Contraindications to the use of an IUD are pregnancy, uterine malformation, nulliparity, and genital infection. IUD users must see a doctor regularly. Short-term complications are uterine perforations at time of insertion, a very rare occurrence in the hands of a skilled clinician. Long-term complications are pregnancy, ectopic pregnancy, and genital or pelvic infection, the most serious of all complications, and one which must be immediately treated, usually with antibiotics. Expulsion or translocation of the device are also possible; in this last case the IUD must be located and surgically removed. The most common side effect of IUD use is excessive bleeding, which can be successfully treated with ergot alkaloids.