| Cramping/bleeding | Most common adverse effect (12% of removal requests). Menstrual blood flow usually increases by 10 to 35 mL. Rate of removal for bleeding and cramping increases the later in the menstrual cycle the IUD is inserted. | Administer NSAID. Evaluate for infection if symptoms are persistent or excessive. If symptoms persist for more than three to four cycles or fail to respond to treatment, consider removing the IUD. |
| Expulsion | Occurs in 1 to 7% of women in first year of use. Most frequent in first three months. More common in younger women and nulliparous women. Increased risk in women with painful menstruation or heavy menstrual flow. Replacement IUD inserted after expulsion is less likely to be expelled. Pregnancy may be the first sign of expulsion. Expulsion rate decreases the later in the menstrual cycle the IUD is inserted. | Remove partially expelled IUD. Replace IUD or use other form of birth control. |
| Failure/pregnancy | In the presence of an IUD, 50 to 60% of pregnancies spontaneously abort. One half of these abortions occur in the second trimester. This risk drops to 20% when the IUD is removed. Septic abortion is 26 times more common in patients with an IUD. Copper T IUDs protect against ectopic pregnancy, while progesterone-releasing IUDs increase the risk of ectopic pregnancy almost twofold. This risk decreases as the amount of progesterone increases. The failure rate increases the later in the menstrual cycle the IUD is inserted, especially after day 17. | Perform a pregnancy test if patient has any unusual delay in menses. Perform an ultrasound examination to determine location of the pregnancy and the IUD. Remove IUD as soon as pregnancy is diagnosed. |
| Uterine perforation | Occurs in 0.1 to 0.3% of IUD insertions. Usually happens at the time of insertion. May tear into or through uterine wall or through cervix into vagina. | Remove IUD surgically when perforation is recognized, by laparoscopy, if intra-abdominal. |
| Misplaced IUD string (tail) | May be due to expulsion or perforation. First sign of pregnancy can be a drawing up of the tail into the uterus. | Rule out pregnancy. If pregnancy test is negative, explore endocervical canal for tail. If unable to locate tail, obtain ultrasonograph or radiograph to locate IUD. If no evidence of an IUD, consider inserting new IUD or using another form of birth control. If IUD is present within the uterine cavity, continue with observation or replace it. |