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Intrauterine Device
Bryan R. Foster, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Intrauterine device (IUD)
            • Intrauterine contraceptive device (IUCD)
            • Levonorgestrel-releasing intrauterine system (LNG-IUS)
          • Definitions

            • IUD
              • Device inserted into endometrial cavity to prevent pregnancy
              • T-shaped polyethylene frame with polyethylene monofilament string
              • 2 types of IUDs in United States
                • Copper-containing (Paragard, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ)
                  • Copper wire wrapped around stem
                  • Works for up to 10 years
                • Levonorgestrel-releasing (Mirena, Shering, AG Pharmaceutical, Germany)
                  • Levonorgestrel-containing collar around stem
                  • Works up to 5 years
              • Other IUDs
                • Plastic IUDs and Lippes loop IUD (older)
                • Round IUD of stainless steel ring in fundus with straight shaft in lower endometrium (commonly used in China)
              • Mechanism of action: Primarily prevents fertilization
                • Also has spermicidal effects and implantation inhibiting effects
                • Partially inhibit ovulation (Mirena only)
                • Copper devices ↑ copper levels → change in cervical mucus, affecting sperm motility and irritating endometrium

          IMAGING

          • General Features

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                CLINICAL ISSUES

                • Presentation

                  • Demographics

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Image Interpretation Pearls

                          Selected References

                          1. Dean G et al: Intrauterine contraception (IUD): Overview: UpToDate. http://www.uptodate.com/contents/intrauterine-contraception-iud-overview. Updated July 14, 2014. Accessed August 15, 2014
                          2. Boortz HE et al: Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics. 32(2):335-52, 2012
                          3. Barber M et al: Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain. J Chiropr Med. 10(2):126-9, 2011
                          4. Moschos E et al: Does the type of intrauterine device affect conspicuity on 2D and 3D ultrasound? AJR Am J Roentgenol. 196(6):1439-43, 2011
                          5. Benacerraf BR et al: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol. 34(1):110-5, 2009
                          6. Peri N et al: Imaging of intrauterine contraceptive devices. J Ultrasound Med. 26(10):1389-401, 2007
                          7. Muhler M et al: [How safe is magnetic resonance imaging in patients with contraceptive implants?] Radiologe. 46(7):574-8, 2006
                          8. Valsky DV et al: The shadow of the intrauterine device. J Ultrasound Med. 25(5):613-6, 2006
                          9. Letti Muller AL et al: Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 72(3):192-5, 2005
                          10. Morales-Rosello J: Spontaneous upward movement of lowly placed T-shaped IUDs. Contraception. 72(6):430-1, 2005
                          11. Schiesser M et al: Lost intrauterine devices during pregnancy: maternal and fetal outcome after ultrasound-guided extraction. An analysis of 82 cases. Ultrasound Obstet Gynecol. 23(5):486-9, 2004
                          12. Caliskan E et al: Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care. 8(3):150-5, 2003
                          13. Hubacher D et al: Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv. 57(2):120-8, 2002
                          14. Stanford JB et al: Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol. 187(6):1699-708, 2002
                          15. Thonneau P et al: Risk factors for intrauterine device failure: a review. Contraception. 64(1):33-7, 2001
                          16. Tatum HJ et al: Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device. Am J Obstet Gynecol. 126(7):869-79, 1976
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              • Clinical Issues

                                • Diagnostic Checklist

                                  TERMINOLOGY

                                  • Abbreviations

                                    • Intrauterine device (IUD)
                                    • Intrauterine contraceptive device (IUCD)
                                    • Levonorgestrel-releasing intrauterine system (LNG-IUS)
                                  • Definitions

                                    • IUD
                                      • Device inserted into endometrial cavity to prevent pregnancy
                                      • T-shaped polyethylene frame with polyethylene monofilament string
                                      • 2 types of IUDs in United States
                                        • Copper-containing (Paragard, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ)
                                          • Copper wire wrapped around stem
                                          • Works for up to 10 years
                                        • Levonorgestrel-releasing (Mirena, Shering, AG Pharmaceutical, Germany)
                                          • Levonorgestrel-containing collar around stem
                                          • Works up to 5 years
                                      • Other IUDs
                                        • Plastic IUDs and Lippes loop IUD (older)
                                        • Round IUD of stainless steel ring in fundus with straight shaft in lower endometrium (commonly used in China)
                                      • Mechanism of action: Primarily prevents fertilization
                                        • Also has spermicidal effects and implantation inhibiting effects
                                        • Partially inhibit ovulation (Mirena only)
                                        • Copper devices ↑ copper levels → change in cervical mucus, affecting sperm motility and irritating endometrium

                                  IMAGING

                                  • General Features

                                    • Imaging Recommendations

                                      DIFFERENTIAL DIAGNOSIS

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Dean G et al: Intrauterine contraception (IUD): Overview: UpToDate. http://www.uptodate.com/contents/intrauterine-contraception-iud-overview. Updated July 14, 2014. Accessed August 15, 2014
                                                  2. Boortz HE et al: Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics. 32(2):335-52, 2012
                                                  3. Barber M et al: Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain. J Chiropr Med. 10(2):126-9, 2011
                                                  4. Moschos E et al: Does the type of intrauterine device affect conspicuity on 2D and 3D ultrasound? AJR Am J Roentgenol. 196(6):1439-43, 2011
                                                  5. Benacerraf BR et al: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol. 34(1):110-5, 2009
                                                  6. Peri N et al: Imaging of intrauterine contraceptive devices. J Ultrasound Med. 26(10):1389-401, 2007
                                                  7. Muhler M et al: [How safe is magnetic resonance imaging in patients with contraceptive implants?] Radiologe. 46(7):574-8, 2006
                                                  8. Valsky DV et al: The shadow of the intrauterine device. J Ultrasound Med. 25(5):613-6, 2006
                                                  9. Letti Muller AL et al: Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 72(3):192-5, 2005
                                                  10. Morales-Rosello J: Spontaneous upward movement of lowly placed T-shaped IUDs. Contraception. 72(6):430-1, 2005
                                                  11. Schiesser M et al: Lost intrauterine devices during pregnancy: maternal and fetal outcome after ultrasound-guided extraction. An analysis of 82 cases. Ultrasound Obstet Gynecol. 23(5):486-9, 2004
                                                  12. Caliskan E et al: Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care. 8(3):150-5, 2003
                                                  13. Hubacher D et al: Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv. 57(2):120-8, 2002
                                                  14. Stanford JB et al: Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol. 187(6):1699-708, 2002
                                                  15. Thonneau P et al: Risk factors for intrauterine device failure: a review. Contraception. 64(1):33-7, 2001
                                                  16. Tatum HJ et al: Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device. Am J Obstet Gynecol. 126(7):869-79, 1976