Removing an intrauterine contraceptive device
Except in the case of desired pregnancy, remove levonorgestrel-releasing and copper intrauterine contraceptive devices (IUDs) on day 1 to 3 of the menstrual cycle, or when there has been no unprotected sexual intercourse in the previous 7 days. This ensures pregnancy does not occur as result of fertilisation by residual sperm or implantation of a fertilised egg from sexual intercourse before device removal.
If the IUD has visible threads and they are of expected length, it can be removed by an experienced practitioner in primary care. If the IUD cannot be removed, arrange an ultrasound to assess location and refer to a specialist service for removal.
If the IUD is known to have threads but the threads are not visible or are shorter or longer than expected, it can often be removed by an experienced practitioner in primary care. Missing or short threads may be visualised by exploring the cervical canal with a cytobrush, fine long forceps or a dedicated disposable thread retriever. See Managing missing, shortened or lengthened IUD threads.
If the IUD does not have threads (often referred to as Chinese Rings), refer to a practitioner experienced in removal of IUDs without threads.
If there is uncertainty about whether the IUD has threads or not (eg if it was inserted overseas), arrange an ultrasound to determine the type of device before attempted removal or referral.
All copper IUDs registered for use in Australia inserted in an individual aged 40 years or older can be left in place until menopause is diagnosed.
Levonorgestrel-releasing IUDs (LNG-IUDs) are replaced every 5 years to provide adequate contraception for individuals younger than 45 years at the time of insertion. If the 52 mg LNG-IUD has been in place for between 5 to 7 years, the risk of pregnancy is low. If a pregnancy test is negative, replace the LNG-IUD and repeat the pregnancy test 4 weeks after insertion, or 3 weeks after insertion if no further episodes of unprotected sex occurred in the first week of use.
For individuals 45 years or older at the time of insertion of a 52 mg LNG-IUD, the IUD can remain in place until menopause is diagnosed or age 55 years1. If ongoing cyclical bleeding or symptoms consistent with ovulatory cycles are experienced, use can continue beyond age 55 years, on a case-by-case basis. Extended use does not apply to the 19.5 mg LNG-IUD, which must be replaced every 5 years until no longer required. See also Contraception for females aged 50 and older.
If the 52 mg LNG-IUD is used for endometrial protection as part of systemic menopausal hormone therapy (MHT), it must be replaced every 5 years, regardless of the age at which it was inserted. The 19.5 mg LNG-IUD cannot be used for endometrial protection for individuals using MHT.