IUD Removal in Istanbul: Missing Strings & Difficult Removal

Removal when the strings are visible

When the strings can be reached and there is no unexpected resistance, a clinician removes the device with controlled traction using an appropriate instrument. Brief cramping can occur, and the removed device is checked for completeness.

Significant pain, resistance or another unexpected finding calls for reassessment. Visible strings do not guarantee a straightforward removal. The device type and any previous unsuccessful attempt also matter.

Missing IUD strings: establish the location first

Strings may have retracted into the cervical canal or uterus, been cut short or broken. Expulsion and perforation must also be considered. “I cannot feel the strings” does not establish either that the device is correctly positioned or that it has fallen out.

Assessment may include a pregnancy test, examination and ultrasound. If ultrasound cannot clearly locate the device, further imaging may be needed. Intrauterine retrieval should not proceed without confirming its location.

Specialist instruments and ultrasound guidance

When the IUD is confirmed to be inside the uterus and office removal is suitable, instruments designed to retrieve the strings or the device may be used. Ultrasound guidance can be considered. The technique is selected for the individual device and clinical findings.

Source: Prabhakaran and Chuang: in-office retrieval of IUDs with missing strings.

Pain relief and anesthesia

Your previous experiences, anxiety and preferences should be discussed before the procedure. Removal without anesthesia may be suitable for some people, but cramps or pain can still occur. Pain relief, local anesthesia or a procedure in another setting may be appropriate.

You can ask for the procedure to stop at any time. Repeated attempts should not continue simply to complete removal without anesthesia. The aim is a suitable, tolerable and clinically appropriate procedure.

Embedded, broken or previously non-removable IUDs

If an IUD is thought to be embedded, its relationship to the uterine wall needs assessment. If a device is broken, the clinician considers whether any part remains. Previous reports and images can help avoid repeating an unsuccessful approach.

When might hysteroscopy be needed?

For a fuller explanation of uterine cavity assessment, pain relief and potential complications, see our English-language hysteroscopy guide.

Hysteroscopy allows the uterine cavity to be viewed with a camera. It may be considered when appropriate office retrieval has not been possible or when embedding or a retained fragment requires direct visualization. An IUD outside the uterus may need a different surgical approach. Missing strings alone do not determine which procedure is needed.

Source: FSRH guideline: intrauterine contraception.

Contraception before removal

If you do not want to become pregnant, use condoms or avoid intercourse for the 7 days before planned removal, and discuss the transition to your next method. Tell the doctor about recent sex without additional protection before removal, even if a same-day replacement is planned: a new device cannot always be fitted as expected.

If you cannot feel the strings, use additional contraception until placement has been assessed. Seek prompt advice if you have recently had unprotected sex, as emergency contraception may need consideration.

Source: NHS: getting a copper coil fitted or removed.

After IUD removal

The next steps depend on whether you want to conceive, continue contraception or address symptoms that led to removal. Follow the instructions given for your procedure. Pregnancy can become possible promptly after removal.

Frequently asked questions