Answer: E. All of the above
As with other women who experience abnormal uterine bleeding in the perimenopausal period, unexpected bleeding should prompt evaluation in women with IUDs. Endometrial sampling can be performed with a small endometrial suction curette; sampling should be repeated if there is insufficient tissue for diagnosis. During cervical ablation or excision procedures, IUD strings may be tucked into the cervical canal if possible, or cut.
5. IUD removal is recommended in pregnant women:
A. When the IUD strings are visible
B. When the strings can be removed safely from the cervical canal
C. Both A and C
Committee on Practice Bulletins—Gynecology, Long-Acting Reversible Contraception Work Group. Practice Bulletin Number 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol.2017 Nov;130(3):e251-e269.