Ultrasound use during IUD removals is on the rise
More and more providers are turning to ultrasound for guidance during complex removals of intrauterine devices (IUDs), according to new data.
The popularity of IUDs for long-term contraception has seen significant growth over the last decade. IUDs provide women with all the benefits of birth control without requiring them to receive injections or take oral pills daily.
After insertion, most IUDs remain in place for several years before they need to be removed. These removals are routinely completed in outpatient offices, but occasionally when complications make removals more challenging, providers are forced to utilize additional tools for assistance.
“Most IUD removals are routine, but complications can arise from missing strings, uterine wall embedment, perforation, or malposition. Management typically begins with a cytobrush attempt, followed by ultrasonography if unsuccessful,” Meaghan Coles, MD, with Northwell Health South Shore University Hospital in New York, and colleagues explained. “In some cases, further evaluation with abdominal X-ray, hysteroscopy, or laparoscopy is required.”
As popularity for IUDs has increased, so too have removals. As such, rates of complicated removals have risen as well. The majority of IUD removals take place in clinics that specialize in women’s health; these clinics also happen to routinely keep ultrasound equipment on hand, making the tool a valuable instrument for assisting in safe IUD removals.
To get a better idea of how common ultrasound use is during IUD removals, researchers retrospectively analyzed the cases of women seen at a large New York Health System between 2017 and 2020. Instances of complicated versus uncomplicated (strings visible, no added assistance needed) were compared alongside the use of additional tools and the need for surgical removal in an operating room.
Of the more than 1,800 removals 11.4% were considered complicated. Of those, ultrasound guidance was utilized in 21%, while 30.2% eventually required surgical intervention. Older women and Spanish-speaking women were more likely to endure a complicated removal than their peers, further emphasizing known disparities in women’s health. Unlike previous studies on the subject, the group did not observe a relationship between higher BMI and complication rates.
The group suggested that their findings highlight a need to keep patients better informed on the risks of the procedure and the potential for complications, both of which remain minimal.
“Online narratives such as those on TikTok, where 40% of IUD-related content describes negative experiences, may contribute to patient concerns,” the authors noted. “However, our study showed that complicated removals are relatively uncommon in comparison. Recognizing this gap between perceived and actual complication rates is important for effective counseling.”
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.