An intrauterine device (IUD) is a highly effective form of long-acting reversible contraception. It is a small, T-shaped device inserted into the uterus to prevent pregnancy, offering protection for several years depending on the type. While IUDs are generally safe and effective, they can, in rare instances, move from their correct position within the uterus. This shifting is referred to as “displacement” or being “out of place.”
Recognizing Displacement
Recognizing signs that an IUD may have moved is important for maintaining contraceptive effectiveness and overall health. One of the primary indicators of displacement involves changes in the IUD strings. These strings are typically 1-2 inches long and extend from the IUD through the cervix into the top of the vagina. If the strings feel noticeably shorter or longer than usual, or if they are entirely missing when you check for them, it could suggest the IUD has shifted.
Self-checking for IUD strings is a practical way to monitor placement. When performing this check, avoid pulling on the strings, as this could further dislodge the device.
Other physical symptoms can also signal a displaced IUD. These may include new or worsening pain or cramping in the lower abdomen or pelvis. Some individuals experience unusual or heavy vaginal bleeding, or noticeable changes in their menstrual patterns, such as unexpected or excessive period-like bleeding with a hormonal IUD or lighter-than-usual menstruation with a copper IUD. Pain or discomfort during sexual intercourse for either partner, or a feeling that the IUD is expelling or falling out, are also potential signs.
Reasons for Movement
Several factors can contribute to an IUD becoming displaced from its intended position within the uterus. Uterine contractions, particularly those experienced during menstruation or in the postpartum period, are a common cause. The uterus naturally contracts, and these movements can sometimes lead to the IUD shifting.
The initial insertion process can also play a role in later displacement. If the IUD is not placed correctly, for instance, if it is positioned too low in the uterus, it may be more prone to moving. Additionally, the unique anatomy of an individual’s uterus can influence the IUD’s stability. Uterine anomalies like fibroids or a bicornuate uterus can affect the IUD’s fit, as can the size and shape of the uterine cavity.
Cervical dilation, such as during childbirth, or if an individual has had multiple pregnancies, can also be a factor that increases the risk of displacement. Displacement can occur as a partial or complete expulsion, where the IUD either partially or fully exits the uterus.
Immediate Actions and Medical Care
If you suspect your IUD is out of place, do not attempt to push, pull, or adjust the IUD yourself, as this could cause further displacement or injury. Tugging on the strings or the device itself can worsen the situation.
The most important step is to contact a healthcare provider immediately. They can properly assess the situation and determine the IUD’s position. While awaiting your appointment, it is crucial to use backup contraception, such as condoms, or abstain from intercourse. This is because a displaced IUD may no longer be effective at preventing pregnancy.
Seeking prompt medical attention is important to prevent potential complications. Your healthcare provider will be able to confirm if the IUD has moved and advise on the necessary next steps. Do not delay in contacting a professional if you experience severe pain, heavy bleeding that soaks through menstrual products quickly, blood clots larger than a quarter, chills, or a fever above 101°F (38°C).
Potential Outcomes
An IUD that is out of place can lead to several potential outcomes, primarily affecting its contraceptive efficacy and potentially posing health risks. The most direct consequence is reduced contraceptive effectiveness, which increases the likelihood of an unintended pregnancy. If pregnancy occurs with a displaced IUD, there is an increased risk of ectopic pregnancy. An ectopic pregnancy happens when a fertilized egg implants outside the uterus, most commonly in a fallopian tube, and this condition can be serious. While IUDs are very effective at preventing uterine pregnancies, they do not offer the same level of protection against ectopic pregnancies.
Although rare, a displaced IUD can potentially lead to uterine perforation. This occurs when the device pierces through the uterine wall, and in some cases, it can migrate into the abdominal cavity. Perforation can cause damage to surrounding tissues or organs, such as the bowel or bladder, and may require surgical removal. While perforation is uncommon, occurring in about 1 in 1,000 insertions, it is a serious complication.
While less common as a direct result of displacement alone, infection can become a concern, particularly if the IUD is partially expelled or if perforation occurs. Pelvic inflammatory disease (PID) is a potential risk, especially if bacteria are introduced during insertion or if there is an untreated sexually transmitted infection. Persistent pain and discomfort are also direct outcomes of an IUD that is not in its correct position. This ongoing discomfort can significantly impact daily life.
Managing a Displaced IUD
When an IUD is suspected of being out of place, healthcare providers follow a specific protocol to confirm its position and determine the best course of action. A pelvic exam is typically the first step, where the provider will attempt to locate the IUD strings. If the strings are not visible or cannot be felt, a transvaginal ultrasound is commonly used to confirm the device’s location within the uterus. In rare cases where the IUD cannot be located by ultrasound, such as if it has migrated outside the uterus, an X-ray of the abdomen and pelvis may be performed.
Once displacement is confirmed, the displaced IUD usually needs to be removed by a healthcare professional. Attempts to reposition an IUD are generally not recommended or successful, as the device is designed to be effective only when properly seated in the uterus. Repositioning may not restore its contraceptive efficacy and could lead to further complications.
After the removal of a displaced IUD, individuals can discuss their contraceptive options with their healthcare provider. This discussion might include the reinsertion of a new IUD, if appropriate for the individual’s circumstances and desired, or switching to another method of contraception. The choice of a new method will depend on factors such as uterine anatomy, personal preference, and overall health.