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25-Year-Old Mom Has Toes Amputated and Hysterectomy after IUD Migrates to Her Stomach

IUDs, often touted as safe and effective, carry a small risk for very serious complications


A woman earlier this year was forced to undergo surgery, a hysterectomy, and have her toes amputated after her intrauterine device (IUD) migrated to her stomach and liver, the media has reported.

“[I] began to have a sharp pain in the bottom right side of my stomach and the first thing that popped in my head was is this that IUD?,” Tanai Smith, a 25-year-old single mom from Baltimore, Maryland, wrote on a GoFundMe page she started to tell her story and her harrowing experience with the IUD.

IUDs are contraceptive devices that are placed in the womb for 2-5 years. Some copper-bearing IUDs, however, can remain effective for as long as 10 years.

According to Smith’s account, she had been using her IUD for three years without noticing any issues. But when Smith went for her annual checkup last October, doctors were unable to locate the device, even after taking two ultrasounds. Smith says that her doctor assured her that her body must have expelled the device.

A few weeks later, Smith began experiencing sharp pains near her stomach. When the pain did not go away but became only worse, she went to the hospital where doctors took an X-ray. When the X-ray revealed that the IUD had migrated to her stomach, Smith was told that she would need surgery to have it removed.

Smith says doctors were able to successfully remove the device. However, following the surgery, Smith was told that the removal procedure had been more difficult than initially anticipated. According to Smith’s account, doctors had told her that the device had broken into several pieces and had migrated to her liver as well.

After the surgery, Smith developed further complications, forcing doctors to remove both her uterus and her ovaries. “I still don’t know why and whether my IUD or initial surgery were to blame,” Smith told Cosmopolitan, “My doctors guessed my body was under stress going into the first surgery, during which I might have picked up some type of bacteria. They really didn’t give me any reason.”

After the hysterectomy, Smith recounts that she fell into septic shock and was admitted to the ICU. Her blood pressure began to drop, her organs began to fail, she was placed on a ventilator and a dialysis machine, and lost sensation in both her hands and feet. After remaining in intensive care for several weeks, Smith began to recover and regain sensation. However, as a result of several weeks of diminished blood flow, Smith recounts that her toes began to turn black from necrosis.

“[I] had my toes amputated and [I] am still getting adjusted to the daily living,” Smith wrote on her GoFundMe page.

Smith has a three-year-old daughter and when not parenting, it appears that her time is split between working two part-time jobs and completing her college degree.

“You question yourself why me or what did [I] do to deserve this?” Smith writes.

Device migration and organ perforation, while uncommon events, are among the most serious and dreaded complications that can result from using the IUD. In rare cases, the device can even puncture the womb, become imbedded within the uterine wall, or migrate to other organs or cavities in the abdominal area.

Smith’s case is not an isolated incident. Studies have shown that uterine perforation due to IUDs occurs somewhere between 0.05 to 13 times per 1,000 insertions, often occurring during the insertion procedure.[1],[2],[3] Since uterine perforation and device migration do not always cause women pain or symptoms, the actual frequency of these events is likely even higher.[4] Known cases of organs that have been perforated by a wayward IUD include the bladder, intestines, colon, liver, ovaries, and other organs.[5],[6],[7],[8],[9],[10]

Device migration and expulsion are not the only adverse side effects associated with the IUD. Many women report pain from the device, particularly at the time of insertion. During clinical trials for Mirena, a popular hormonal IUD brand sold in the U.S., 23% of women reported pelvic or abdominal pain, 9% reported breast pain, and 8% reported back pain while using the device.[11] Nearly 32% of users also reported unscheduled bleeding.[12]

In a separate study in the U.K., nearly half of the women in the study chose to stop using Mirena early.[13] The most common reasons cited for discontinuation were unscheduled bleeding, abdominal pain, bloating, headache, weight gain, depression, breast tenderness, and loss of libido.[14]

While gynecologists, in general, believe that hormonal IUDs reduce women’s exposure to artificial progestins, studies have not confirmed this to be true.[15] A recent large study of Danish women found that women who use levonorgestrel-releasing IUDs have a significantly higher risk for being diagnosed for depression than women not using hormonal contraception.[16] And despite the fact that hormonal IUDs release much smaller doses of progestins than the amount of progestins in a single oral contraceptive pill, the findings from the Danish study left no indication that women using levonorgestrel-releasing IUDs are any less likely to experience depression than women using oral contraceptives.[17]

The likelihood of developing complications such as organ perforation or device expulsion is dependent, in part, on a variety of factors including the skill level of the doctor inserting the device, device placement, and uterine size or position.[18] Having previously had a Cesarean section has also been noted to be a risk factor for uterine perforation.[19]

As is clear from Tania Smith’s case, device migration and organ perforation can cause serious morbidity,[20] and even, in some cases, life-threatening complications. Even so, the IUD is often touted as a safe and effective family planning method. The World Health Organization and the CDC recommend little to no restrictions on permitting IUD insertion immediately after birth or after 4 weeks postpartum.[21],[22]

However, one study has shown that device expulsion is significantly more likely when inserted immediately after birth than if they had waited at least 6 weeks after birth before inserting the device.[23] And while some studies claim that uterine perforation is no more likely when inserted soon after birth, other researchers have disagreed. One rather large study in Turkey found that women were significantly more likely to experience uterine perforation even as far out as 6 months after birth.[24]

International NGOs like the International Planned Parenthood Federation (IPPF) often emphasize that there are no minimum age or parity requirements for using an IUD.[25] However, IUD use may carry more risk for nulliparous women. A large study of nulliparous women in Mexico found that over 70% of women who used a popular copper-bearing IUD model stopped using it within 1 year, mostly because the device caused them unacceptable pain or bleeding.[26]

According to Dr. Ayman Ewies, a consultant gynecological surgeon and an associate editor for the Journal of Obstetrics and Gynaecology, there are health concerns for nulliparous women using IUDs. “I would never insert it in a woman who had never had children before, because of the risk of infection,” Ewies told Vice in an interview.

In Tania Smith’s case, Smith was offered the IUD six weeks after the birth of her first child. According to Smith, her doctors say she probably experienced complications with the device because she received it too soon after birth or because the device was forced out of her womb during one of her monthly cycles.

According to Smith’s GoFundMe page, she chose the IUD largely because it was the method her doctor most highly recommended. “I accepted it because [I] was told that it was safe and it was [t]he best type,” Smith wrote on her page.

In recent years, doctors and contraceptive advocacy groups have been increasingly pushing for more women to accept long-acting reversible contraception (LARCs) methods like IUDs, implants, and injections. LARCs are often touted for their long-term effectiveness, preventing pregnancy or implantation for several months or even years without women having to do anything more. With LARCs, there is little room for human error. The chances that someone will become pregnant while using an IUD are much less than for other contraceptive methods. As a result, some doctors prefer LARCs because they believe that they are “better” for their patients, the possible adverse side effects associated with these methods notwithstanding.

Consequently, many contraception advocates view recent increases in LARC acceptance, particularly increases in IUD acceptance, both in the U.S. and abroad, positively. “I am delighted LARC use is rising, Dr. Mary Jane Minkin, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, told Time in an interview back in 2015, “It’s terrific and I would like to see even more.”

Others may have less noble reasons for pushing LARCs on their patients. Helena Blackstone, in a 2016 article written for Vice, happened to stumble across a case where doctors where pushing for their patients to accept larger IUDs because they offered longer contraceptive coverage. “[T]he doctor mentioned that he was competing with other doctors to reach higher years’ worth of contraception prescribed,” Blackstone reported.

Worse still, some NGOs, like Marie Stopes International (MSI), maintain targets for increasing LARC uptake among their patients. An inspection of MSI clinics in England by the U.K. Government’s Care Quality Commission last year found that the organization appears to have maintained a target of 50% LARC acceptance for post-abortive clients.[27] MSI achieved 32% LARC acceptance for this group in Q4 of 2016.[28] MSI was apparently successful in getting a much higher percentage of its own clients accept these contraceptive methods compared to the general population. Indeed, only 9% of women overall in the U.K. use a LARC method.

Similarly, as recently as 2015, IPPF maintained targets for number of couple-years protection (CYPs) offered to clients through its affiliate organizations.[29] A CYP is a theoretical measurement of how many years of contraceptive coverage can be provided through procured contraceptive devices and commodities, based on how long each method is effective. Since LARCs provide several years’ worth of contraceptive coverage, they count for more CYPs per unit than other  methods do. As a result, LARCs are more efficient in meeting targets for CYPs.

 

 

[1] Heinberg EM, McCoy TW, Pasic R. The perforated intrauterine device: endoscopic retrieval. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2008 Jan;12(1):97.

[2] Tosun M, Celik H, Yavuz E, Çetinkaya MB. Intravesical migration of an intrauterine device detected in a pregnant woman. Canadian Urological Association Journal. 2010 Oct;4(5):E141.

[3] Caliskan E, Öztürk N, Dilbaz BÖ, Dilbaz S. Analysis of risk factors associated with uterine perforation by intrauterine devices. The European Journal of Contraception & Reproductive Health Care. 2003 Jan 1;8(3):150-5.

[4] Tosun M, Celik H, Yavuz E, Çetinkaya MB. Intravesical migration of an intrauterine device detected in a pregnant woman. Canadian Urological Association Journal. 2010 Oct;4(5):E141.

[5] Heinberg EM, McCoy TW, Pasic R. The perforated intrauterine device: endoscopic retrieval. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2008 Jan;12(1):97.

[6] Tuncay YA, Tuncay E, Güzin K, Öztürk D, Omurcan C, Yücel N. Transuterine migration as a complication of intrauterine contraceptive devices: six case reports. The European Journal of Contraception & Reproductive Health Care. 2004 Jan 1;9(3):194-200.

[7] Thomalla JV. Perforation of urinary bladder by intrauterine device. Urology. 1986 Mar 1;27(3):260-4.

[8] Tosun M, Celik H, Yavuz E, Çetinkaya MB. Intravesical migration of an intrauterine device detected in a pregnant woman. Canadian Urological Association Journal. 2010 Oct;4(5):E141.

[9] Nceboz Ü, Özçakir HT, Uyar Y, Cağlar H. Migration of an intrauterine contraceptive device to the sigmoid colon: a case report. The European Journal of Contraception & Reproductive Health Care. 2003 Jan 1;8(4):229-32.

[10] Eke N, Okpani AO. Extrauterine translocated contraceptive device: a presentation of five cases and revisit of the enigmatic issues of iatrogenic perforation and migration. African Journal of Reproductive Health. 2003 Dec 1:117-23.

[11] Bayer Healthcare. Full prescribing information: Mirena; Revised 2017 Jun. FDA Reference ID: 4107719.

[12] Ibid.

[13] Ewies AAA. Mirena: the other side of the story. BJOG. 2007 Oct 1;114(10):1307-8.

[14] Ibid.

[15] Id.

[16] Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. 2016 Nov 1;73(11):1154-62.

[17] Ibid.

[18] Tosun M, Celik H, Yavuz E, Çetinkaya MB. Intravesical migration of an intrauterine device detected in a pregnant woman. Canadian Urological Association Journal. 2010 Oct;4(5):E141.

[19] Ibid.

[20] Tuncay YA, Tuncay E, Güzin K, Öztürk D, Omurcan C, Yücel N. Transuterine migration as a complication of intrauterine contraceptive devices: six case reports. The European Journal of Contraception & Reproductive Health Care. 2004 Jan 1;9(3):194-200.

[21] World Health Organization (WHO). Medical eligibility criteria for contraceptive use. 5th ed. Geneva: World Health Organization (WHO); 2015.

[22] Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–104. doi:http://dx.doi.org/10.15585/mmwr.rr6503a1.

[23] Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009 Oct 1;80(4):327-36.

[24] Caliskan E, Öztürk N, Dilbaz BÖ, Dilbaz S. Analysis of risk factors associated with uterine perforation by intrauterine devices. The European Journal of Contraception & Reproductive Health Care. 2003 Jan 1;8(3):150-5.

[25] International Planned Parenthood Federation (IPPF). Myths and facts about…intra-uterine devices [internet]. International Planned Parenthood Federation (IPPF); 2012 Feb 18 [cited 2018 Jun 12]. Available from: https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices.

[26] Otero-Flores JB, Guerrero-Carreño FJ, Vázquez-Estrada LA. A comparative randomized study of three different IUDs in nulliparous Mexican women. Contraception. 2003 Apr;67(4):273-6.

[27] Marie stopes international. Quality report. London: Care Quality Commission, Department of Health and Social Care; 2017 Jul 21.

[28] Ibid.

[29] International Planned Parenthood Federation (IPPF). Annual performance report 2015. London: International Planned Parenthood Federation (IPPF); 2016 Jun.

 

 

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