The inability to feel your intrauterine device (IUD) strings can be an unsettling experience for anyone who relies on this form of contraception. These thin, flexible threads are attached to the device that sits inside the uterus. The strings serve two primary functions: they allow you to perform a monthly self-check to confirm the IUD is still in its correct position, and they enable a healthcare provider to gently remove the device when it is time for replacement or discontinuation. While the absence of strings can signal a problem, many non-threatening reasons exist for why they might be temporarily out of reach.
Benign Explanations for Missing Strings
In the majority of cases where strings are missing, the IUD is still correctly positioned and fully effective. One of the most common reasons is that the strings have simply coiled up high inside the cervical canal, making them inaccessible to your finger during a self-check. They might be lying flat against the cervix or hidden within a fold of vaginal tissue.
The position of the cervix naturally changes throughout the menstrual cycle, which affects the accessibility of the strings. The cervix sits lower and is easier to reach during menstruation, but it moves higher into the body during other phases, potentially pulling the strings out of reach. If your strings were cut particularly short during insertion, a slight shift in the cervix’s position or a change in your checking posture could be enough to hide them entirely, leading to the false impression that the strings are gone.
Serious Implications of Missing Strings
Even though many causes are benign, the inability to locate the strings can sometimes indicate that the IUD is no longer providing reliable contraception or that a medical issue has occurred. The most frequent concern is partial or full expulsion, where the IUD has shifted downward or fallen out of the uterus completely. Expulsion most often occurs within the first year after insertion and can happen without you noticing the device physically passing out of the body.
If the IUD has moved down from its proper position at the top of the uterus, it can lead to a loss of contraceptive efficacy. This displacement can be partial, with the IUD shifting within the uterine cavity, or a full expulsion where the device is no longer in the uterus at all. Symptoms like heavier-than-usual bleeding, severe cramping, or a change in your typical menstrual flow may accompany a displaced IUD.
A much rarer but more serious complication is uterine perforation, which occurs when the IUD pushes into or through the wall of the uterus, potentially migrating outside the uterine cavity. If perforation occurs, the strings will be absent because the device is no longer properly seated within the uterine space. The IUD will need to be surgically removed.
Essential Steps After String Loss
If you are unable to feel your IUD strings, the first step is to avoid any further forceful attempts to locate them, which could inadvertently pull on the device if it is partially expelled. Immediately begin using a non-hormonal barrier method, such as condoms, for all sexual activity until a healthcare provider confirms the IUD’s placement, as the contraceptive effect may be compromised.
You should contact your healthcare provider promptly to schedule an appointment for a placement check. During the examination, the clinician will first attempt to visualize the strings using a speculum and may use a small brush or specialized instrument to gently sweep the cervical canal for coiled strings. If the strings cannot be found, the provider will typically order a transvaginal ultrasound to confirm the IUD is correctly positioned within the uterus.
If the ultrasound is inconclusive or suggests the device is absent from the uterus, an X-ray of the abdomen and pelvis may be performed to check for migration outside the uterine cavity, which is necessary to rule out perforation. If the IUD is found to be displaced or has perforated the uterine wall, the provider will discuss removal options. These may involve specialized instruments or, in rare cases of perforation, a procedure like operative hysteroscopy or laparoscopy.