An intrauterine device, commonly known as an IUD, is a small, T-shaped device inserted into the uterus by a healthcare provider. It is recognized as a highly effective form of long-term contraception, offering reliable pregnancy prevention for several years without daily attention. IUDs come in two main types: hormonal, which release progestin, and non-hormonal, which use copper to prevent pregnancy. While generally reliable, some individuals may have concerns about their placement and the possibility of the device moving.
Frequency of IUD Expulsion
IUD expulsion occurs when the device moves from its original position within the uterus, either partially or completely, and it is a relatively uncommon event. Studies indicate that first-year expulsion rates typically range from 2% to 10%, varying based on the IUD type and specific study populations. Most expulsions tend to happen within the first few months after insertion, but they can also occur later, often during menstruation.
An expulsion can be either complete or partial. A complete expulsion means the IUD is fully pushed out of the uterus and into the vagina, sometimes without being noticed. A partial expulsion involves the IUD moving out of its correct position at the top of the uterus but remaining partly inside. Both partial and complete expulsions compromise the IUD’s effectiveness in preventing pregnancy.
Reasons for IUD Expulsion
Uterine contractions, particularly during menstruation, are a common mechanism, as these contractions can physically push the device out of place. Heavy menstrual bleeding or severe cramping, which increase uterine activity, are significant risk factors for expulsion.
Improper insertion technique can also increase the risk of expulsion, especially if the IUD is not placed correctly at the fundus, the top of the uterus. Uterine abnormalities, such as fibroids that distort the uterine cavity or congenital anomalies, can make proper placement difficult and raise the likelihood of expulsion.
Individual characteristics also influence expulsion rates. Younger individuals (14-19) have shown higher rates of IUD expulsion compared to older women. While nulliparity (never having given birth) was once considered a risk factor, its impact is complex, with some studies suggesting lower expulsion rates for nulliparous individuals over 20 compared to those who have had children. Immediate postpartum insertion also carries an increased risk of expulsion.
Recognizing IUD Expulsion
Identifying IUD expulsion often involves noticing specific changes or symptoms. One primary method of detection is regularly checking for the IUD strings. If the strings feel shorter or longer than usual, or if they cannot be located at all, it might indicate that the IUD has moved or expelled. A healthcare provider usually shows how to perform this check after insertion.
Physical sensations can also signal an expulsion. These include feeling the IUD itself protruding from the cervix or vagina, experiencing unusual pain or severe cramping, or noticing abnormal vaginal bleeding or discharge. Some individuals might experience the return of pregnancy symptoms if the IUD has become ineffective. It is possible for an IUD to fall out without being noticed, especially if an individual has a very heavy menstrual flow.
Actions After IUD Expulsion
If you suspect or confirm that your IUD has expelled, it is important to contact your healthcare provider immediately. Even if the IUD has only partially moved, it must be removed. Until you can see a professional, use a backup method of contraception, such as condoms, to prevent unintended pregnancy, as the IUD may no longer be effective.
Never attempt to reinsert the IUD yourself, as this can cause injury or infection. Your healthcare provider will likely perform a physical examination and may use an ultrasound or X-ray to confirm the IUD’s position or locate it if it’s missing. Based on the situation, they can discuss options such as reinserting a new IUD, if appropriate, or exploring other birth control methods.