Complications associated with copper IUD removal at a university hospital

Abstract

Objective: This study aimed to analyze the complications that led to removal of the copper Intrauterine Device (IUD) among women treated at a university hospital in northeastern Brazil, as well as the factors associated with device removal. Methods: This retrospective study analyzed medical records and institutional registries of 488 women who underwent Cu-IUD insertion between February 2022 and December 2023. Complications were defined as events leading to device removal, including malposition, pelvic pain, abnormal uterine bleeding, or the combination of pain and bleeding. Results: Among the 488 women evaluated, 139 (28.5%) required device removal due to complications. Malposition was the most frequent complication (61.1%), followed by pelvic pain associated with abnormal uterine bleeding (14.4%). Lower parity and shorter postpartum intervals were significantly associated with a higher likelihood of device removal. Conclusion: Malposition was the main complication associated with copper IUD removal in the sample analyzed. Nulliparity, age ≤19 years, and insertion between six weeks and three months postpartum were associated with a higher likelihood of device removal. These findings reinforce the importance of individualized assessment before insertion, post-procedure follow-up, and adequate counseling of users. As this was a retrospective study based on institutional records and conducted at a single center, the results should be interpreted with caution, without direct causal inference.