An intrauterine device, commonly known as an IUD, is a small, T-shaped contraceptive device placed into the uterus to prevent pregnancy. IUDs are a highly effective and long-acting reversible form of birth control. While they are generally reliable, it is possible for an IUD to come out of the uterus on its own, a rare occurrence known as expulsion.
Understanding IUD Expulsion
IUD expulsion refers to the device partially or completely moving out of its correct position within the uterus. This movement can happen without the individual noticing any symptoms, known as asymptomatic expulsion, or it can present with clear indications. Expulsion rates are relatively low, typically ranging from 0.05% to 10% of users. Expulsion is most likely to occur within the first three months after the IUD has been inserted.
Factors Contributing to Expulsion
Several factors can increase the likelihood of an IUD expelling from the uterus. The physical characteristics of the uterus, such as its shape, size, or the presence of fibroids, can influence whether the device remains in place, with a smaller or irregularly shaped cavity posing a challenge. Heavy or prolonged menstrual bleeding is a significant factor, as strong uterine contractions during menstruation can potentially push the IUD out.
Severe cramping can also contribute to expulsion by causing the uterine muscles to contract more intensely. Recent childbirth is another important consideration, particularly if the IUD is inserted immediately after delivery, with risk notably higher following a vaginal delivery compared to a cesarean section. Individuals with a history of a previous IUD expulsion have an elevated chance of experiencing another one. Younger individuals may also face a higher risk due to a potentially smaller uterine cavity.
Recognizing Signs of Expulsion
Several signs and symptoms can indicate that an IUD may have expelled or shifted from its intended position. One noticeable sign is being able to feel the hard, plastic part of the IUD itself, which should not be palpable when properly in place. Changes in the IUD strings are also a common indicator, such as the strings feeling missing, shorter, or longer than usual. Regular string checks are a simple way to monitor the IUD’s position.
Experiencing new or worsening pain or cramping can signal a problem with the IUD’s placement. Unusual bleeding patterns, such as heavy or irregular bleeding, or abnormal vaginal discharge, may also suggest that the IUD has moved. In some instances, the IUD may become visible at the opening of the cervix, or a sexual partner might feel the device during intercourse. Should any of these signs occur, it is important to remember that the IUD may no longer be effective at preventing pregnancy.
What to Do If Expulsion Occurs
If there is a suspicion that an IUD has expelled or shifted, contacting a healthcare provider immediately is the appropriate next step. It is important to avoid attempting to reinsert or adjust the device manually, as this could cause further issues. To prevent unintended pregnancy, it is necessary to use a backup method of birth control, such as condoms, until a healthcare professional can assess the situation. Sexual intercourse should also be avoided until the IUD’s position is confirmed.
A healthcare provider will conduct an examination, which may include an ultrasound, to confirm the IUD’s location. If the IUD has indeed expelled, it will need to be removed. The provider can then discuss options for contraception, which may include inserting a new IUD during the same appointment or exploring other birth control methods.