An intrauterine device (IUD) is a small, T-shaped contraceptive device placed inside the uterus to prevent pregnancy. While IUDs are effective, they can shift or completely exit the uterus, a process known as expulsion. This can occur without immediate awareness, raising concerns about continued contraceptive protection.
Understanding IUD Expulsion
IUD expulsion describes the movement of the device from its intended position at the top of the uterus. This can be a partial shift or a complete exit from the body. While not common, expulsion rates typically range from 2% to 10% of users. It is most likely to occur within the first few months after insertion, often during a menstrual period.
Factors that may increase the likelihood of IUD expulsion include a history of heavy or painful periods, being younger than 20 years old, or having the IUD inserted shortly after childbirth, particularly a vaginal delivery. The uterus is a muscular organ that contracts, and these contractions can sometimes push the IUD out of place.
Recognizing the Signs
Recognizing potential IUD expulsion involves regularly checking the IUD strings. Healthcare providers instruct individuals on how to feel for these strings after IUD insertion, usually once a month after a menstrual period. To check, wash your hands, then squat or sit, and insert a finger into the vagina until you feel the firm, rubbery cervix, then gently feel for the strings.
Any change in the strings, such as them feeling shorter, longer, uneven, or entirely missing, could indicate that the IUD has moved. Avoid pulling on the strings, as this could unintentionally dislodge the device. Other potential symptoms of expulsion include:
- Unusual changes in bleeding patterns, such as heavier or prolonged bleeding
- Increased or new cramping
- Abdominal or pelvic pain
- Pain during sexual activity
- Feeling the IUD itself
While some discomfort or spotting can occur after insertion, persistent or worsening pain warrants attention.
What to Do If Expulsion is Suspected
If you suspect your IUD has moved or expelled, contact a healthcare provider immediately. Do not attempt to reinsert the IUD yourself, as this could cause injury or complications. If you are sexually active, use a backup birth control method, such as condoms, because contraceptive protection may be compromised.
Your healthcare provider will perform a physical examination to check the position of the IUD strings. If the strings are not visible or the IUD’s position is uncertain, an ultrasound may be used to confirm its location. Depending on the findings, the provider will discuss options, which may include removing the dislodged IUD and potentially inserting a new one or exploring alternative contraception methods.
Risks of Unnoticed Expulsion
The primary consequence of an unnoticed IUD expulsion is the loss of effective contraceptive protection. This can lead to an unintended pregnancy, which is a significant concern for individuals relying on the IUD for birth control.
If pregnancy occurs with an IUD still in place, there are increased risks, including a higher chance of miscarriage or preterm delivery. While rare, there is also a risk of ectopic pregnancy, where the fertilized egg implants outside the uterus. Prompt awareness and medical attention are important to manage these potential outcomes and ensure ongoing reproductive health.