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Intrauterine contraception: Management of side effects and complications

Gillian Dean, MD, MPH
Alisa B Goldberg, MD, MPH
Section Editor
Courtney A Schreiber, MD, MPH
Deputy Editor
Kristen Eckler, MD, FACOG


Intrauterine contraception is generally well-tolerated, but side-effects and complications sometimes occur. This topic will review management of the most common problems related to intrauterine contraception with the copper T380A intrauterine device (IUD) (called TCu380A) and the IUD containing 52 mg levonorgestrel (called LNg20 because of an initial release-rate of levonorgestrel 20 mcg daily). At this time, there are sparse data on the newer IUD containing 13.5 mg levonorgestrel (called LNg14 because of an initial release-rate of levonorgestrel 14 mcg daily).

General issues related to intrauterine contraception and insertion and removal of IUDs are discussed separately. (See "Intrauterine contraception: Devices, candidates, and selection" and "Intrauterine contraceptive device: Insertion and removal".)

Several terms are used to describe intrauterine contraception, including intrauterine device (IUD) and intrauterine contraceptive (IUC); the LNg20 is also referred to as an intrauterine system (IUS). In this topic, we use the term IUD for all types of intrauterine contraception.


Expulsion risk is greatest in the first year of use and decreases thereafter [1]. In the first year of use, expulsion occurs in 3 to 10 percent of women with the TCu380A and 3 to 6 percent of women with the LNg20 IUD [1-5]. In a large retrospective study, the risk of expulsion with the TCu380A was double that of the LNg20 (6 versus 3 percent at 12 months) [1]. The manufacturer of the LNg14 IUD reports an expulsion rate of 3.2 percent; however, data are limited.

Risk factors for expulsion include prior expulsion [1,6], menorrhagia, severe dysmenorrhea [7], and insertion immediately after a second trimester abortion or postpartum [8,9]. There is no increased risk of expulsion with insertion immediately after first trimester abortion compared with interval insertion [10]. Nulliparity does not appear to increase the risk of IUD expulsion, while the effect of young age (less than 20 years) is unclear [1,2,7,11]. The length of the endometrial cavity does not appear to be a risk factor for expulsion of modern IUDs [12,13].


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Literature review current through: May 2017. | This topic last updated: Dec 13, 2016.
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