Intrauterine Device (IUD) Removal in India and UAE | Complete Patient Guide

• Patients whose copper or hormonal IUD has reached or exceeded its licensed effective lifespan (copper: 5–10 years; LNG-IUS: 3–8 years depending on formulation)

• Patients planning conception who require IUD removal prior to attempting pregnancy

• Patients experiencing medically significant side effects including menorrhagia, chronic pelvic pain, recurrent dyspareunia, or systemic hormonal intolerance attributable to the device

• Patients diagnosed with pelvic inflammatory disease (PID) or tubo-ovarian abscess (TOA) requiring device removal as part of antibiotic management

• Patients with confirmed IUD malposition on transvaginal ultrasound (low-lying device, rotated device, or device with one or both arms embedded in the myometrium)

• Patients with a fractured or partially expelled device identified on pelvic X-ray or ultrasound

• Patients with suspected or confirmed partial uterine perforation (IUD arms penetrating the myometrium ≥50% of its thickness or extending into the peritoneal cavity)

• Patients who are post-menopausal and wish to have the device removed

REQUIRED DIAGNOSTICS PRIOR TO REMOVAL:

• Transvaginal ultrasound (TVUS): mandatory first-line imaging to confirm IUD location, assess string visibility, and evaluate myometrial embedding depth

• 3D transvaginal ultrasound or saline infusion sonohysterography (SIS): indicated when standard 2D TVUS does not clearly delineate device-to-myometrium relationship

• Plain pelvic X-ray (AP and lateral): indicated when TVUS cannot localise the device, to exclude complete uterine perforation with intraperitoneal migration

• High-sensitivity urine or serum beta-hCG: mandatory before any removal procedure to exclude concurrent intrauterine pregnancy

• Endocervical swabs for Chlamydia trachomatis and Neisseria gonorrhoeae (NAAT): indicated if PID is suspected

• Full blood count (FBC) and coagulation screen: required if operative hysteroscopy or laparoscopy under general anaesthesia is planned

CONTRAINDICATIONS TO OFFICE/OUTPATIENT REMOVAL (REFERRAL TO OPERATIVE SETTING REQUIRED):

• Confirmed complete uterine perforation with intraabdominal IUD migration (requires laparoscopic retrieval)

• IUD embedded >50% of myometrial thickness confirmed on 3D TVUS (significant perforation risk with transcervical traction)

• Uncontrolled active PID with haemodynamic instability (stabilise with IV antibiotics before removal)

• Known or suspected concurrent intrauterine pregnancy where removal may precipitate miscarriage (requires specialist shared decision-making)

ROUTINE TRANSCERVICAL REMOVAL (OUTPATIENT / OFFICE-BASED):

The standard technique requires no anaesthesia or only topical cervical anaesthesia (lidocaine gel 2% applied to the ectocervix). The clinician visualises the cervix with a bivalve speculum, identifies the IUD strings at the external os, and grasps them with Allis or sponge-holding forceps. Steady, continuous traction along the uterine axis causes the device arms to fold inward as it passes through the internal os. The procedure typically takes under 5 minutes. Oral NSAIDs (e.g., ibuprofen 400–600 mg) taken 60 minutes prior reduce procedural discomfort. No recovery period is required, and the patient may resume normal activities immediately.

HYSTEROSCOPIC IUD RETRIEVAL (OFFICE OR OPERATIVE SETTING):

Indicated when IUD strings are absent, retracted into the endocervical canal, or when ultrasound confirms partial embedding. Two approaches are used:

• Office/Mini-hysteroscopy (vaginoscopic approach, 3–4 mm hysteroscope, no speculum, no tenaculum): Performed under paracervical block or nitrous oxide analgesia. The IUD or its strings are visualised directly. Grasping forceps (5-French) or a hook electrode is passed through the working channel to retrieve the device. Success rate: 85–92% for strings-missing cases without significant embedding.

• Operative hysteroscopy under general or spinal anaesthesia: Indicated for devices with myometrial embedding, broken or fragmented IUDs, or when office hysteroscopy fails. A 5 mm continuous-flow resectoscope with monopolar or bipolar energy allows careful dissection of embedded device arms from the myometrium before extraction. Simultaneous laparoscopic monitoring (the 'combined approach') is added when perforation risk is assessed as high based on preoperative imaging.

LAPAROSCOPIC RETRIEVAL:

Required when the IUD has completely perforated the uterus and migrated intraperitoneally. Under general anaesthesia, a 10–12 mm umbilical port and one or two 5 mm ancillary ports are placed. Laparoscopic graspers retrieve the device from the peritoneal cavity, the bladder wall, the broad ligament, or the omentum—the most common sites of migration. Uterine repair with absorbable sutures is performed if the perforation site requires closure. Typical operative time: 30–60 minutes. Overnight hospital stay is standard.

ULTRASOUND-GUIDED TRANSCERVICAL REMOVAL:

For partially embedded devices without full perforation, real-time transabdominal or transvaginal ultrasound guidance during transcervical retrieval reduces the risk of incomplete removal and uterine perforation. This technique is increasingly performed in high-volume centres in India and the UAE as a first step before escalating to hysteroscopy.

PHARMACOLOGICAL ADJUNCTS:

• Misoprostol 400 mcg (sublingual or vaginal, administered 2–4 hours before the procedure): Used to soften and dilate the cervix in nulliparous patients or those with cervical stenosis, reducing the force required for transcervical passage and minimising risk of perforation.

• Paracervical block with 1% lidocaine (10 mL): Standard pharmacological support for office hysteroscopy.

• Prophylactic single-dose antibiotics (azithromycin 500 mg or doxycycline 100 mg): Considered in high-risk patients (positive STI screen, history of PID) undergoing operative retrieval.

STEP 1 — PRE-TRAVEL CONSULTATION (2–4 WEEKS BEFORE TRAVEL):

GAF Healthcare coordinates a secure teleconsultation between the patient and the assigned gynecologist. The patient uploads recent TVUS or 3D ultrasound reports, pelvic X-rays (if applicable), and a summary of IUD insertion history (device type, date of insertion, inserting clinician's notes). The specialist reviews imaging and classifies the case as routine, intermediate (strings missing, office hysteroscopy likely), or complex (embedding or perforation confirmed, operative intervention required). A personalised treatment plan, cost estimate, and travel timeline are issued within 48 hours.

STEP 2 — ARRIVAL AND SAME-DAY OR NEXT-DAY PRE-PROCEDURE ASSESSMENT:

On arrival, the patient undergoes a repeat TVUS (mandatory, as IUD position can change) and a clinical examination. Blood tests (beta-hCG, FBC, coagulation) are drawn if operative intervention under anaesthesia is planned. The anaesthesiologist reviews the patient if general or spinal anaesthesia is anticipated. Written informed consent is obtained with a GAF Healthcare patient advocate and, if required, a certified medical interpreter.

STEP 3 — THE REMOVAL PROCEDURE (DAY 1 OR DAY 2):

• Routine removal: Performed in an outpatient clinic room or minor procedures suite. Duration: 5–10 minutes. The patient rests for 30–60 minutes post-procedure and is discharged.

• Office hysteroscopy: Performed in a dedicated endoscopy suite under paracervical block. Duration: 20–40 minutes. The patient is observed for 1–2 hours and discharged.

• Operative hysteroscopy or laparoscopic retrieval: Performed in a fully equipped operating theatre. Duration: 30–90 minutes. The patient recovers in a post-anaesthesia care unit (PACU) and is admitted for 4–12 hours of overnight observation, or up to 24 hours if laparoscopy was performed.

STEP 4 — IMMEDIATE POST-PROCEDURE RECOVERY (HOURS TO 24 HOURS):

Mild uterine cramping and light spotting are expected for 24–48 hours post-removal. NSAIDs (ibuprofen 400 mg every 8 hours for 2–3 days) are prescribed for analgesia. The patient is advised to avoid sexual intercourse, tampon use, and strenuous physical activity for 48–72 hours (routine) or 5–7 days (operative procedure).

STEP 5 — PRE-DISCHARGE REVIEW AND FIT-TO-FLY ASSESSMENT:

• Routine removal: Fit to fly within 24–48 hours. No restrictions on air travel.

• Operative hysteroscopy (without general anaesthesia complication): Fit to fly within 3–5 days. Mild activity restrictions for 1 week.

• Laparoscopic retrieval under general anaesthesia: Fit to fly within 5–7 days. A clinical review and a brief written Fit-to-Fly certificate are provided by the treating surgeon before departure.

STEP 6 — POST-DEPARTURE FOLLOW-UP:

GAF Healthcare arranges a structured telemedicine follow-up at 2 weeks and 6 weeks post-removal. The treating gynaecologist provides a full discharge summary and operative report (if applicable) for the patient's home-country physician. If the patient desires immediate alternative contraception, this is discussed pre-discharge and prescriptions are issued where appropriate.