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Operative hysteroscopy

Lost or displaced IUD: hysteroscopic removal

When the IUD threads can no longer be seen, the device is usually still in the uterus, simply drawn up. After an ultrasound locates it, it is removed by hysteroscopy in the consulting room within minutes. A new IUD can be fitted at the same visit.

Written and reviewed by Dr Olivier KadochUpdated 18 October 20264 min read

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Hysteroscopic view: IUD displaced in the uterine cavity (illustration)

Hysteroscopic view · illustration

Key points

  • Threads that cannot be seen do not mean the IUD is lost: it is usually inside the uterus.
  • First step: rule out pregnancy and locate the IUD on ultrasound.
  • Hysteroscopic removal in the consulting room if the threads cannot be reached.
  • An IUD outside the uterus is removed by laparoscopy.
Contents
  1. Why can't the threads be seen?
  2. What should be done first?
  3. How is it removed?
  4. What about contraception?
  5. Frequently asked questions
  6. References

Why can't the threads be seen?

IUD threads normally protrude from the cervix and are used to remove it. They can disappear because they have been drawn up into the cervical canal, were cut too short, or the IUD has moved within the cavity. More rarely, the IUD has been expelled unnoticed, or has passed through the wall of the uterus.

Frontal section of the uterus, tubes and ovaries Uterine fundusFallopian tubeOvary Myometrium Endometrium Isthmus Cervical canal Vagina Tubal openings Pedunculated polyp Submucosal fibroid Uterine septum Adhesions Caesarean scar niche(anterior wall) Retained tissue Displaced IUD Endometrium removedor destroyed Thin endometrium(atrophy) Endometrial tumourinvading the myometrium
Hysteroscopic view: IUD displaced in the uterine cavity (illustration)

Hysteroscopic view · illustration

IUD with missing threads: what hysteroscopy showsLeft, the finding placed in a frontal section of the uterus; right, how it looks on screen during the examination.Diagram: Hystéroscopie Paris · View: Guillaume Blanchet

What should be done first?

  • rule out pregnancy with a test, and use backup contraception meanwhile;
  • have an ultrasound to locate the IUD;
  • if the IUD is not seen in the uterus, an abdominal X-ray checks whether it was expelled or has left the uterus.

How is it removed?

SituationRemoval
Threads in the cervical canalSimple retrieval with forceps in clinic
IUD in the cavity, threads out of reachHysteroscopic removal, in the consulting room, no anaesthesia
IUD partly embedded in the wallHysteroscopy, sometimes in theatre
IUD outside the uterusLaparoscopy

Under hysteroscopy, the IUD is located on screen, grasped with forceps and removed through the cervix under direct vision. It takes a few minutes.

Hysteroscopy: set-up — The operator, seated facing the patient, follows the image of the uterine cavity on the endoscopy tower screen.
Hysteroscopy: set-upThe operator, seated facing the patient, follows the image of the uterine cavity on the endoscopy tower screen.Illustration: Guillaume Blanchet · © Dr Olivier Kadoch

What about contraception?

A new copper or hormonal IUD can be fitted at the same visit if you wish. Otherwise another method is discussed during the consultation.

Frequently asked questions

If I can't feel the threads, am I still protected?

Not with certainty. Use backup contraception, such as condoms, until ultrasound confirms the IUD is correctly placed.

Is hysteroscopic removal painful?

It is done in the consulting room without anaesthesia, with discomfort similar to having an IUD fitted.

Can a new IUD be fitted straight away?

Yes, if the uterus is normal and pregnancy is ruled out, a new IUD can be fitted at the same visit.

Can an IUD migrate into the abdomen?

Rarely. This usually results from a perforation at the time of insertion. The IUD is then removed by laparoscopy.

References

FSRH · 2015, mis à jour 2023Clinical guideline: intrauterine contraceptionFaculty of Sexual and Reproductive Healthcare
CNGOF · 2018Contraception : recommandations pour la pratique cliniqueGynecol Obstet Fertil Senol
HASFiches mémo : méthodes contraceptives, focus sur les méthodes les plus efficacesHaute Autorité de santé
CNGOF · 2013Recommandations pour la pratique clinique : hystéroscopieJ Gynecol Obstet Biol Reprod

Written and reviewed by Dr Olivier Kadoch · 18 October 2026

This page is for information; it does not replace a consultation. Each situation is discussed individually.

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