Good Question!: Most perforations occur at insertion & can go unrecognized. However, in the last 5 years, i've seen several Mirena (levonorgestrel) iuds with normal follow up exams, normal placement verification (by exam) inexplicably be "lost" & then a negative ultrasound followed by an x-ray locating it in the abdomen..... I would tend to believe it can happen gradually but i've yet to find a good explanation...It happens!
Answered 3/31/2023
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With insertion: Perforation with an iud happens with insertion.
Answered 12/14/2012
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Gradually: If perforation didn't occur at time of insertion most likely it is a gradual process, however it can occur at once. It is very uncommon for iud's to spontaneously perforate after ultrasound has documented proper placement.
Answered 1/13/2013
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