Seeing an IUD on X-Ray
Intrauterine devices (IUDs) are a popular form of long-acting reversible birth control. Getting an x-ray while you have an IUD lets doctors ensure proper positioning. It also allows for evaluation if you experience any issues like pain, bleeding or missing strings.
Knowing what to expect when seeing an IUD on x-ray can help understand this useful imaging test.
How An X-Ray Works
An x-ray sends radiation beams through the body. Dense tissues like bone block more rays, while soft tissues allow more to pass through onto the detector plate.
This creates detailed images contrasting harder and softer structures. It lets doctors view internal body parts like reproductive organs, detect issues like breaks and observe devices like IUD placement.
Why Doctors Use X-Rays With IUDs
Doctors may order a plain pelvic x-ray to check an IUD's positioning soon after insertion to ensure proper placement. Strings connect to the device so it can later be removed.
If strings cannot be located, an x-ray locates the IUD. Seeing it is still there brings peace of mind. If missing on x-ray, it likely expelled unnoticed, requiring placement of a new device.
Later on, x-rays also help evaluate:
- Missing strings
- Intermenstrual bleeding or cramps
- Making sure the IUD has not shifted prior to removal
What An IUD Looks Like On X-Ray
When positioned correctly, and IUD is visible as a distinct shape with greater density than surrounding soft tissues on plain film x-ray.
Copper IUDs
Paragard copper IUDs look like a clear "T" shape, with side arms that curve slightly. Two removable strings are visible descending from the base of the "T" down into the cervical canal and upper vagina.
The actual IUD measures 32 mm horizontally. Side to side across the arms spans 36 mm. Copper wire coiled around the vertical stem and horizontal arms appears darker on the film in most cases.
Hormonal IUDs
Hormonal IUDs like Mirena, Kyleena, Liletta and Skyla have a thinner, lighter "T" shape than Paragard. Rather than copper coils, a vertical cylinder holds the hormone supply.
Mirena measures 32 mm across with a 32 mm stem. The arms sweep downward with a 30 mm span. Kyleena, Liletta and Skyla are smaller, with 28 mm spans.
On x-ray, the hormone cylinder often appears darker than the surrounding plastic framing. Strings are also commonly visible extending down from the IUD's base.
What Correct IUD Placement Looks Like
A normally positioned IUD sits at the very top of the uterus, called the fundal region. The uterus lies in the pelvis tilted slightly forwards, bending over the bladder.
Proper Positioning
When placed properly, the IUD's side arms span evenly across the fundus, leaving the vertical stem and strings extending directly downward through the uterine cavity and into the cervical canal.
On an anteroposterior film, taken from the front through the back, the IUD aligns close to midline within the uterine shadow. The strings appear as two thin lines dropping down closer to the patient's left side, following the tilt of the uterus.
Misplacement Risks
Sometimes an IUD can shift sideways from the fundus toward the front, back or sides of the uterine cavity. Expulsion into the cervix or displacement into surrounding structures is also possible.
When the IUD lies too low, cramping and bleeding may result. Embedding into uterine muscle raises infection risk. Perforating outside the uterus requires prompt removal.
Using X-Rays to Spot Issues
If pregnancy occurs with an IUD in place, x-rays help locate the device before proceeding. Improper positioning also warrant imaging assessment.
Signs of Improper Placement
Issues raising suspicion of IUD misplacement include:
- Missing or significantly shortened strings
- Severe cramping and bleeding
- PID or post-insertion infection
- Pregnancy
In these cases, doctors use x-rays to identify the IUD's orientation. Then removal, repositioning or a new device can be pursued as appropriate.
What X-Rays Reveal
When IUD positioning looks questionable on exam, x-rays provide clarification. Signs of suboptimal placement on images include:
- Tilted or crooked alignment
- Rotation on the stem axis
- Low position near the cervix
- Migration to the walls or corners of the uterus
- Embedding into the uterine lining
- Protrusion through uterine tissue
In difficult diagnostic cases, 3D imaging like CT or MRI may better delineate anatomy and device position if available.
Removing a Misplaced IUD Under Imaging Guidance
When an IUD requires removal, visualizing the exact positioning first is key for safe retrieval.
Ultrasound-Guided Procedures
Ultrasound provides detailed images from inside the uterus without radiation. If strings are visible, removal often proceeds like a routine IUD extraction.
For non-visible strings, doctors may use ultrasound during the process to locate and grasp the device with special thin instruments manipulated under real-time imaging.
Fluoroscopic Techniques
Fluoroscopy displays continuous x-ray images on a screen during procedures. This allows precise, safe navigation of instruments to detach embedded IUDs or those protruding outside the uterus.
Grasping devices and atraumatic clamps slide under x-ray vision until reaching the misplaced device. Gentle traction then withdraws the IUD under imaging guidance.
What Happens After IUD Removal From Improper Positioning
After removing an IUD no longer optimally situated, patients discuss replacement options with their gynecologist at follow up visits.
Trying Again
If desiring ongoing contraception, another IUD insertion may be attempted for reliable birth control. This requires caution if the initial device perforated or caused complications.
Considering Alternatives
If a patient prefers non-hormonal options but wants to avoid repeat IUD issues, the copper Paragard IUD could be swapped for hormone-free birth control choices like:
- Condoms
- Fertility awareness methods
- Tubal ligation
Hormonal implants, shots or pills present alternatives for those open to trying systemic methods instead.
Weighing the Benefits and Risks
Reviewing the odds of recurrent problems guides next step decisions. IUDs remain extremely effective options for most women with proper placement and follow up care.
Discussing preferences, reproductive plans and any related health issues helps determine optimal future contraception after addressing IUD complication.
FAQs
Why do doctors order x-rays to look at IUDs?
X-rays help confirm proper IUD positioning after insertion. Later they evaluate issues like bleeding, cramping, missing strings or suspected displacement. X-rays locate non-visible IUDs and identify abnormalities needing removal.
What does an IUD look like on x-ray?
IUDs are visible on x-ray as T-shaped devices with short arms spanning the uterus width and a vertical stem with descending strings. Paragard copper IUDs have coiled wire while hormonal IUDs like Mirena contain a dense hormone cylinder.
When does an IUD appear wrongly positioned on imaging?
Signs of IUD issues on x-ray include tilting, low position, rotation, embedding in uterus lining or perforation outside the uterus. Strings may also appear shortened or absent. 3D CT or MRI can further assess difficult cases.
How are misplaced IUDs removed under imaging guidance?
Ultrasound helps locate and grasp non-visible IUDs in real time. Fluoroscopy uses continuous x-ray to safely guide instruments to reach difficult IUDs for withdrawal under imaging vision. Further contraception is then discussed.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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