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Pelvic pain in IUD user — DFSRH MCQ

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HardIntrauterine contraceptionPelvic pain in IUD userDFSRH

A 35-year-old attends 6 weeks after copper-IUD insertion. Threads cannot be seen, pregnancy test is negative and she has no pain or bleeding. Pelvic ultrasound does not identify the device in the uterine cavity. What is the next best step?

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Correct answer: A — Use alternative contraception and image the abdomen and pelvis

The best answer is “Use alternative contraception and image the abdomen and pelvis”. When threads are missing and ultrasound does not show an intrauterine device, expulsion cannot be assumed until extrauterine perforation has been excluded. Alternative contraception is needed while abdominal-pelvic imaging locates the device. Blind instrumentation or immediate replacement risks injury or two devices, and absence of pain does not rule out perforation.

Reference: CoSRH/FSRH, Intrauterine Contraception (March 2023, amended January 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf