An intrauterine device (IUD) is a small, T-shaped device placed inside the uterus that offers highly effective, long-acting reversible contraception. While IUDs are reliable, there is a small risk that the device may move from its intended position, a phenomenon known as expulsion. Expulsion can be partial, where the device shifts but remains partly in the uterus, or complete, where it is fully pushed out. Recognizing the signs of expulsion is important because it compromises contraceptive protection.
Symptoms of Partial or Full Expulsion
Changes in physical comfort and bleeding patterns are often the first indicators that an IUD may have shifted or expelled. Many people report experiencing severe or unusual abdominal cramping or pelvic pain that differs from their typical menstrual discomfort. This pain can signal that the IUD is irritating the uterine wall or cervix as it moves.
Changes to the menstrual cycle are also common signs of displacement. Users might notice sudden, heavy vaginal bleeding or persistent spotting between periods. For those with a hormonal IUD who typically experience lighter or absent periods, any unexpected return of heavy bleeding is concerning.
In cases of partial expulsion, the hard plastic or copper part of the IUD may become noticeable. If the IUD has begun to pass through the cervix, a person might feel the firm, T-shaped device near the top of the vagina. Pain during intercourse can also occur if the device is positioned incorrectly.
Checking for the IUD Strings
The most common method for self-monitoring the IUD’s position is by checking the attached strings, which extend a short distance through the cervix into the upper vagina. Healthcare providers recommend performing this check monthly, often after the menstrual period when the cervix is lower and the strings are easier to reach. The process begins with thoroughly washing hands to minimize the risk of introducing bacteria.
Once hands are clean, assume a comfortable position, such as squatting or sitting, and insert an index or middle finger into the vagina until reaching the cervix. The cervix feels firm and rubbery, similar to the tip of a nose. The strings should feel like one or two thin pieces of fishing line emerging from the center of the cervix.
It is important to determine not just the presence of the strings, but also their length relative to previous checks. Strings that feel noticeably longer than usual may indicate that the IUD has begun to slip down the uterus. Conversely, if the strings feel shorter or are completely absent, the device may have expelled or the strings may have curled up inside the cervix. The inability to feel the strings when they were previously detectable indicates that the IUD’s position needs professional confirmation.
Immediate Actions After Suspecting Expulsion
If there is any suspicion that the IUD has moved, the immediate action is to assume that contraceptive protection is no longer reliable. Backup contraception, such as condoms or abstinence, must be used immediately to prevent unintended pregnancy. A displaced IUD cannot effectively prevent fertilization.
The next step is to contact a healthcare provider, such as an OB-GYN, right away to schedule an examination. Avoid attempting to push the IUD back into place or pull it out if the device is visible or felt. Manipulating the device can cause further displacement or injury to the uterus.
The healthcare provider will likely perform a physical examination to locate the strings. If the strings are not visible, an ultrasound or X-ray may be ordered to confirm the IUD’s exact location. If expulsion is confirmed, the device will need to be removed or replaced.
Risk Factors for IUD Expulsion
IUD expulsion is relatively uncommon, occurring in approximately 2 to 10% of users, but certain factors increase the likelihood of the device moving. The highest risk period is typically within the first few months after the initial insertion. This is often attributed to the uterus adjusting to the presence of the device.
Strong uterine contractions are thought to trigger expulsion, making heavy menstrual bleeding the strongest risk factor. Individuals who experience severe pain during menstruation, or dysmenorrhea, may also face an elevated risk. Insertion immediately following childbirth or second-trimester abortion, as well as breastfeeding, can increase the chances of expulsion due to recent changes in uterine size and tone.
Other factors tied to a higher risk include having had four or more children, being younger than 24 years old, and having a history of a previous IUD expulsion. Anatomical considerations, such as uterine fibroids or structural irregularities, may also make proper placement more challenging, contributing to the risk of displacement.