IUD migration is not always an emergency, but it can be. The answer depends on how far the device has moved and whether it has passed through the uterine wall. A device that has simply shifted lower in the uterus is a non-urgent problem you can address with your provider in the coming days. A device that has perforated completely through the uterus into the abdominal cavity is rare but life-threatening, requiring immediate surgical intervention.
Understanding the difference between these two scenarios, and knowing which symptoms point to which, can help you decide whether to call your clinic or head to the emergency room.
Displacement vs. Perforation: Two Very Different Problems
Most cases of IUD movement are simple displacement, where the device slides down toward the cervix but stays inside the uterus. This is by far the more common situation. Malpositioned IUDs typically settle in the lower uterus, where they can cause abnormal bleeding, cramping, and reduced contraceptive effectiveness. This is not an emergency. It does usually warrant removal, since the device is no longer working as intended, but you have time to schedule an appointment.
Complete perforation is the scenario that qualifies as a true emergency. This is when the IUD pushes entirely through the uterine wall and enters the abdominal cavity. Once outside the uterus, the device can attach to the bowel, bladder, or other organs, potentially causing obstruction, internal perforation, or serious infection. Complete perforation often causes severe abdominal pain and requires immediate surgery. Fortunately, it’s uncommon: uterine perforation occurs in roughly 1 to 2 out of every 1,000 IUD insertions.
Symptoms That Signal an Emergency
The tricky part is that some perforations produce no obvious symptoms at first. Many people with a migrated IUD experience only mild lower abdominal discomfort or light abnormal bleeding in the days after the device moves, symptoms that are easy to dismiss as normal cramping. In one reported case, a woman had no gynecologic symptoms for three years after her IUD perforated through the uterus and lodged near her bladder. Her only signs were frequent and painful urination that didn’t respond to antibiotics.
Certain symptoms, however, point clearly toward a serious problem:
- Severe, sudden abdominal pain that feels different from typical menstrual cramps, especially if it’s sharp and doesn’t ease up
- Fever or chills alongside pelvic pain, which could indicate infection or early sepsis
- Heavy vaginal bleeding that soaks through a pad in an hour or less
- Pain during urination or bowel movements that develops after IUD insertion, especially weeks or months later
- Feeling faint, dizzy, or generally unwell in combination with any of the above
If you experience severe abdominal pain with or without fever, treat it as an emergency. If your symptoms are limited to mild cramping and spotting with missing strings, call your provider’s office for a timely evaluation rather than heading to the ER.
What Happens Inside the Body When an IUD Migrates
Once an IUD leaves the uterus, it doesn’t just sit harmlessly in the abdomen. It commonly ends up in a space behind the uterus called the pouch of Douglas, but it can travel further. The body treats the device as a foreign object and forms scar tissue around it, a process called adhesion formation. These adhesions can bind loops of intestine together, leading to bowel obstruction.
If the device contacts the bladder, minerals in urine can crystallize around it and form bladder stones. If it presses against the bowel wall, it can eventually erode through and perforate the intestine. Rarer complications include inflammation of the appendix, gangrene of the small intestine, and kidney problems caused by scar tissue forming around the tubes that drain urine from the kidneys.
Because of these risks, the current medical recommendation is to remove any IUD found outside the uterus, whether in the abdominal cavity or embedded in the uterine muscle wall, even if the person has no symptoms at all.
How a Migrated IUD Is Found and Removed
If your IUD strings are missing or shorter than expected, the first step is usually a pelvic ultrasound. This is enough to locate the device in most cases, since it’s typically still somewhere in the uterus. If the ultrasound doesn’t find it, an abdominal X-ray can confirm whether the IUD is still in your body or was expelled without you noticing. For devices that have migrated outside the uterus, a CT scan pinpoints exactly where the IUD ended up and which organs it may be affecting. If bladder involvement is suspected, a scope examination of the bladder may be used.
Removal depends on where the device landed. A displaced IUD still inside the uterus can often be pulled out in a clinic visit, though it may be more uncomfortable than a standard removal if the device is embedded. An IUD that has perforated into the abdomen almost always requires laparoscopic surgery, a minimally invasive procedure using small incisions and a camera. In cases where there’s active infection or bowel perforation that needs repair, open abdominal surgery may be necessary instead.
Pregnancy Risk After Displacement
A displaced IUD is a poorly functioning IUD. If the device has shifted out of its correct position at the top of the uterus, your pregnancy risk goes up. And if you do become pregnant with an IUD in place, the pregnancy is more likely to be ectopic, meaning the embryo implants outside the uterus, usually in a fallopian tube. A meta-analysis found that among women who conceived with an IUD in situ, the odds of ectopic pregnancy were roughly six times higher than in women who conceived without one.
This doesn’t mean IUDs cause ectopic pregnancies. It means that the small number of pregnancies that do occur despite an IUD are disproportionately ectopic. If your IUD has shifted and you experience a positive pregnancy test along with one-sided pelvic pain or unusual bleeding, that combination needs urgent evaluation.
Getting a New IUD After Expulsion
If your IUD was expelled or removed due to displacement, a new one can typically be placed during the same visit. Data from a large clinical trial found that no perforations occurred in women who had a new IUD inserted after an expulsion, which is reassuring. However, reinsertion isn’t guaranteed to work on the first try. In that same trial, about 4% of reinsertion attempts after expulsion failed, usually meaning the device couldn’t be properly positioned.
Having one expulsion does raise your chances of experiencing another, though many people go on to use a second IUD without any problems. Your provider may check the size and shape of your uterine cavity before reinserting to improve the odds of a secure fit.
How to Monitor Your IUD at Home
The simplest way to catch early displacement is to check your IUD strings periodically. You can do this by inserting a clean finger into the vagina and feeling for the thin threads that hang through the cervix. The strings should feel roughly the same length each time. If they suddenly feel much shorter, much longer, or you can’t find them at all, the device may have shifted. If you feel hard plastic at your cervix, the IUD is partially expelled and no longer effective.
Checking once a month, such as after your period, is a reasonable habit. Keep in mind that missing strings don’t always mean migration. Sometimes the strings curl up around the cervix and become hard to reach. But missing strings are always worth a call to your provider and an ultrasound to confirm the device is still in the right place.