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uterus perforated with IUD insertion

Yup, it happened to me. 

I'm a 29 year old with a one-year-old son, who I am still breastfeeding.  I had a Paragard years ago and found it excruciatingly painful with tons of bleeding, so removed it after five months.  I decided to try a Mirena now because I love the low-maintenance, high reliability offered by an IUD and I wanted slim to no periods.  My periods have not returned yet due to frequent breastfeeding and cosleeping with my baby and luck.

I tried to have a Mirena placed in January but the NP and MD who tried were unable to pass the sound through my cervical os to check the size of my uterus.  They did a paracervical block (numbing medicine) and tried again, and they couldn't get it through and I couldn't tolerate the pain, despite having done fine with an unmedicated midwife-attended home birth last summer, so they stopped.  They recommended I prepare with misoprostol next time.

I waited six months, prepared with misoprostol and ibuprofen, got the paracervical block, and had the Mirena inserted.  It hurt less than when I got the Paragard placed.  But the NP said the placement felt a little different than others she had done and she wanted me to have an ultrasound the next day to confirm that it was well-positioned.

I had the ultrasound the next day, with abdominal and vaginal probes, and the IUD was nowhere to be found.  The strings had also disappeared since the previous day.  I went home and looked in the sheets, the bathtub, shook out every piece of laundry in the hamper, and did not locate the IUD.

I then had an abdominal xray and there it was, above my uterus somewhere.

I then saw two gynecologic surgeons and got scheduled for the next day for laparoscopic surgery to remove it.

I was in surgery for an hour and they found the IUD behind my uterus (which is apparently very retroverted) in the rectouterine pouch, where it had moved since the xray.  She expected to find it tangled in the omentum, since that's where she found the last few wayward IUDs she removed in surgery.  I was under general anesthesia for the surgery.  I have a sore throat, no voice (from the breathing tube used in anesthesia), blown veins in one hand from the IV, and three incisions in my abdomen from the surgery.  They also had to insert a metal tool of some kind into my cervix so that they could pull on the uterus to reposition it to get at the Mirena, so I've also been bleeding lightly vaginally.   I'm in pain, of course, but taking ibuprofen and vicodin.  When I woke up shaking uncontrollably from the anesthesia, I was given Demerol, then fentanyl for pain, and that followed the toradol during surgery.  Also antibiotics in surgery, and zofran for nausea caused by anesthesia.

The surgeon provided me with photos from the laparoscopy and I could see where the IUD had perforated through my uterus when it was inserted.  My uterus is healing fine and this whole experience should have no bearing whatsoever on my future fertility or childbearing.  My surgeon did recommend against trying an IUD in the future, and said if I did ever want to try, I should have the placement done by a specialist under ultrasound guidance.  I have no intention to try an IUD ever again!

So there you go, uterine perforation does happen, rarely, and that's what it looks like.  Damn it!  I had such high hopes for the IUD.  There is very little information online about what happens when an IUD perforates the uterus, so I wanted to share my experience here.

I also want to point out that uterine perforation is addressed as a rare complication and a risk in the consent documents and is something I talked about with the healthcare providers, so I can't say no one told me.  There's no issue of medical malpractice or negligence here, just shitty luck.  The NP doing the insertion is a good NP who was following good technique, but because my uterus was strangely positioned, and maybe because the uterine walls are thinner because of my extended lactational amenorrhea, this complication was likelier.   Obviously I wish this had never happened, but I can't identify any step she did wrong, and I'm on the road to recovery now.  Of course I have no contraception, but that's hardly a concern while I feel so crappy!

Has anyone else had this experience? 

Comments

( 11 comments — Leave a comment )
________puberty
Jul. 3rd, 2011 05:13 am (UTC)
that really sucks! i'm sorry you had to go through that, sounds horrible! Also thanks for sharing.

I was wondering about perforation... This might be a really naive question but is the uterus really thin? How could something perforate so easily? I'm imagining like skin... it would have to be like stabbed through? It seems like it would hurt immensely and bleed a lot but it sounds like you didn't notice that.
no_iud_for_me
Jul. 3rd, 2011 05:29 am (UTC)
No, it's thick muscle, and it's astonishing that I couldn't feel that something was obviously wrong!
elephantus45
Jul. 3rd, 2011 02:31 pm (UTC)
Thank you for sharing that, its a sad/horrible situation. Laps can be rough but you should be feeling better soon :)

It is interesting though that the paragard was fine but the mirena wasn't, after childbirth.
knittinggoddess
Jul. 3rd, 2011 06:23 pm (UTC)
Thanks for sharing your story. I'm sorry that happened to you, and hope you feel better soon. (Is Implanon an option?)
no_iud_for_me
Jul. 3rd, 2011 09:21 pm (UTC)
I considered Implanon, but I tend to form painful keloid scars on my upper back, shoulders, and upper arms. Condoms certainly seem like a lot less trouble now than they used to! I might try continuous cycling the nuva ring. We'll see. I'll talk about it with my doc at my three week surgery follow up visit.
gregorysgirl
Jul. 4th, 2011 03:15 am (UTC)
I continuous cycled the nuvaring for several years before switching over to mirena and I had no issues.

Thanks for sharing your story and I hope you feel better soon.
dianaroyale
Jul. 4th, 2011 05:20 am (UTC)
Oh man! I'm so sorry you're going through this. Thank you so much for sharing this and I hope you're on the mend and feeling better soon.
mylissa1
Jul. 7th, 2011 08:29 pm (UTC)
Similar situation happened to me
I had given birth to my son 9 months ago. Wanted an paragard because of it's absence of hormones. Went to get it inserted and she perforated my uterus and was not able to get it in. She tried twice. Then, she said she would put it in but she wanted the hole she made in my uterine wall to heal a month first and to come back. I have been bleeding for over a week now and have a strange feeling in my side. I too gave birth naturally to my three children without medication. I have a high pain tolerance and hope that I am not underestimating any damage that may be done. I want to try again with someone else but I keep reading nothing but horror stories. They uterine perforation only happens 1 in 1000. I just can't believe that.
alyssam3888
Dec. 21st, 2012 08:43 pm (UTC)
I know this comment is pretty late (with reference to your original post date), but I experienced pretty much the exact same experience.

I am 29 years old and have a 3 month old child. I am breast feeding and co-sleeping and my period hasn't returned. I wanted a form of contraception that didn't necessitate a daily routine and my OB highly recommended the Mirena IUD.
I am pretty sure my OB took all the proper precautions before inserting the Mirena. I know he measured my uterus and he did take a blood pregnancy test. The insertion wasn't too painful, just felt like a contraction or bad period cramps during the length of the procedure (2-3 min?). I never experienced any sharp pains that would have led me to expect something had gone wrong.
The next day or so, I started having sharp stabbing pains around, what I thought was my rectal wall, which was really the lower portion of my cervix. The pains were infrequent ( once or twice a day) and lasted no longer than 5-10 seconds. The second day, post insertion, my husband and I felt rigorously for the strings and couldn't find a thing. The third day I was still experiencing these pains, so I called the on-call physician for my OB's clinic. She assured me that what I was experiencing was normal, that most people don't feel their strings, to take ibuprofen, and that the one month check-up would tell me if my Mirena was working correctly (in retrospect, it pisses me off that she told me "not to worry" and to "wait a MONTH" with such confidence).
That evening I took an ibuprofen and went for a run. At the end of my run I almost fell over because the stabbing pains were greater in strength and duration.. After my run, the stabbing pains recurred every hour or so. I KNEW something wasn't right, so I called the on-call physician and demanded my OB talk to me. My OB immediately told me to go to the ER and guess what, yep, perforated uterus.
The laparoscopic procedure wasn't bad at all. A little tiny slit just above my C-section scar and a similar slit inside my belly button. Can't complain about the size or appearance of those, but what I can complain about is the down time. All the waiting to work out from the cesarean procedure was postponed AGAIN. For some reason my stomach ached after every meal, too. I assume it was unrelated though because when googling stomach ache and laparoscopy, nothing comes up. I am about one month post op now, and my stomach aches after eating have subsided. They really only lasted about two weeks.
As far as contraception goes, my husband and I are now exercising the pull-and-pray technique. It worked for us for seven years, and I never had to have surgery from it. After the operation to remove my IUD my doctor explained that I have an extremely retroflexed uterus, just like you. He said he knew I had a retroflexed uterus, but that he didn't realize how extreme it was before insertion. I am on the fence about pursuing a law-suit, but I have to be sure he was negligent before-hand. I feel that he wasn't, but a second opinion will ensure that for me.
I hope you healed up well and haven't had any other issues with this IUD mishap. I would be really interested in keeping in contact with you if you plan on having anymore children. My husband and I want a few more children, but not for some time. Not much really seems to be known about the after affects of uterus perforation via IUD, so I don't feel very comfortable with being "assured' that I will have no problem bearing more children. I have never posted on a message board like this before, so I don't know how we would keep in contact. Feel free to e mail me, that is if you even get online to check this thread anymore :) I am going to make an account so you can contact me.

Best,
Alyssa
no_iud_for_me
Dec. 31st, 2012 02:25 am (UTC)
Hi Alyssa,

I'm actually not at all worried about future fertility, pregnancy, labor, and birth being complicated by my history of uterine perforation.

Women heal from Cesarean births and can go on to have VBACs, and that's a MUCH larger insult to the integrity of the uterus, and doesn't affect fertility at all. The perforation was basically a poke through the top of my uterus and in the laparoscopy photos I saw, it was already pretty much healed only a few days after it perforated. After I recovered from the surgery, I haven't had any problems related to the uterine perforation. My periods came back when my son was 18 months old and were normal, and then I decided to go on the pill, and that's been fine for me. My laparoscopy scars are tiny and don't cause me any trouble.

I'm a nurse practitioner and I still recommend the IUD to many of my patients, though I do say that perforation is one of the risks, albeit not an especially common one. It was a miserable experience for me but I think the only longterm consequence it has for me personally is that I won't be getting another IUD anytime soon! I hope to have another child in about 2 years and after that *may* actually consider having a Mirena placed by the OB/GYN who did my surgery, and have her do it under ultrasound guidance. Maybe.

And as far as "pull and pray," if a man actually knows his body well enough to reliably withdraw before ejaculation, it can be surprisingly effective. The problem is that for many couples, they don't reliably withdraw, and then it's more like not practicing ANY form of contraception.

Good luck! I hope you can rest easy as far as worries about future childbearing.
aliblaise
Jan. 26th, 2013 09:30 am (UTC)
Just wanted to let you know that I had no problem having another child after the Mirena IUD perforated my uterus.
( 11 comments — Leave a comment )

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