I Can Feel My IUD in My Uterus: What Should I Do?

Feeling something “off” inside your pelvis after getting an IUD is common, and in most cases it reflects normal cramping or awareness of the strings rather than a device that has actually shifted. That said, persistent or worsening discomfort, sharp pain, or the sensation of something hard and low in your cervical canal are signals worth taking seriously. The key is figuring out whether what you feel is the expected adjustment process, a harmless awareness of the IUD strings, or an early sign that the device has moved.

What You Are Probably Feeling

Your uterus is a muscular organ with a rich nerve supply. Pain signals from the uterus travel mainly through the pelvic splanchnic nerves, and the ligaments supporting the uterus carry their own mix of sensory fibers.¹ When a foreign object sits inside the uterine cavity, those nerves notice. The result is cramping, pressure, or a vague awareness that something is there. Most people describe it as period-like cramps rather than a sharp, localized pain. If what you feel is a dull ache or intermittent cramping, you are likely experiencing the uterus adjusting to the device.

The IUD also has thin strings that hang through the cervix into the top of the vaginal canal. These strings are what you (or your provider) check to confirm the device is still in place. In a study of IUD users, only about half of the participants were willing and able to feel their strings, and among those who tried, success was inconsistent. Women who had been instructed on how to check were nearly ten times more likely to attempt it.² The strings feel like thin fishing line or thread coming out of the cervix. If you can reach your cervix and feel the strings at a consistent length, that is a reassuring sign. What you should not feel is anything hard, plastic, or poking through your cervix. That is different, and it suggests the device may have moved.

Normal Cramping After Placement

Cramping is most intense in the first week after insertion and tapers from there. A study tracking both copper and hormonal IUD users over 90 days found that the median number of cramping days was about 18 over the first three months, with the worst cramping concentrated in the first week. The type of IUD did not change the cramping pattern much.³ A longer-term study of copper IUD users found that cramping frequency continued to decline over six months, dropping from roughly bimonthly-to-weekly episodes early on to once or twice a month.⁴

If your IUD was placed recently and you are within those first few months, some degree of cramping and awareness is expected. The question is whether the discomfort is trending better or worse. Improving cramps are normal. Worsening cramps, cramps that spike suddenly after a pain-free stretch, or cramps paired with heavy or irregular bleeding deserve a call to your provider.

When the IUD Has Actually Moved

Roughly one in six IUDs is found to be malpositioned when checked with imaging within the first two months after placement.⁵ “Malpositioned” covers a range of situations: the device may sit too low in the uterus, it may be tilted, or one of its arms may be embedded in the uterine wall. A retrospective study of 175 patients with malpositioned IUDs found that about half of them had symptoms like pelvic pain or abnormal bleeding, while the other half had no symptoms at all. Low placement was the most common pattern. Importantly, being able to see the strings during a routine exam did not reliably rule out malposition.⁶

This means that even if your provider sees strings at a checkup, the IUD could still be sitting incorrectly inside the uterus. Conversely, it also means that feeling your IUD or experiencing cramps does not guarantee the device has moved. An ultrasound is the definitive way to sort this out.

Why Some IUDs Fit Poorly

Your uterine cavity has three dimensions: length, width, and front-to-back depth. A standard T-shaped IUD is rigid enough that it cannot flex to match all three simultaneously. When there is a mismatch between the device and the cavity, the result can be pain, embedment of the device arms in the uterine wall, or expulsion.⁷ Think of it as a too-large shoe rubbing against your heel: the friction and pressure cause discomfort even though nothing is technically broken.

A nested case-control study looked at specific cavity measurements and found that women whose uterine width exceeded a certain threshold had a substantially higher risk of IUD expulsion or displacement. The association held for different IUD models, though the critical width varied by device design.⁸ This is one reason why some people do fine with one type of IUD but not another. Smaller-framed IUDs or frameless designs exist partly to address this dimensional mismatch problem, though frameless devices require a specific anchoring technique that adds its own learning curve for providers.

Risk Factors for Expulsion

Complete expulsion, where the IUD falls out entirely, is less common than partial displacement but more alarming when it happens. Several risk factors have been identified. Heavy menstrual bleeding is consistently the strongest predictor, especially when a person has a history of heavy periods over multiple cycles. Younger age (particularly under 25), higher parity, and higher body mass index also raise the risk.⁹

Timing of insertion matters too. A large cohort study found that IUDs placed in the immediate postpartum window (the first three days after delivery) had about five times the expulsion risk compared to IUDs placed outside the postpartum period. The expulsion risk was even higher when placement happened between four days and six weeks postpartum.¹⁰ A meta-analysis confirmed these numbers, showing pooled expulsion rates near 10% for immediate postpartum placements and close to 30% for early postpartum placements, compared to under 2% for interval placements done four or more weeks after delivery.¹¹ Vaginal delivery also carried a higher expulsion risk than cesarean delivery within that early postpartum window.

If you had your IUD placed shortly after giving birth and you are now feeling something unusual, the statistical reality is that your risk of displacement is meaningfully higher than someone who had theirs placed months later. That does not mean your IUD has moved, but it does mean the threshold for getting checked should be lower.

How Doctors Confirm What Is Going On

A standard two-dimensional pelvic ultrasound can show whether the IUD is roughly in the right spot. But for more subtle problems, like one arm of the IUD poking into the wall of the uterus, three-dimensional ultrasound is considerably more sensitive.¹² In one study of 167 patients imaged with 3D ultrasound, about 17% had IUD arms embedded in the muscle layer of the uterus, and the abnormal positioning was only visible on the 3D reconstructed view, not on standard imaging.¹³

If your provider does a standard ultrasound and tells you the IUD “looks fine” but you continue to have pain, it is reasonable to ask about 3D imaging. An embedded arm pressing into the myometrium is exactly the kind of problem that causes a persistent feeling of something being wrong inside the uterus, and it can be invisible on a routine scan.

Perforation Is Rare but Real

The word “perforation” scares people, and it should be taken seriously, but the absolute numbers are reassuring. A large multisite cohort study found a cumulative perforation incidence of about 0.2% at one year and 0.6% at five years overall.¹⁰ A separate European surveillance study reported perforation rates of roughly 1.1 to 1.4 per 1,000 insertions, depending on whether the device was copper or hormonal.¹⁴

The single biggest risk factor for perforation is breastfeeding at the time of insertion. Across studies, breastfeeding raised perforation risk roughly six to tenfold compared to non-breastfeeding.¹⁵ Among lactating women in one analysis, perforation incidence was about 4.5 per 1,000 insertions versus 0.6 per 1,000 in non-lactating women. A recent systematic review confirmed that breastfeeding at the time of insertion was associated with higher relative perforation risk, though the absolute rates remained low overall.¹⁶ The general clinical view is that even with this elevated risk, the benefits of effective contraception and breastfeeding together outweigh the small perforation risk for most people.¹⁷

Perforation sometimes happens silently, without dramatic symptoms. If you cannot feel your strings at all, or if you develop sudden severe pain, those are reasons to seek care promptly. A partial perforation, where part of the device pushes into or through the uterine wall, can cause chronic pain that is easy to dismiss as “just cramps.”

Infection Risk Is Highest Right After Insertion

If what you are feeling is not just cramping but fever, foul-smelling discharge, or worsening pelvic pain in the days or weeks after insertion, infection is worth considering. The insertion process itself introduces bacteria into the uterine cavity, temporarily raising the risk of pelvic inflammatory disease about sixfold during the first 20 days.¹⁸ After that initial window, the infection rate drops sharply and stays low, comparable to the background rate in sexually active people without an IUD.¹⁹

The practical takeaway: if your IUD was placed within the last few weeks and you feel increasingly unwell rather than gradually better, do not wait it out. Pelvic inflammatory disease is treatable with antibiotics, but delayed treatment can lead to complications. If your IUD has been in place for months or years and you suddenly develop pain with fever, the IUD itself is unlikely to be the cause, though an infection from other sources still needs evaluation.

What to Actually Do Right Now

Your immediate steps depend on the severity and character of what you feel.

• Mild cramping, recently placed: This is usually normal. Over-the-counter pain relief, a heating pad, and time are the standard approach. If the cramping is tolerable and improving week to week, you are on a normal trajectory.
• You can feel something hard at your cervix: This suggests the IUD has partially expelled. Use backup contraception and contact your provider soon. Do not push the device back in yourself.
• Strings feel longer or shorter than usual: A change in string length can mean the IUD has shifted. It is not an emergency, but it warrants an ultrasound to check position.
• Sharp or severe pain: Especially if it comes on suddenly, this could indicate perforation, expulsion, or another complication. Seek same-day care.
• Pain plus fever or unusual discharge: Possible infection. Contact your provider the same day.
• Persistent discomfort over weeks or months: Even if it is not severe, ongoing pain that is not improving deserves investigation. Ask about 3D ultrasound if standard imaging looks normal.

For an IUD found to be malpositioned but not causing symptoms, management can sometimes be conservative. Case reports and small studies have documented watchful waiting in asymptomatic patients whose imaging shows a displaced device, particularly when the IUD has migrated outside the uterus entirely but is not causing bowel or bladder issues.²⁰ However, when a mislocated IUD is causing symptoms, removal is the standard recommendation.²¹ Individualized management is especially important for younger patients and anyone with a prior history of expulsion.

Why You Should Not Remove It Yourself

There is a growing conversation in some online communities about IUD self-removal, and it is worth addressing directly. While clinical guidance recommends that a trained provider remove the device, some people do pull their own IUDs out by the strings. The medical literature cautions against this because of the potential for cervical injury, infection, or incomplete removal, where part of the device breaks off and stays behind. The evidence base on how often these complications actually occur during self-removal is thin, precisely because it happens outside clinical settings and goes largely undocumented.²² The risk is not enormous for a normally positioned IUD with visible strings, but if your IUD is malpositioned, embedded, or partially perforated, pulling on the strings yourself could cause real harm. If you are feeling your IUD and want it out, the safest path is having it removed in a clinical setting where your provider can image it first and manage any complications.

When Uterine Shape Complicates Things

Some people have uterine conditions that make IUD discomfort more likely regardless of the device. Adenomyosis, a condition where tissue similar to the uterine lining grows into the muscle wall, is a common culprit. The uterus may be enlarged or irregularly shaped, and this affects how well the IUD sits. A retrospective study found that uterine volume before IUD insertion was an independent predictor of spontaneous expulsion in one subtype of adenomyosis.²³ Fibroids, congenital uterine anomalies like a septate or bicornuate uterus, and a very small cavity in nulliparous individuals can all contribute to poor fit and ongoing awareness of the device.

If you have a known uterine condition and are feeling your IUD, the discomfort may be partly related to anatomy rather than a malfunction of the device itself. That does not mean you should ignore it, but it does mean the conversation with your provider should include whether a different size or style of IUD might work better, or whether an alternative contraceptive method makes more sense for your body. Hormonal IUDs, for instance, are sometimes used to treat adenomyosis symptoms, so removal is not always the obvious choice even when the fit is imperfect.

After Removal or Expulsion

If your IUD is removed because of malposition or discomfort, you are not necessarily done with IUDs forever. Many people have a second device placed successfully. In one trial of postpartum IUD placement, 10 out of the women who experienced expulsion chose to have another hormonal IUD placed.²⁴ If the problem was related to timing of insertion (such as early postpartum placement), waiting for an interval placement may solve it. If the problem was dimensional mismatch, switching to a smaller-framed device may help.

The critical point is that if your IUD is removed and you do not want to become pregnant, you need alternative contraception immediately. This sounds obvious, but in the moment of dealing with a painful or displaced IUD, contraceptive coverage can fall through the cracks. Your provider should discuss a backup plan before or at the time of removal. If you want another IUD, many providers will place the new one in the same visit if the situation allows.