Partial IUD expulsion and EC — DFSRH MCQ

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HardIntrauterine methodsPartial IUD expulsion and ECDFSRH

A 30-year-old has pain and bleeding three weeks after copper-IUD insertion. Ultrasound shows the device entirely within the cervical canal. Pregnancy testing is negative and UPSI occurred four days ago. What is the best plan?

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Correct answer: D — Remove it and assess the need for emergency contraception

The best answer is “Remove it and assess the need for emergency contraception”. A device in the cervical canal is partially expelled and cannot be relied upon for contraception. It should be removed, with pregnancy risk from recent intercourse assessed and EC offered when indicated. Reinsertion can be planned once pregnancy is excluded and circumstances permit, pushing the expelled device back is not appropriate. Emergency-contraception choice requires the timing of every episode of UPSI, likely ovulation, weight or BMI, recent progestogen exposure, enzyme-inducing medicines, gastrointestinal absorption and the person’s willingness to use a copper IUD. The copper IUD remains the most effective option and is the only method effective after ovulation; oral agents mainly work by delaying ovulation and are not interchangeable in every scenario.

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 | CoSRH/FSRH, Emergency Contraception (amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf