An intrauterine device (IUD) is a small, T-shaped device inserted into the uterus to prevent pregnancy. IUDs are highly effective, over 99% at preventing pregnancy. Once placed by a healthcare provider, an IUD can provide protection for several years, generally ranging from 3 to 12 years depending on the specific type.
How Displacement Occurs
IUD displacement refers to the movement of the device from its correct position within the uterus. This can manifest in several ways, including partial or complete expulsion, where the IUD moves out of the uterus, or perforation, where it moves through the uterine wall. These events can occur due to internal uterine dynamics and anatomical factors rather than external force.
Complete expulsion, where the IUD fully exits the uterus, happens in 5–10% of women during the first year of use, most often within the first few months after insertion. Partial expulsion occurs when the IUD is visible or can be felt at the external cervical opening, or if its stem is located in the cervix. Perforation involves the IUD puncturing the uterine wall, occurring in approximately 1 in 1,000 insertions. In some cases, the IUD may simply shift within the uterus, known as migration, without fully expelling or perforating, potentially leading to reduced effectiveness.
Recognizing the Signs of Displacement
Recognizing the signs of IUD displacement is important for maintaining its effectiveness. One common indicator is a change in the IUD strings: they may feel shorter or longer than usual, or you might be unable to feel them at all. While checking for these strings monthly is often advised, some individuals may never feel them due to coiling inside the cervix.
New or worsening pain can also signal a displaced IUD, including severe or persistent cramping, abdominal pain, or discomfort during sexual intercourse. Unusual bleeding patterns, such as heavier or prolonged periods, irregular bleeding, or spotting between periods, may occur. A person might also feel the plastic tip of the IUD coming out of the cervix or during sex. About a third of individuals with a displaced IUD might not experience any symptoms.
Factors That Increase Risk
Several factors can increase a person’s risk of IUD displacement. Recent childbirth is a significant factor, as the uterus is still returning to its pre-pregnancy size and shape. The risk of expulsion is higher in women who have given birth fewer than two times. Nursing can also increase this risk.
Certain uterine conditions can predispose individuals to displacement. These include structural irregularities such as uterine fibroids or congenital anomalies like a bicornuate or arcuated uterus, which can distort the uterine cavity and affect proper IUD placement. A history of heavy or prolonged menstrual bleeding is also a risk factor for expulsion. A previous IUD expulsion makes a subsequent expulsion more likely.
What to Do if Displacement is Suspected
If you suspect your IUD has moved, contact a healthcare provider immediately. Displacement can lead to a higher risk of unintended pregnancy, and attempting to self-remove or push the IUD back into place is not advisable. While waiting for your appointment, use a backup method of contraception, such as condoms, to prevent pregnancy.
Your healthcare provider will perform an examination, which may include a pelvic exam and an ultrasound, to confirm the IUD’s position. If the IUD is displaced, the provider will discuss next steps, typically involving removing the device. In some cases, a new IUD may be inserted during the same visit, provided there are no contraindications. For IUDs that have perforated the uterine wall or migrated to other areas, surgical procedures like laparoscopy or hysteroscopy may be necessary for removal.