An Intrauterine Device (IUD) is a small, T-shaped, long-acting reversible contraceptive that is highly effective at preventing pregnancy. IUDs are placed inside the uterus, where they work for several years, depending on the type, by either releasing hormones or copper to prevent fertilization. While IUDs are over 99% effective, there is a small possibility that the device can shift from its intended position. This shift makes it important for users to be aware of how to monitor the device. Regular self-checks and vigilance for unusual symptoms are part of responsible IUD use.
Understanding IUD Displacement and Expulsion
IUD movement is generally categorized into two types: displacement and expulsion. Displacement occurs when the IUD shifts slightly within the uterine cavity, often moving down toward the cervix but remaining inside the uterus. Expulsion is the more complete form, where the uterus pushes the IUD partially or entirely out through the cervix and into the vagina. Expulsion rates are low, typically occurring in 2–10% of users, with most instances happening within the first few months after insertion.
The movement is often a result of strong uterine contractions. Factors that increase the risk of movement include severe cramping, heavy menstrual bleeding, or the size and shape of the individual’s uterus. Insertion immediately following childbirth also increases the risk, as the uterus takes time to return to its pre-pregnancy size. A displaced IUD may still offer some protection, but its effectiveness is compromised, making proper positioning crucial for preventing pregnancy.
Key Signs of IUD Dislodgement
The most common sign of a dislodged IUD is a change in the length of the attached threads. Two thin strings hang through the cervix into the upper part of the vagina, and feeling for these threads during a monthly self-check confirms the IUD’s position. If the threads feel noticeably longer or shorter than usual, or if they cannot be felt at all, the device may have moved. Do not confuse threads that have simply coiled up inside the cervix with a true displacement.
Another significant sign of movement is the onset of new, severe, or persistent discomfort, such as sharp cramping or lower abdominal pain. If the IUD has partially expelled, a user or their partner may be able to feel the hard plastic T-shaped tip of the device protruding from the cervix or in the upper vaginal canal.
Changes in bleeding patterns and discharge can also indicate a problem with the IUD’s placement. Unexplained heavy or irregular bleeding, spotting between periods, or atypical vaginal discharge may suggest the IUD is irritating the uterine lining. For those with a hormonal IUD, a return to a heavier menstrual flow or the reappearance of periods may signal a shift affecting hormone delivery.
Immediate Steps If You Suspect Dislodgement
If any signs of movement are observed, assume that contraceptive protection is compromised and begin using a backup method immediately. Condoms or abstinence should be used consistently until a healthcare provider has confirmed the IUD’s correct position. This action helps mitigate the risk of an unintended pregnancy.
Do not attempt to push, pull, or adjust the IUD or its threads, as this could cause injury or further dislodge the device. Avoid using tampons and instead use pads for any bleeding, as the suction created by removing a tampon could interfere with a partially expelled IUD. Refrain from sexual intercourse until a medical professional has evaluated the situation.
Contact a healthcare provider or clinic immediately to schedule an urgent appointment for evaluation. Clearly explain the suspected issue and the symptoms experienced to ensure a timely visit. Confirmation of the IUD’s position is necessary to restore reliable contraception.
Medical Confirmation and Follow-Up Options
The provider will typically begin with a pelvic exam to visually inspect the cervix and locate the IUD threads. If the threads are not visible, the provider may use a small brush to sweep the cervical canal, as the threads may have retracted. If the exam suggests the IUD is not in the correct position, an ultrasound is the standard method for confirmation.
An ultrasound provides a clear image of the uterus, allowing the provider to confirm the IUD’s placement high within the uterine fundus. If the IUD cannot be located via ultrasound, an X-ray of the abdomen and pelvis may be performed to check for uterine perforation, where the device has moved outside the uterus. A partially or fully expelled IUD must be removed, as its effectiveness is lost.
The removal of a displaced IUD is usually a straightforward procedure, often done by gently pulling the threads or using specialized instruments. After removal, the patient and provider will discuss follow-up options, which may include immediate replacement with a new IUD during the same visit. Alternatives include switching to a different size or type of IUD, or choosing a completely different form of contraception. Patients should be aware that experiencing one expulsion increases the likelihood of a second expulsion.