A woman blighted by a rare complication discovered that her IUD had migrated from her uterus to another part of her body. 

The unnamed 39-year-old female patient from Tunisia first realized something was wrong when she experienced lower urinary tract symptoms, including the need to urinate frequently and pain when she passed urine. 

After the symptoms persisted for six months, the woman consulted urologists at the Charles Nicole Hospital.

The doctors discovered that she had had a copper IUD device inserted by her gynecologist four years prior but had never had a follow-up. 

An IUD is inserted through the vagina into the uterus and is 99 percent effective in preventing pregnancy for up to 10 years. There are two types, and the copper version works by releasing copper ions that are toxic to sperm. 

Doctors found that the strings of the IUD, which are meant to hang out of the cervix, were not present in the vagina and the device was missing from the uterus, where it should have been positioned.

A follow-up ultrasound and X-ray of the patient’s abdomen were performed, which revealed that the IUD had perforated the uterus wall and made its way into the woman’s bladder, a complication that can lead to potentially fatal infections if not treated.

In the bladder, it began to calcify, when calcium builds up and causes tissue to harden. This then became a ‘bladder stone,’ a hardened mineral mass that can form in the bladder when urine remains there for a long time.

A woman blighted by an ultra-rare complication discovered that her IUD had migrated from her uterus to another part of body (stock image)

The ailment, which is caused by any foreign material present in the bladder, can cause difficulty urinating and pain.  

To remedy the problem, doctors removed the calcified IUD endoscopically using a flexible, tube-like tool called an endoscope and the woman was discharged 24 hours after the surgery.

At a follow-up a month later, the patient reported a complete resolution of all symptoms and no urinary or vaginal leakage was reported.

Uterine perforation and migration of the IUD are rare complications occurring in approximately one to two people per 1,000 insertions. 

Getting an IUD is a minor procedure during which a doctor inserts a speculum into the vagina and uses a small tube to pass the IUD through the cervical opening and into the uterus. 

There are two types of IUDs – copper and hormonal. The first releases a small amount of copper into the uterus, which creates an inflammatory response that is toxic to sperm and eggs.

An abdomen X-ray showing the IUD which had calcified in the woman’s bladder after migrating

Uterine perforation and migration of the IUD are rare complications occurring in approximately one to two people per 1000 insertions

The latter releases a small amount of the hormone progestin, which thickens cervical mucus and makes it difficult for sperm to reach an egg. It may also stop an egg from being released from the ovaries. 

According to the 2023 National Health Statistics Reports on contraceptive use – the latest year available – 20 percent of sexually active women between 15 and 49 years old reported ever using an IUD between the years of 2015 and 2019. 

One study from Belgium looked at all case reports on IUD migration, published between 2002 and 2022. 

The review revealed that about half of these patients present with pain and that a third are completely asymptomatic, meaning they have no symptoms. 

The most common sites of migration are the intestine, bladder, and omentum, a membranous double layer of fatty tissue that covers and supports the intestines and organs in the lower abdominal area.

Typically, an IUD is removed by pulling on its strings, but in the case of a migrated device, a laparoscopy is the preferred method.

This procedure, usually performed in the abdomen or pelvis, uses small incisions with the aid of a camera. 

Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. 

In light of their findings, the researchers noted that healthcare providers should be ‘vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation’. 

They added: ‘When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.’