Intrauterine devices (IUDs) are highly effective, long-acting reversible birth control methods. While generally safe and effective, a potential issue that can arise is displacement, where the device shifts from its intended position within the uterus.
What “Out of Place” Means for an IUD
An IUD is designed to sit securely at the top of the uterine cavity, with its arms extending laterally to maintain proper placement. When an IUD is “out of place,” it refers to several scenarios where it is no longer in this optimal position. One common form is partial expulsion, where the IUD begins to move out of the uterus, with part of it potentially protruding through the cervix. If the IUD completely exits the uterus, it is known as complete expulsion.
Another type of displacement is migration, where the IUD moves within the uterine cavity but does not exit the uterus, often settling in a lower or rotated position. The IUD’s frame can rotate on its axis or transversely, with the arms potentially unfolding or extending in different directions. A more serious, though rare, form of displacement is perforation, which occurs when the IUD punctures or pushes through the uterine wall. While some individuals may experience no symptoms with a slightly displaced IUD, significant changes in placement can reduce its effectiveness.
Reasons for IUD Displacement
Several factors can contribute to an IUD moving from its correct position, most commonly occurring within the first three months after insertion. Strong uterine contractions are a primary cause of IUD displacement, particularly during menstruation. Individuals who experience heavy menstrual bleeding may have a higher risk of expulsion due to these more forceful contractions.
The technique used during insertion also plays a role. If the IUD is not placed correctly at the fundus, or top, of the uterus, it may be more prone to shifting. The specific anatomy of the individual’s uterus can also influence IUD stability. For instance, a uterus with an abnormal shape, such as a bicornuate uterus, or the presence of fibroids, can affect how well the IUD fits and stays in place. If there is not enough space in the uterus to accommodate the IUD, the body may begin to expel it.
Individual characteristics can also increase the likelihood of displacement. Younger individuals, especially those under 20, may have a higher rate of IUD expulsion, potentially due to a smaller uterine cavity. Additionally, IUDs inserted immediately after childbirth or abortion, when the uterus is still undergoing changes and involution, may have an elevated risk of displacement. Breastfeeding during IUD insertion has also been linked to a higher rate of uterine perforation, which can lead to displacement. The type of IUD can also be a factor, with some studies suggesting a higher rate of malpositioning with copper IUDs compared to hormonal IUDs.
Signs of IUD Displacement
One common indicator is a change in the IUD strings. You might notice that the strings, which are normally about 1-2 inches long and hang into the vagina, are missing, feel shorter, or feel longer than usual. It is important to regularly check these strings, ideally once a month after your period, by gently inserting a clean finger into the vagina to feel for them near the cervix.
Other physical symptoms can include increased or persistent abdominal pain or cramping, which may be severe. Changes in bleeding patterns are also common, such as heavier or irregular vaginal bleeding, or spotting between periods, especially if you previously had lighter periods with a hormonal IUD. Some individuals or their partners might feel the hard plastic part of the IUD itself, either poking out of the cervix or during sexual intercourse. Less common but concerning signs can include unusual vaginal discharge, fever, or chills, which could suggest an infection.
Steps to Take If Your IUD Moves
If you suspect your IUD has moved, it is important to contact your healthcare provider immediately. Do not attempt to reinsert or adjust the IUD yourself, as this can cause further displacement or injury. While waiting for your appointment, you should use a backup method of contraception, such as condoms, because a displaced IUD may not be effective at preventing pregnancy.
Your healthcare provider will typically perform a pelvic exam to check the IUD strings and may use a cytobrush to locate them if they are not visible. To confirm the IUD’s position, an ultrasound is commonly used, which can show if the device is correctly placed within the uterus. If the IUD cannot be located by ultrasound, an X-ray of the abdomen and pelvis may be performed to check if it has perforated the uterus and migrated outside. Depending on the degree and type of displacement, management options may include removing the displaced IUD, and in some cases, a new IUD can be inserted during the same visit. Your provider will discuss whether reinsertion is appropriate or if an alternative contraceptive method would be better suited for you.