IUD migrates to bladder after perforation

An unusual case shows a copper IUD moving from the uterus to the bladder after years without follow up.

Copper IUD Perforates Uterus and Migrates to Bladder

A 39-year-old woman from Tunisia experienced urinary symptoms such as frequent urination and pain for six months. She had a copper IUD inserted four years earlier and had not undergone follow up. At Charles Nicole Hospital, doctors found the strings were not visible and the device was missing from the uterus. Ultrasound and abdominal X-ray revealed the IUD had perforated the uterine wall and migrated into the bladder, where it began to calcify into a bladder stone. The device was removed endoscopically and the patient was discharged 24 hours later; a month after surgery she reported complete resolution of symptoms.

Uterine perforation and migration are rare complications, occurring in about one to two per 1,000 insertions. IUDs come in two types: copper and hormonal. The copper IUD releases ions that deter sperm, while hormonal IUDs release progestin to thicken cervical mucus and inhibit ovulation. The case adds to a growing body of evidence that migration can target the bladder, intestine, or omentum. A Belgian review of reports from 2002 to 2022 found many patients experience pain, while a third have no symptoms. Removal is usually performed via laparoscopy, and outcomes are generally favorable but not always risk-free. The report underscores the need for vigilance by clinicians and timely removal when perforation is diagnosed to prevent severe complications. National data from 2023 show that 20 percent of sexually active women aged 15 to 49 used an IUD between 2015 and 2019, underscoring the continued role of this contraception method.

This case highlights how a widely used form of birth control can carry unseen risks when follow-up care is lacking. The patient’s situation shows why medical teams should emphasize post-placement checkups and clear guidance on symptoms that warrant evaluation. It also raises questions about access to timely imaging and specialized removal procedures, especially in settings with limited resources. While the benefits of IUDs for family planning remain substantial, clinicians must balance those benefits with the rare but serious possibility of perforation and migration, and ensure patients understand warning signs that require prompt attention.

Highlights

In birth control care, vigilance and access to checkups remain as important as choice itself.