An Intrauterine Device (IUD) is a highly effective, long-acting reversible contraceptive. This small, T-shaped device is inserted into the uterus to prevent pregnancy for several years. Monitoring your IUD is important to ensure its continued effectiveness and proper placement.
Understanding Normal IUD Position and String Check
A correctly positioned IUD sits in the upper part of the uterus. Two thin strings extend through the cervix into the upper vagina. These strings allow for easy removal by a healthcare provider and enable users to perform regular self-checks.
Checking your IUD strings monthly helps confirm the device remains in place. This check is often recommended after a menstrual period, when the cervix may be lower and strings easier to feel.
To perform the check, wash your hands thoroughly. In a comfortable position, insert a finger into the vagina until you feel your cervix, which has a firm, rubbery texture similar to the tip of your nose. The IUD strings should feel like thin fishing line protruding from the cervix. Avoid pulling on the strings, as this could dislodge the device. If the strings feel consistent in length and position each time, your IUD is likely in its correct location.
Symptoms That May Indicate Misplacement
Several physical changes can suggest an IUD has shifted. A common indicator is a change in the length of the IUD strings, which might feel shorter, longer, or entirely absent during self-checks. This alteration can signal the IUD has moved upwards, descended lower, or partially or completely expelled.
New or worsening pelvic or abdominal pain can also signal misplacement. This discomfort may include sharp cramps, persistent aches, or pain not relieved by common pain relievers. Additionally, unusual changes in bleeding patterns, such as heavier or prolonged periods or unexpected spotting, could indicate a problem. For hormonal IUD users, a return to heavier bleeding after lighter periods is a particular concern.
Discomfort or pain during sexual intercourse, for you or your partner, can also suggest IUD movement. In some instances, a misplaced IUD might be felt directly during a self-check or by your partner during intercourse. Other signs include unusual vaginal discharge, or in rare cases, fever or chills, which may indicate an infection.
What to Do If You Suspect Misplacement
If you notice any of the described symptoms or suspect your IUD has moved, contact your healthcare provider without delay. They can provide guidance and schedule an appointment to assess the situation.
Avoid attempting to adjust the IUD yourself or pulling it back into place, as this could cause further displacement or injury. Until your healthcare provider confirms the IUD’s position and effectiveness, use a backup method of birth control, such as condoms, or abstain from sexual intercourse. This precaution is necessary because a misplaced IUD may no longer provide reliable contraceptive protection.
Professional Diagnosis and Care
When you consult a healthcare provider about suspected IUD misplacement, they will typically begin with a thorough pelvic examination. During this exam, they may attempt to visually locate the IUD strings or retrieve them if coiled inside the cervix. If strings are not visible or misplacement is still suspected, imaging techniques are commonly used to determine the IUD’s exact location.
An ultrasound, specifically a transvaginal ultrasound, is the primary method for confirming the IUD’s position within the uterus. In cases where the IUD cannot be located via ultrasound, an X-ray of the abdomen and pelvis may be performed to check if the device has perforated the uterine wall and migrated outside the uterus. Once misplacement is confirmed, the course of action depends on the IUD’s specific location.
A misplaced IUD is often removed, as its contraceptive effectiveness may be reduced, and it can cause ongoing symptoms like pain or bleeding. If the IUD has partially expelled or is embedded in the uterine wall, removal might be performed in the office if the strings are accessible, or require a hysteroscopy, a procedure allowing direct visualization inside the uterus. In some instances, a new IUD can be inserted during the same appointment after the misplaced device is removed. While uncommon, misplacement can lead to complications such as continued pain, unintended pregnancy, or, in rare cases, uterine perforation.