Does perforation with the mirana iud happen suddenly or gradually if it doesn't occur during the insertion?

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!

With insertion: Perforation with an iud happens with insertion.

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.