ParaGard IUD Perforation Symptoms: 4 Dangers To Be On High Alert For

Introduction

In recent years, growing attention has been paid to complications involving ParaGard, a common intrauterine device (IUD) for birth control. ParaGard IUDs can embed or punch through the uterine wall, called uterine perforation. This can cause a host of health problems. ParaGard IUD perforation symptoms are often overlooked or dismissed. Users are often unaware of the symptoms of IUD perforation they need to look out for. Outcomes are worse if treatment is delayed, so users must be adequately informed.  This article will explain the most important symptoms of ParaGard IUD uterine perforation to be on high alert for.

IUDs are small devices made of metal or plastic that are inserted into the uterus as a form of birth control. Some IUDs slowly release hormones similar to oral birth control methods [1]. Copper IUDs like ParaGard prevent the sperm from meeting with the egg by disrupting their ability to move [2]. IUDs are popular because they only require a single outpatient procedure and provide effective protection for years [1]. They also can be used as a highly effective form of emergency contraception. In general, they are a safe birth control method, but the ParaGard IUD carries risks that aren’t effectively communicated to patients or care providers by the manufacturer.

What are the risks of ParaGard

There are always risks associated with placing anything in the body, including ParaGard IUDs. The most common side effects of ParaGard are cramps, heightened menstrual pain, and irregular bleeding in-between periods. Rarely, some users of ParaGard experience a serious complication called uterine perforation [3].

Complete uterine perforation is when an IUD pierces through the wall of the uterus and into the body cavity. Partial uterine perforation is less likely and occurs when a portion of the IUD gets embedded in the wall of the uterus. 

Uterine perforation is rare and often doesn’t pose immediate harm to the user. Still, it can sometimes be dangerous and requires surgery to address, especially if the user is planning a future pregnancy. Unfortunately, because the condition is relatively rare and early symptoms are similar to side-effects of a safe IUD insertion, many ParaGard users miss the telltale symptoms of ParaGard uterine perforation. This can delay treatment, worsening potential outcomes.

To help you avoid these outcomes, the following are the four most important ParaGard uterine perforation symptoms you need to watch out for. Inform your care provider if you experience any of these perforation symptoms [4]:

• Changes in blood pressure and heart rate
• Excessive bleeding
• Extreme or persistent pelvic pain
• Absence of the IUD string

IMPORTANT: If your pain actively worsens or vaginal bleeding intensifies, seek emergency medical care immediately because this could indicate a life-threatening complication. 

What to do

If your caregiver determines you have ParaGard IUD uterine perforation, you will need to have the device or its fragments removed from your body. First, the ParaGard IUD must be located with ultrasound imaging, CT scanning, or exploratory laparoscopy, where a small fiber-optic cable is inserted into the abdomen. This device allows surgeons to see inside the abdomen and perform minor surgeries. Perforated IUDs are typically found in the peritoneal cavity, the space in the abdomen that contains organs like the stomach, liver, and intestines [3, 5]. Laparoscopic surgery or laparotomy, where the abdomen is cut open, are the most common ways to remove a perforated IUD. However, sometimes colonoscopy and appendectomy are needed [5, 6].

Causes

In the past, it was commonly thought that IUD perforation was caused by contractions forcing the IUD through the uterus wall and into the body cavity. Although It is possible for uterine contractions to force a partially embedded IUD fragment through the uterine wall, this is rare. Instead, ParaGard perforation usually occurs when the device breaks apart while being removed or inserted by a clinician.  

Consequences of IUD perforation

IUD uterine perforation is commonly asymptomatic and isn’t detected until months or years later [7]. However, a migrating IUD can damage other organs, most commonly the bowels and urinary tract [8, 9].

In recent years, many women have filed lawsuits against Teva Pharmaceuticals, the manufacturer of ParaGard. These women and other users experienced breakage upon removal that led to partial or complete IUD uterine perforation. Plaintiffs claim that Teva did not fully inform patients or providers of ParaGard breakage or perforation risks [10]. In one recent case study, the patient required a hysterectomy after uterine perforation [11].

Risk Factors for IUD perforation

There are many risk factors for IUD uterine perforation.  Insertion of the device by an inexperienced clinician is significantly more likely to result in perforation [7]. IUD placement within the first six months after delivery is associated with a higher risk of uterine perforation [12]. A higher number of previous pregnancies decreased the risk of perforation, while the number of abortions increased it [13]. Finally, breastfeeding is considered a risk factor for IUD perforation [14].

While ParaGard IUDs are generally safe and effective, a substantial number of users experience uterine perforation and other side effects. These risks were not communicated clearly by the manufacturer. If you or a loved one has experienced uterine perforation by a ParaGard IUD, you may be entitled to financial compensation. Please contact us today to schedule a consultation.

Frequently Asked Questions 

How common is ParaGard uterine perforation?

ParaGard Uterine Perforation occurs in approximately 1 out of every 1,000 insertions [15].

What does IUD uterine perforation feel like?

There is no standard way that IUD uterine perforation feels. Sometimes there is intense cramping. Other times there are no symptoms for years [8].

Why does uterine perforation occur?

Uterine perforation normally happens when the IUD breaks during insertion or removal [16].

References:

1.     Lanzola, E.L. and K. Ketvertis, Intrauterine Device, in StatPearls. 2021: Treasure Island (FL).
2.     Roblero, L., et al., Effect of copper ion on the motility, viability, acrosome reaction and fertilizing capacity of human spermatozoa in vitro. Reprod Fertil Dev, 1996. 8(5): p. 871-4.
3.     Rowlands, S., E. Oloto, and D.H. Horwell, Intrauterine devices and risk of uterine perforation: current perspectives. Open Access J Contracept, 2016. 7: p. 19-32.
4.     Katherine D Pocius, D.A.B. Intrauterine contraception: Management of side effects and complications. 2019; Available from: https://www.uptodate.com/contents/intrauterine-contraception-management-of-side-effects-and-complications?search=iud%20complications&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1277060819.
5.     Mederos, R., L. Humaran, and D. Minervini, Surgical removal of an intrauterine device perforating the sigmoid colon: a case report. Int J Surg, 2008. 6(6): p. e60-2.
6.     Santos, A.P., et al., Laparoscopic removal of migrated intrauterine device. BMJ Case Rep, 2017. 2017.
7.     Harrison-Woolrych, M., J. Ashton, and D. Coulter, Uterine perforation on intrauterine device insertion: is the incidence higher than previously reported? Contraception, 2003. 67(1): p. 53-6.
8.     Tabatabaei, F. and M. Masoumzadeh, Dislocated intrauterine devices: clinical presentations, diagnosis and management. Eur J Contracept Reprod Health Care, 2021. 26(2): p. 160-166.
9.     Sepulveda, W.H., et al., Sonographic diagnosis of bladder perforation by an intrauterine device. A case report. J Reprod Med, 1993. 38(11): p. 911-3.
10.   UNITED STATES JUDICIAL PANEL ON MULTIDISTRICT LITIGATION IN RE: PARAGARD IUD PRODUCTS. 2020.
11.   Sarver, J., M. Cregan, and D. Cain, Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: A case report. Case Rep Womens Health, 2021. 29: p. e00287.
12.   Sun, X., et al., Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs). Gynecol Surg, 2018. 15(1): p. 3.
13.   Caliskan, E., et al., Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care, 2003. 8(3): p. 150-5.
14.   Heinemann, K., et al., Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception, 2015. 91(4): p. 274-9.
15.   Heinemann, K., et al., Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception, 2015. 91(4): p. 280-3.

16.   Kaislasuo, J., et al., Uterine perforation caused by intrauterine devices: clinical course and treatment. Hum Reprod, 2013. 28(6): p. 1546-51.