Challenges in Removing a Mirena IUD: Expert Insights and Solutions

Removal of honeycomb issues?

Currently living abroad, this is my second intrauterine device (IUD), which I have been using for nearly five years.
When I went to the clinic to replace the IUD, the doctor was unable to locate the original IUD despite using various tools.
An ultrasound revealed that the IUD has been pushed into a corner of the uterus by a uterine fibroid, making it impossible to remove it through the normal procedure.
I am currently waiting for a referral and would like to ask the doctor: 1) How would this situation be handled in Taiwan? 2) This IUD has been in place for nearly five years; is there a need to remove it within a certain timeframe? If so, how long is that? 3) Is there a risk of overdose if I take oral contraceptives while the IUD is still partially effective? Thank you!

Niming, 30~39 year old female. Ask Date: 2021/12/28

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Hysteroscopy can be performed for removal.
2.
If removed after more than 5 years, there is no guarantee of effectiveness for contraception and treatment of adenomyosis.
(The intrauterine device itself increases the risk of pelvic inflammatory disease.) 3.
No.

Reply Date: 2021/12/28

More Info

When it comes to the challenges of removing a Mirena IUD, particularly in cases where it has been displaced by uterine fibroids, there are several important considerations to keep in mind. Based on your situation, I will address your questions and provide additional insights into the management of such cases.

1. Management in Taiwan: In Taiwan, if a Mirena IUD is not easily retrievable due to displacement, the typical approach would involve the use of hysteroscopy. This minimally invasive procedure allows doctors to visualize the inside of the uterus and safely retrieve the IUD. The procedure is usually performed under local anesthesia and can be done in an outpatient setting. If the IUD is embedded in fibroids or if there are complications, further imaging studies or surgical intervention may be necessary. The healthcare provider would assess the situation based on the ultrasound findings and the patient's overall health.

2. Duration of IUD Use: The Mirena IUD is approved for use for up to five years for contraception and for the treatment of heavy menstrual bleeding associated with uterine conditions. After five years, the efficacy of the device may decrease, and it is generally recommended to have it removed or replaced. If you have been using it for nearly five years, it is advisable to plan for its removal or replacement soon, even if you are not experiencing any immediate issues. Prolonged use beyond the recommended duration can increase the risk of complications, including pelvic inflammatory disease and uterine perforation.

3. Using Oral Contraceptives with Mirena: Taking oral contraceptives while having a Mirena IUD in place is generally considered safe and does not lead to an overdose of hormones. The Mirena releases a small amount of levonorgestrel, a progestin, which primarily works locally in the uterus. If you are using oral contraceptives concurrently, they will provide additional contraceptive protection. However, it is essential to consult with your healthcare provider to ensure that this combination is appropriate for your specific health needs and to monitor for any potential side effects.

Additional Insights
The situation you are experiencing with the Mirena IUD being displaced by fibroids is not uncommon. Uterine fibroids can change the shape of the uterus and may push the IUD out of its intended position, making removal more complicated. In such cases, it is crucial to have a thorough evaluation by a healthcare provider who specializes in gynecology. They can provide tailored advice based on your medical history, the size and location of the fibroids, and any symptoms you may be experiencing.

The presence of fibroids can also affect menstrual cycles and overall reproductive health. If you are experiencing heavy bleeding, pain, or other symptoms, it may be worth discussing treatment options for the fibroids themselves, which could include medication, non-invasive procedures, or surgery, depending on their size and location.

In conclusion, while the challenges of removing a Mirena IUD due to displacement by fibroids can be daunting, there are effective management strategies available. It is essential to work closely with your healthcare provider to ensure the best outcomes for your reproductive health. Regular follow-ups and open communication about any concerns you have will help in navigating this situation effectively.

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