In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

Salvatore Giovanni Vitale,Gaetano Riemma,Jose Carugno,Attilio Di Spiezio Sardo,Pasquale De Franciscis,Luis Alonso Pacheco

doi:10.1007/s13304-022-01246-0

Abstract

To investigate about the opinions of gynecologists regarding the in-office hysteroscopic removal of retained or fragmented intrauterine device (IUD) without anesthesia. An online survey was made available to gynecologists who routinely performed in-office hysteroscopy. Five areas of interest were analyzed: average number of hysteroscopic procedures performed without anesthesia, availability on their local market of the different types of hormonal and non-hormonal IUDs, reasons for the hysteroscopic removal of the IUD, types of IUDs that were more commonly found retained or fragmented and, overall difficulty of the hysteroscopic removal. A total of 419 surgeons voluntarily responded the survey, of which 19 were excluded for not performing in-office hysteroscopy. The most commonly available IUD was the Levonorgestrel-based Mirena (Bayer Healthcare, Germany) or similar, (399/400, 99.7%), followed by Copper T (Paragard, CooperSurgical INC, United States) (397/400, 99.2%), Multiload (234/400, 58.5%) and Jaydess (Bayer Healthcare, Germany) (227/400, 56.7%). The intracavitary retention of the IUD with (44.5%, 178/400) and without (42.2%, 169/400) visible strings accounted as the most common reason for undergoing hysteroscopic IUD removal. Copper T IUD was the most common intracavitary retained (297/400, 74.2%) as well as fragmented device (236/400, 59.9%). The in-office hysteroscopic removal of the IUD was considered an easy procedure by almost all the operators (386/400, 96.5%). In-office hysteroscopy without anesthesia is seen as a feasible and easy approach to remove retained or fragmented IUDs inside the uterine cavity or cervical canal. While the Levonorgestrel-based IUD is the most commercialized, Copper T IUDs are the most commonly found retained or fragmented.

Highlights

The use of long acting reversible contraception (LARC), especially the intrauterine devices (IUDs) has dramatically increased over the last thirty years
Even if contraception remains their main purpose, IUDs are used for several non-contraceptive issues [2], especially with the advent of the levonorgestrel-releasing intrauterine system (LNG-IUS) device, which is considered a great treatment option for women with abnormal uterine bleeding and heavy menstrual bleeding, as well as dysmenorrhea [2, 3]
Nineteen surgeons were excluded from the analysis since they were not the operators of the IUD removal

Summary

Introduction

The use of long acting reversible contraception (LARC), especially the intrauterine devices (IUDs) has dramatically increased over the last thirty years. Even if contraception remains their main purpose, IUDs are used for several non-contraceptive issues [2], especially with the advent of the levonorgestrel-releasing intrauterine system (LNG-IUS) device, which is considered a great treatment option for women with abnormal uterine bleeding and heavy menstrual bleeding, as well as dysmenorrhea [2, 3]. LNG-based IUDs are commonly used by women desiring to use local hormonal contraception [5]. A non-hormonal intrauterine contraceptive option is the Copper IUD which is one of the most common LARC option used by young women [6]. The placement of a non-hormonal IUD after hysteroscopic lysis of adhesions or any other intrauterine adhesion generating procedure such as extensive myomectomy, is an effective strategy to avoid intrauterine adhesion formation and restore a normal anatomy of the uterine cavity [8, 9]

Methods

Results

Discussion

Conclusion