Comparison of the Cervical Priming Effect of Different Medical Methods in Postmenopausal Women before the Removal of the Intrauterine Devices

The intrauterine device (IUD) is the most widely used reversible forms of contraception in the world [1]. Given its excellent efficacy and long-acting properties, IUD remains the most simple, cost-effective contraceptive method that is widely used in China. Ideally, the IUD should be removed soon after the menopause, however, many women with an IUD fail to remove it following the menopause for a variety of reasons, and the longer it remains in the uterus, the more difficult it becomes with removal because of the atrophy of the vagina, cervix and uterine body, and the cervix may become firmly closed and rigid. Many patients require cervical dilatation prior to IUD extraction, especially in patients with rigid cervix, cervical adhesions and IUD deformation. However, in women with a firmly closed and rigid cervix, dilatation can lead to considerable traumatization of the tissue. Several selected medical agents have been widely used for ripening of the cervix in early pregnancy before surgical abortion [2], later in pregnancy to induce labor [3] and in non-pregnant women if intrauterine surgery is indicated [4]. To improve IUD removal following the menopause and decrease the risk of complications, we have compared several commonly used agents to evaluate their effectiveness and safety for cervical softening before IUD removal in postmenopausal women.