Risk of Intrauterine Device Displacement with Uterine Manipulation During Endometriosis Surgery

Intrauterine devices (IUDs) are frequently used in the field of gynecology and are often in place at the time of pelvic surgery. However, there are no guidelines for management of an IUD during surgery in which a uterine manipulator is used. Some surgeons may always insert a new IUD, and others may only replace if visibly displaced. We conducted a retrospective chart review of patients who had a laparoscopic excision of endometriosis surgery with the use of a uterine manipulator and had an IUD in place from 2019 to 2024. Of 76 patients who met inclusion criteria, 16 (21.1%) had their IUD displaced. Of those 16, 12 (75.0%) were noted intraoperatively, and 4 (25.0%) were diagnosed within 6 months postoperatively. The RUMI ® manipulator was less likely to be associated with displacement than other manipulators. Surgeons should consider counseling about the risk of displacement and can consider either proactive IUD replacement or replacement only if visibly displaced as options.