Facilitating Safe Removal
There is no formal CoSRH training for IUD removal: follow local pathways for developing and maintaining competence. CoSRH resources to support clinicians removing IUC:
CoSRH Bitesize: Intrauterine contraception (IUC) removal | CoSRH
- E-lfh eSRH Module 15, Section 10 “Removal of IUC”.
Clinicians removing LNG-IUDs should be:
- Able to discuss ongoing contraception needs and provide this or signpost to another provider.
- Able to provide preconception counselling or signpost to another provider.
- Able to recognise pregnancy risk and the need for Emergency Contraception
- Competent at speculum examination
- Able to recognise an abnormal cervix and know how to refer for further examination.
- Aware of how to manage non-routine findings (e.g. non-visible threads).
Timing of LNG-IUD removal or replacement
- Individuals who do not wish to become pregnant should be advised to avoid UPSI for 7 days prior to IUD removal.
- Individuals should be advised to avoid UPSI for 7 days prior to IUD removal and replacement in case it is not possible to insert the new device.
Table 4: LNG-IUS removal [from CoSRH Clinical Guideline: Intrauterine contraception (March 2023)]
|
Situation |
Advice |
|
Removal for a planned pregnancy |
· Offer preconception advice · IUD can be removed at any time · User should be advised that pregnancy is possible as soon as IUD removed |
|
Removal – not for planned pregnancy and not switching to an alternative |
· Abstain/use condoms in the 7 days prior to removal · If there has been UPSI in the 7 days prior to removal, ideally defer IUD removal until no UPSI for 7 days · Where this is not possible, consider EC AND Recommend a PT 21 days after the last episode of UPSI |
|
Removal – menopause |
· Contraception is no longer required when an individual: o Is aged 55 years o OR is an LNG-IUD user, aged >50 years, and an FSH ≥12 months ago was ≥30 IU/L · IUC should normally be removed when it is no longer required and not left in situ indefinitely · Although no longer required for contraception, an individual may continue to use a 52 mg LNG-IUD for endometrial protection as part of HRT. This should be replaced very 5 years. |
|
Removal and replacement |
See table 3 – timing of insertion |
|
Removal – switching to an alternative method of contraception |
See CoSRH Guidance Switching or Starting Methods of Contraception |
Unexpected findings at IUD removal
On removal of an IUD check the device is intact and that it is the expected device and therefore the correct information about duration of use/follow-up/ongoing contraception has been given.
For advice with regards to broken or /incomplete device refer to CoSRH Clinical Guideline: Intrauterine contraception (March 2023)
fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf
Removal of an unusual device
For advice with regards to IUDs inserted abroad where the clinician is not familiar with the device refer to CoSRH Clinical Guideline: Intrauterine contraception (March 2023)
fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf
Difficult removals:
Most IUD removals are straightforward. Difficult IUD removals may be due to a number of factors including anatomical variations, IUD malposition (including perforation), clinician experience and/or the level of pain or discomfort experienced. When there is difficulty in removing an IUD, a referral should be made to an experienced provider.