A menstrual disc is a flexible, shallow, cup-shaped product, typically made of medical-grade silicone. It is folded and inserted high into the vaginal fornix, collecting menstrual fluid rather than absorbing it. The disc is held in place by tucking its rim behind the pubic bone. The intrauterine device (IUD) is a small, T-shaped contraceptive device inserted by a healthcare provider directly into the uterus, making it a form of long-acting reversible contraception (LARC). The IUD has two thin strings that extend through the cervix and rest in the upper part of the vagina, used to check its placement and for its eventual removal. This article addresses the compatibility of using both a menstrual disc and an IUD simultaneously and the necessary safety precautions.
Compatibility: Can They Be Used Together?
A menstrual disc can generally be used safely with an IUD, but necessary precautions must be taken to minimize the risk of IUD displacement or expulsion. Many individuals successfully use both products without issue, but the potential for accidental dislodgement must be acknowledged. Healthcare providers often recommend waiting at least six weeks, or two menstrual cycles, after IUD insertion before using any internal menstrual products to allow the IUD to settle.
The primary concern is the risk of the IUD being pulled out. Menstrual cups rely on a suction seal, which is associated with a higher risk of IUD expulsion if the seal is not properly broken. Menstrual discs are considered a safer option because they are held in place by the pubic bone and do not rely on creating a vacuum seal.
Understanding the Risk of IUD Expulsion
The risk of IUD expulsion with a menstrual disc is lower than with a menstrual cup, but it is not zero. The risk comes mainly from two mechanical forces during the removal process. The first is the possibility of accidentally snagging the IUD strings with a finger or the disc itself.
The second mechanical force involves pressure and suction. If a disc is removed quickly without being gently dislodged from behind the pubic bone, the sudden change in pressure within the vaginal space could exert a slight downward pull on the cervix. This action, combined with any accidental tension on the IUD strings, could potentially contribute to the partial or total expulsion of the IUD. Expulsion is more likely to occur if the IUD is already shifting or if the user has risk factors like a history of heavy periods.
Safe Techniques for Disc Removal
To mitigate the risk of IUD displacement, the removal technique must be slow, gentle, and intentional.
Preparing for Removal
Relax the pelvic floor muscles by squatting or sitting on the toilet and bearing down slightly. This action helps move the disc lower and makes it easier to reach.
Unhooking the Disc
Once a clean finger can reach the disc, slide it up to hook the rim, taking care to avoid the IUD strings near the cervix. The goal is to first unhook the rim from behind the pubic bone before pulling it out. Pulling horizontally, rather than directly downward, helps ensure the disc maintains a gentle trajectory as it is removed from the vaginal canal.
Final Steps
Before exiting the vaginal canal, the disc should be tilted slightly to break the seal and avoid any potential suction effect. Confirm the IUD strings are not tangled around the disc or caught by the rim before the final removal. Taking time and being mindful of the IUD strings throughout the removal process significantly reduces the risk of accidental pulling.
What to Monitor After Starting Disc Use
After beginning to use a menstrual disc with an IUD, regular monitoring is necessary to confirm the IUD remains in place. Checking the IUD strings should become part of the routine after each menstrual period. To check the strings, insert a clean finger into the vagina until the cervix is reached, and feel for the two fine threads extending from the cervical opening.
The strings should feel the same length as they normally do; if they feel suddenly longer, shorter, or cannot be felt at all, the IUD may have shifted. Other signs of IUD expulsion or displacement include unusual or severe cramping, abnormal bleeding or spotting, or feeling the hard plastic tip of the IUD itself. Any of these symptoms warrant an immediate call to a healthcare provider to have the IUD position confirmed, often with an ultrasound.