An intrauterine device (IUD) is a small, T-shaped device placed inside the uterus by a healthcare provider to prevent pregnancy. IUDs are highly effective, with over 99% efficacy, meaning fewer than 1 in 100 people using an IUD will become pregnant each year. While generally safe and reliable, IUD dislodgement is a rare occurrence that users should be aware of. This article will explore what IUD dislodgement entails, how to recognize its signs, factors that may contribute to it, and the appropriate actions to take.
Understanding IUD Dislodgement
IUD dislodgement refers to the IUD moving from its intended position within the uterus. This can happen in two primary ways: partial dislodgement or complete expulsion. Partial dislodgement occurs when the IUD shifts but remains partially inside the uterus.
Complete expulsion means the IUD has entirely exited the uterus. Both partial dislodgement and complete expulsion compromise the IUD’s effectiveness as a contraceptive device. Dislodgement can sometimes occur without immediate noticeable symptoms, making regular self-checks and awareness of potential signs important.
Recognizing the Signs
Recognizing signs of IUD dislodgement is important for maintaining its effectiveness. One common indicator is a change in the IUD strings, which typically hang into the top of the vagina. The strings might feel shorter or longer than usual, uneven, or become completely missing.
Unusual or severe pelvic pain and cramping are also potential signs, as are abnormal vaginal bleeding or discharge. Some individuals might even feel the IUD itself, for instance, a hard plastic part poking out of the cervix, or a partner might feel it during intercourse. The ultimate sign of a dislodged IUD is an unexpected pregnancy.
Factors Contributing to Dislodgement
Several factors can influence the likelihood of IUD dislodgement, though it remains an uncommon event, with expulsion rates in the first year ranging from 2% to 10%. The skill and experience of the clinician inserting the IUD can play a role. Uterine characteristics, such as the presence of fibroids or an unusually shaped uterus, may also increase the risk.
Heavy or prolonged menstrual bleeding and severe cramping have been identified as a strong risk factor for IUD expulsion. IUD insertion immediately postpartum, particularly within 48 hours of a vaginal birth, can also elevate the risk of dislodgement. A history of previous IUD expulsion further increases the chance of re-expulsion.
Actions to Take and Medical Management
If IUD dislodgement is suspected, it is important not to attempt to remove or adjust the device yourself. Immediately begin using a backup method of contraception, such as condoms, as the IUD may no longer be effective at preventing pregnancy. Contact a healthcare provider as soon as possible to report your concerns.
A healthcare provider will perform a physical examination, which often includes a pelvic exam, to check for the IUD strings and assess the position of the device. If the strings are not visible or the position is uncertain, an ultrasound will be performed to confirm the IUD’s location within the uterus. If the IUD cannot be located by ultrasound, an X-ray of the abdomen and pelvis may be used to determine if it has completely expelled or migrated outside the uterus.
A dislodged IUD will need to be removed by a healthcare professional. The method of removal depends on the IUD’s position; if the strings are visible, it can often be pulled out. For IUDs that have migrated or become embedded, procedures like hysteroscopy, which involves inserting a scope into the uterus, or, in rare cases, laparoscopy might be necessary. Following removal, your provider will discuss options, which may include re-insertion of a new IUD or choosing an alternative birth control method.