INTRAUTERINE CONTRACEPTIVE DEVICE (IUD): REMOVAL

DEFINITION

Steps to follow in removing a patient’s Intrauterine Device (IUD).

SUBJECTIVE

Mustinclude:

1. LNMPand menstrual history.

2. Medicalandsexualhistoryupdate.

3. Historyofanyrecentintercourse,ifpatientnotcurrentlymenstruating(maywantto delayremovalif recentexposure).

4. DocumentationofreasonforIUDremovalrequest.

5. IfpatientwantstocontinueIUDuse,but isrequestingremovalbecauseherIUDhasbeeninplacefor thenumberofyearsforwhichitisrecommended,consultwithMDtodetermineifanoff-label extensionofyearsofuseispossible.

OBJECTIVE

  1. Pelvicexamination.CheckforanysignsofinfectionorincorrectIUDplacement.

LABORATORY

Mustinclude:

1. Hemoglobin/hematocrit(ifhistoryofexcessivebleeding).Ifanemianoted,consult with MD.

2. Negativesensitivepregnancytestifpatientsymptomatic(Iftestpositive,seeIUDComplications- DelayedMensesprotocol.)

ASSESSMENT

Candidate for IUD removal

PLAN

1. IfIUDstringsvisible:

a. IfthereareanysignsorsymptomsofcervicalinfectionorPID,provideappropriatesystemic antibioticsandadministerfirstdosepriortoremoval.

b. RemoveIUDfollowingmanufacturer’sinstructions.

2. IfIUDstring(s)aremissingorbreakduringremovalattempt,refertoIUDComplications-Missing String(s)protocol.

3. IfIUDhasbeeninplaceformorethan5 yearsorifpatienthasbeenexperiencinganysignsor symptomsofuppertractinfection(e.g.,vaginaldischargeorlowerabdominalpain),considertesting IUDorIUDscrapingsforactinomycis.

4. Ifpatientseekingpregnancy,providepreconceptionalcounseling.

5. Ifpatientdesirescontraception:

a.Ifpatienthasre-qualifiedforanIUD,youmayplaceanotherIUDthissamevisit.(SeeIdentificationofIntrauterineContraceptive(IUD)Candidate protocol).

b. Ifpatientdesiresanothermethod,provideit.

6. IfpatienthashadintercourseinthelastfivedaysandisatriskforpregnancyifIUDremoved,offer emergencycontraceptionordelayremovalofIUD.

7. IfpatientwithnopriorhistoryofhypertensionhasBP≥140/90verifiedatleastoneadditionaltime thisvisitwithnosmokingorcaffeinefor30minutes, follow agency’s hypertension protocol or consider referralforevaluationofpossiblehypertension.

PATIENT EDUCATION

1. CounselregardingriskofpregnancyorectopicpregnancyifIUDremovedin absenceof menseswith recentintercourse;tellpatientIUDnolongerprotectsherfrompregnancy.EncourageEC use. See Emergency Contraceptive (EC) protocol.

2. EncouragewomenwhodesireIUDremovalinordertobecomepregnanttouse folicacid supplementsforatleast1-3monthspriortoremovaloratleasttoconception.

3. AdvisewomenwhohaveIUDremovedbutarenotseekingpregnancytoimmediatelyinitiateanother effectivemethod.RemindthemthattheIUDprovidesnoresidualcontraceptiveprotectiononceit is removed.

4. Zika virus education and prevention strategies

  1. Avoid traveling to impacted areas
  2. Avoiding mosquito bites if traveling to impacted areas
  3. Using condoms to prevent transmission of virus
  4. Avoiding pregnancy if infected or partner infected

1)Risk to unborn fetus

REFER TO MD/ER

  1. A patient with elevated BP or difficult IUD removal.

REFERENCES

1. CentersforDiseaseControlandPrevention (CDC).U.S.MedicalEligibilityCriteriaforContraceptiveUse,2016.Availableat

2. CentersforDiseaseControlandPrevention(CDC).USSelectedPracticeRecommendationsfor ContraceptiveUse,2016. Available at

3.HatcherRA,etal(editors).ContraceptiveTechnology20theditionArdentMedia.NewYork,NY 2011:147-92.

4. Centers for Disease Control and Prevention (CDC). Zika Virus Homepage-

5. Mirenawebsite:

6. ParaGardwebsite:

7.Skyla website:

8. Liletta website:

9. Kyleena website:

Reviewed/Revised 2017

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