One of the most common problems is the disappearance of the trans-cervical threads. When the threads are not visible, it may well be that they were cut too short and can be found within the cervical canal.
As the devices are radiopaque, an X-ray plate of the pelvis or of the abdomen may be taken to check whether the device is in the projection of the uterus, or in the pelvis, or free in the abdominal cavity. The placement of the tenaculum on the cervix, or a uterine sound in the uterine lumen will increase the diagnostic certainty as to the position of the device
Usually the delicate insertion and moving of the uterine sound in the uterus is
sufficient. The sound transmits to the hands of the physician the sensation of rubbing the hard surface of the device, which is quite different from passing the sound over the velveted surface of the endometrium.
Spontaneous Expulsion: Spontaneous expulsion of the IUD occurs rather frequently. It is the most frequent or the second most frequent cause for expulsion of all devices except the bow. The spiral has the highest expulsion rates and the bow the lowest. Most expulsions occur in the first few months after insertion, most often during menstruation. They are related apparently to the shape and stiffness of the device.
Bleeding or Pain: Bleeding and pain are the most common causes for IUD removal and
discontinuation. Uterine cramps or pain or pelvic discomfort may accompany insertion. These usually last only a short time. Occasional cramping and pain beyond the time of insertion is also reported by a number of patients. In the great majority of cases, the pain is well tolerated and tends to disappear spontaneously after a few days
Perforation: Perforation of the uterine wall is one of the most serious complications of IUD insertion, especially if not noticed. Perforation usually occurs or is started by partial puncture of the myometrium during insertion, although it is possible that some perforations may occur
spontaneously by gradual migration of the IUD through the uterine wall, most likely through the mechanism of pressure necrosis and uterine contractions.
Since it is difficult to predict which device may produce extensive peritoneal adhesions or cause an obstruction, it is advisable in general to remove all extra-uterine devices
Only when the strings are not visible is expulsion or less commonly, perforation considered. However, even though the strings may be seen, uterine perforation may have occurred. Ultrasound of the pelvis may not locate the IUD and an X-ray may be necessary.
Pelvic Inflammatory Disease (PID): A frequent IUD complication is the occurrence of a pelvic inflammatory disease. In most cases antibiotic therapy alone has sufficed to correct P.I.D. without removing the IUD. While many physicians remove the IUD immediately without waiting to start antibiotic therapy, such action should be weighed carefully since the manipulation might help to spread and aggravate the P.I.D.
Embedding. Embedding into the endometrium is usually without major significance, except that it increases the likelihood of bleeding pattern disturbances. It occurs in various degrees with all devices as does embedding into the myometrium and the cervix. It is unknown also whether this complication occurs after a partial perforation or just by pressure necrosis and subsequent scarring. With open devices, embedding will most often go totally undetected since it produces no major effect
Ectopic Pregnancies: The IUD provides little protection against ectopic pregnancies, which are more than six times more likely to occur than when medical contraceptives are used. Thus about one in 20 pregnancies, which occur with the device in situ, is ectopic pregnancies.