Perimenopause Is Not My Friend: Episode 5

I went to get my IUD of nine years removed. 

Let me back up.

Shortly after my daughter was born — nine and three-quarters years ago, as she will tell you — I had a copper IUD inserted. It has served its purpose for almost a decade as Izzy successfully has no siblings. 

Unfortunately, it was done so soon after my labor that my uterus was not yet involuted — the process the uterus takes after birth to shrink back to its pre-pregnancy size. 

When my uterus finally did involute (you’re welcome for that new vocabulary work), the IUD became embedded in the uterine wall. It caused me no pain or any issues and so it stayed put. To add to the adventure, the string — which makes the removal process much more straightforward — was lost.

If you've read perimenopause episodes 1, 2, and 3, you'll know this has been a journey of seeing doctors who are dismissive or simply not knowledgeable about perimenopause. So I went to see a new doctor. He was a man — but I won't hold that against him since he had an incredible bedside manner, and was beyond likable. 

So, I decided to let him do a fishing expedition in my uterus.

He went looking for the IUD and couldn't retrieve it — the tool typically used to remove an IUD hooks onto the string and pulls it out, but since there was no string... Twenty minutes later with only a light spray of lidocaine to relieve the pain, we came up empty handed.

The doctor who inserted this IUD just really wanted to make sure I didn't get pregnant. 

He asked me to come back that afternoon, said he'd order a specialized device from the hospital, and that this device successfully removes 90% of difficult IUDs. It doesn't need a string — it grabs directly onto the IUD and pulls it out.

So I went home, rested my uterus a bit, and came back for fishing expedition number two. After another twenty minutes — just me and my lidocaine — still no success. He said he could connect to the IUD, but that pulling too hard might break it, cause me excruciating pain, and make it even harder to remove any parts left behind.

My IUD clearly just loved me and wanted to stay. And honestly, fair enough. It had kept me not-pregnant for almost ten years through multiple moves, a pandemic, perimenopause, and whatever else life threw at us. It deserved its moment of gratitude before eviction.

So, my doctor scheduled an ultrasound-guided hysteroscopy in the IVF ward of Arab Medical Center where I'd be put under to have my cervix dilated and the IUD extracted. The surgical rooms there have ultrasounds and intravaginal cameras in case he needed visual assistance. 

We went from “we’ll try again this afternoon” to “you need to be put under in a surgical ward,” in that matter of a few hours.

In between apologies for the pain and inconvenience, he said that we really need to figure out how to make an IUD for men — because women already go through enough. I wanted to ask him to marry me right there and then.

Typically, IUD removal is done during your period because the cervix is naturally dilated, which makes it less painful. In my case, I needed to be completely finished with my period because the camera assist required clear visibility — blood would have made it impossible to see. 

This was especially relevant because one of the reasons I was getting the copper IUD out and replacing it with a hormonal coil was my blood flow, which runs about four times the average volume. A typical menstrual cycle involves 80 milliliters of blood loss. My last cycle was 360 ml mostly over 3 days.

So I had my period, waited for my husband to come home from traveling — he'd need to drive me home from the appointment — and awaited the appointment. 

I can report that the IUD was successfully removed on Thursday, a new one inserted, and that I’ve had no complications since. Afterward, my doctor told me this was the hardest IUD he had ever removed. 

I think that means I win gold.

A note on healthcare in Jordan: it's remarkable to be able to get this kind of specialist procedure so quickly and easily and walk out the door without paying a cent. When the bill did arrive, it was 1,200 JD — about $1,800 — covering everything: hospital, anesthesiologist, doctor's fees, all of it. And it will likely cost me nothing in the end thanks to insurance.

If you are in Amman and struggling to feel seen on your menopausal journey, I cannot recommend my doctor highly enough. Bonus, he even has MHT and knows how to prescribe it. Feel free to reach out to me if you want his deets.

When the procedure was finished and I started to come around, the doctor told me he’d handed my husband the old IUD in a cup. 

I told him I was going to gild it and hang it on my Christmas tree.