An intrauterine device (IUD) is a highly effective, long-acting form of contraception, but it carries a small risk of complication, such as expulsion. Expulsion occurs when the device partially or completely slips out of the uterus. This complication is relatively uncommon, but when it happens, the device is no longer positioned correctly to prevent pregnancy. Recognizing the indicators of migration or expulsion is important for swift action to maintain protection and prevent potential health issues.
Recognizing the Signs of IUD Migration or Expulsion
The most immediate indicators of IUD movement involve changes to the marker strings that extend from the cervix. When performing a self-check, you may notice the strings feel significantly shorter, longer, or even completely missing. A change in string length signals that the IUD has shifted from its position, either moving down toward the cervix or retracting higher into the uterine cavity.
In cases of partial expulsion, you might feel the hard, plastic tip of the IUD protruding from the cervix or into the vaginal canal. Physical sensations often accompany IUD migration, including the sudden onset of unusual cramping or severe, persistent abdominal pain. This discomfort is typically noticeably different from normal menstrual pain.
You may also observe a change in your typical bleeding pattern, such as heavy or prolonged menstrual bleeding, or an increase in spotting between periods. This atypical bleeding can be a symptom that the IUD is no longer fully seated. If a sexual partner reports feeling the hard plastic part of the device during intercourse, this is another strong indication that the IUD has moved.
Immediate Safety Measures and Precautions
The first step upon suspecting IUD expulsion is to assume your contraceptive protection is compromised. Immediately begin using a backup barrier method, such as condoms, or abstain from sexual intercourse to prevent unintended pregnancy. Do not wait to see a healthcare provider, as the device’s effectiveness is no longer reliable.
Resist the urge to try and fix the problem yourself, even if you can feel the device. Never attempt to push the IUD back into place or pull it out, as this can cause injury to the cervix or uterus. Physical manipulation by a non-professional can result in further migration or, in rare cases, uterine perforation.
As a precaution against further irritation or potential infection, stop using any internal menstrual products. Switch from tampons or menstrual cups to external products like sanitary pads until a medical professional evaluates the device’s position. Avoiding internal products reduces the risk of accidentally tugging on the IUD strings or introducing bacteria.
When to Seek Professional Medical Care
Contact your healthcare provider immediately if you experience severe, continuous pain or cannot locate your IUD strings at all. An urgent appointment is warranted for any confirmed sign of expulsion, as prompt intervention addresses contraceptive failure and potential health risks. The provider will typically start with a pelvic examination to visualize the cervix and check for the presence of the IUD strings or the device itself.
If the IUD cannot be located through a visual exam, the next step is usually a pelvic ultrasound to determine its exact location. The ultrasound confirms if the IUD is still in the uterus, partially migrated into the cervix, or fully absent (complete expulsion). If the device has migrated out of the uterus, surgical removal may be necessary.
If you had unprotected intercourse leading up to or after the suspected expulsion, discuss the need for emergency contraception with your provider. If the IUD is confirmed to be displaced or expelled, you will need to decide on a replacement method. Options include having a new IUD inserted, provided there are no contraindications, or switching to an alternative birth control method.
Common Reasons Why IUD Expulsion Occurs
While the exact cause is not always clear, IUD expulsion is often related to strong uterine contractions or anatomical factors. The strongest predictor for expulsion is a history of heavy or prolonged menstrual bleeding, as the force of contractions may push the device downward. Another significant risk factor is the timing of insertion, particularly if it occurs immediately after a vaginal delivery or a second-trimester abortion.
The uterus is still changing size and shape in the immediate postpartum period, which increases the likelihood of the IUD shifting. Younger individuals, especially those under age 25, also have a statistically higher risk of expulsion, possibly due to a smaller uterine cavity or stronger muscle tone. Additionally, having high parity (four or more previous births) is associated with an elevated risk.
Expulsion is most likely to occur within the first few months after insertion, though it can happen at any time during the device’s use. Individuals who have previously experienced an IUD expulsion are at a higher risk of having a subsequent device expel.