When should the IUD be removed? Solve your doubts

Any contraceptive method has advantages and disadvantages that we must weigh. The IUD has more and more followers thanks to its few side effects and its long duration of use. Despite this, there comes a time when, like any other, it needs to be replaced, which is why the question arises: When should the IUD be removed? Solve your doubts. To do this, we must first know how this contraceptive works. The IUD is a T-shaped device made of plastic and copper that is placed inside the cervix and acts mechanically in the case of the copper IUD, or through hormones with the Mirena IUD. Each of them has its advantages and disadvantages, so you must weigh all the factors when choosing one or the other. 

When should the IUD be removed?

• The Mirena and copper IUDs have a different durability. Once you have it in place, and unless there is a problem, the IUD can remain in the body for several years while maintaining its reliability. The copper IUD can be maintained for a period of ten to twelve years, although some models can last up to fourteen years. The Mirena IUD has a shorter but equally long lifespan, ranging from five to twelve years.
• When removing the IUD, make sure it is done properly. For this reason we must go to the gynecologist, who will determine the best moment, normally during menstruation. The IUD is folded and removed thanks to the threads that are left to indicate its position, and once this procedure is done you can start with a different contraceptive, or re-insert a new IUD.
• There are other times, however, when IUD removal must be done out of necessity. If the IUD has moved, it must be removed as soon as possible, and the same applies to the possibility of pregnancy or diseases such as vaginal infections and cancer. In the event of any suspicious symptom, it is best to go quickly to the gynecologist to carry out a complete analysis of the individual personal circumstances and, of course, carry out periodic reviews.

## How to know it's time — warning signs and urgent removal The general rule is: remove an IUD when its labeled duration has been reached, or sooner if there are problems. In practice, that means knowing both the device-specific timeframe (brand and model) and watching for symptoms that require urgent evaluation. - **Device lifespan reminders (practical approach):** - Keep a copy of the device name and insertion date in your health record and phone. If you don't know the brand, ask your clinic for the insertion record or ultrasound image. - Typical durations (common examples): **copper IUDs** (e.g., Paragard or similar) are commonly used for up to about 10 years; some copper models were used for longer in the past — always check the specific model. **Levonorgestrel IUS** products (Mirena, Kyleena, Liletta, Skyla) have approved durations that vary by product — most are 3–8 years depending on the brand and indication. If you aren’t sure, verify with the clinic or the product leaflet. - Action: Schedule a removal or replacement visit **at least** 1–3 months before the stated expiration, to avoid lapses in contraception. - **Urgent signs that require prompt removal or evaluation:** - Visible or palpable string absence combined with pelvic pain or abnormal bleeding. - Severe pelvic pain, fever, or signs of pelvic infection (may indicate pelvic inflammatory disease or partial expulsion). - Suspected pregnancy — if pregnancy occurs with an IUD in place, attend clinic urgently. - New, severe pain during intercourse or unusual discharge. - Provider suspects malposition on exam or ultrasound (IUD in cervix, embedded in myometrium, or perforation). Real example: A 32-year-old woman with a copper IUD inserted 9 years ago presents with heavier, crampy cycles for three months and notes she can’t feel the strings. On pelvic exam, strings are not visible; ultrasound shows the device displaced low in the cavity. I removed it that same day under local anaesthesia; she switched to a levonorgestrel IUS two weeks later after discussing options. - **Pregnancy with IUD in place — key points** - If pregnancy is suspected or confirmed and the IUD strings are visible, removal is usually recommended because keeping the device increases the risk of miscarriage, infection, and prematurity. Removal is typically done after confirmation of intrauterine pregnancy; if removal risks damaging the pregnancy (strings not visible), decisions are individualized with ultrasound guidance. - Example: A patient had a Mirena and became pregnant. Strings were visible; after counselling she opted for string removal in the clinic, and we monitored her pregnancy more frequently for infection signs. Outcome: ongoing pregnancy with no complications. - **Perforation and embedded IUD** - Uterine perforation is rare (1 pad/hour), fainting, or signs of sepsis — go to emergency care. - If you suspect vaginal infection with IUD in place (unusual discharge or odor), seek urgent evaluation; infection may require antibiotics and potential removal. ## Two expert-level tips for clinicians and advanced patients - **Tip for clinicians: use ultrasound proactively when strings are not visible** - Before proceeding to blind retrieval attempts, a transvaginal ultrasound clarifies location. It reduces unnecessary manipulations and informs whether hysteroscopic or laparoscopic removal is needed. - Document device type and placement images in the chart for future comparisons. - **Tip for patients wanting immediate replacement but with a long-standing infection risk** - Screen for chlamydia and gonorrhea before same-day insertion in high-risk individuals. If infection is suspected, treat first; insertion into an infected uterus increases the risk of pelvic inflammatory disease. ## FAQ ## FAQ ### How long can I keep my IUD? Do different brands have different limits? Different IUDs have different approved durations. Generally, copper IUDs are commonly used for up to around 10 years (some older models were used longer), while levonorgestrel intrauterine systems (Mirena, Liletta, Kyleena, Skyla) have approved durations that vary by product (commonly 3–8 years depending on brand and indication). Always check your insertion record, the device leaflet, or ask your provider. If in doubt, plan removal or replacement a few months before the expected expiry rather than after it. ### What should I do if I can’t feel my IUD strings? First, don’t panic. Many people cannot feel their strings. Schedule an appointment with your clinician for an exam. The provider will look for strings with a speculum and may perform a transvaginal ultrasound to confirm the IUD’s position. If the device has moved or is not in the uterine cavity, removal will be planned accordingly. Avoid trying to manipulate or pull strings at home. ### Is removal painful and can I take something beforehand? Most removals are brief and cause only short, crampy pain similar to menstrual cramps. Taking an NSAID (ibuprofen 400–600 mg or naproxen 500 mg) about 30–60 minutes before the appointment can reduce cramping. If you have anxiety or a history of difficult extractions, discuss local anaesthesia (paracervical block) or procedural sedation options with your clinician. For embedded or surgical removals, expect more recovery. ### Can I get pregnant immediately after removal? When should I use contraception? Yes — fertility typically returns rapidly after IUD removal. If you are not trying to conceive, use contraception starting immediately: a new IUD can be inserted the same day in most cases, and many hormonal pills or injections can be started right away (follow product instructions). If you choose barrier methods or abstain, remember that pregnancy is possible from the next ovulation. ### What happens if I become pregnant with an IUD in place? Contact your provider promptly. An ultrasound will confirm pregnancy location (intrauterine vs ectopic). If the strings are visible and the device can be removed easily, removal is usually advised because it reduces pregnancy complications. If the IUD cannot be removed without risking the pregnancy (strings not visible, embedded device), the clinical team will counsel you about risks and monitor closely. In some cases, ongoing pregnancy with the IUD in place is managed with increased surveillance and antibiotics if infection is suspected. --- Category: Tips & Tricks Topic: When should the IUD be removed? Solve your doubts If you have further questions or need help scheduling removal or replacement, contact your gynecology clinic. For device information and resources, check our [related topic](/blog) or visit our [shop](/shop) for recommended supplies and educational materials.