognize, namely that the IUD does not come out as easily as they’d expect. This could mean the device is perforated or embedded, which is something that would happen at the time of insertion but not be recognized.
“When you place the IUD you insert it up until the fundus, and it stays there,” Dr. Wahdan explains. “But in the case of perforation, the insertion can go beyond the fundus, beyond the wall of the uterus, and basically poke through the wall of the uterus… Embedment means it’s in the wall of the uterus.”
If that is the case, the patient may need a procedure to look inside the uterus and see what’s going on, or if it’s perforated, a little more invasive surgery to find the IUD and remove it.
“Those happen less than 1% of the time,” Dr. Wahdan emphasizes. “But they are risks.”
Step Six: The Recovery
A typical removal (read: without complications) is usually pretty quick to recover from. Both Dr. Alexander and Dr. Wahdan warn that there will be some cramping, but other than that, patients are up and about much sooner than they were after the process of getting one inserted.
“Only if it was not able to get removed would we think to try again with a medicine that opens up the cervix or under light sedation,” says Dr. Alexander. If sedation or surgery is involved in removing the IUD, then recovery is a bit more involved, and your doctor will have the best recommendations for how to best aid the process.
Step Seven: Payment
The money question always depends on your health plan coverage, but Dr. Wahdan recalls that removal is generally covered under the global fee for an IUD. “But again,” she stresses. “It depends on the person’s type of coverage.”
Step Eight: Moving Forward
What comes after removal depends on your reason for the appointment in the first place. If the IUD was removed because it reached the end of its time limit, and you still want to continue using contraception, the next IUD could in fact be inserted in the same appointment. This is also the case for something like the arm implant. If you want to switch to the pill, then you would start that based on your menstrual cycle.
That’s the choice Sam made when it came to removal: “I opted to go back on a pill after getting it out, because I prefer to have the control, rather than leave it up to something I can’t see or fix if something goes wrong.”
If you’ve decided to remove the IUD in order to get pregnant, then your provider can best advise you on next steps. However, if preventing pregnancy is still your intention, then there are some important things to keep in mind.
“Nobody wants to have an ‘oops’ pregnancy in the interval in between,” explains Dr. Alexander. “If they have the IUD removed and had unprotected intercourse in that week, they could ovulate.”
And when switching to a new contraception, whether that’s another IUD or something like the Pill, there’s an interval of uncertainty. “I hesitate to say that you’re fully covered for about two weeks,” Dr. Alexander adds.