Feeling IUD strings that seem longer than usual or visibly protruding from your vagina is a sign that the device may have shifted from its proper position, and the most important step is to use backup contraception and contact your healthcare provider for evaluation. A normally placed IUD sits at the top of the uterus, with its thin threads trailing through the cervical canal so that just a centimeter or two hangs into the upper vagina. When those strings suddenly feel much longer, or when you can feel hard plastic at or near your cervical opening, the device may be partially expelled, meaning it has started sliding out of position. This is not a medical emergency in most cases, but it does need attention because a displaced IUD may no longer be protecting you from pregnancy.
What Normal IUD Strings Feel Like
After insertion, your provider trims the IUD strings so they extend about two to three centimeters past the cervix. When you reach inside your vagina with clean fingers, you should feel thin, flexible threads coming from the small opening of the cervix. They often curl around the cervix and soften over time, which is why many people stop noticing them after the first few weeks. The strings are there so a provider can eventually remove the device by gently pulling on them.
If the strings feel the same length they have always been, and you cannot feel any hard plastic, things are probably fine. What should concern you is a noticeable change: strings that are suddenly much longer than before, strings you can see outside your body, or the sensation of the rigid plastic frame of the IUD itself near or at the cervical opening. Any of these shifts suggests the device has moved.
Partial Expulsion Versus Complete Expulsion
When an IUD moves out of its ideal position, it falls into one of two categories. A partial expulsion means the device has slipped lower in the uterus or into the cervical canal but has not come all the way out. A complete expulsion means the device has fallen out entirely, sometimes without you even noticing. Strings that are hanging noticeably lower usually point to partial expulsion, where the IUD is on its way out but still physically inside you.
A randomized trial comparing early versus interval postpartum IUD placement found that partial expulsion occurred in roughly 8 to 9 percent of participants over six months, while complete expulsion was far less common at around 2 percent or less depending on timing of placement.1JAMA. Early vs Interval Postpartum Intrauterine Device Placement: A Randomized Clinical Trial In the broader population, a large study found cumulative expulsion rates of roughly 2.3 percent within the first year and about 4.5 to 4.8 percent over five years, regardless of whether the device was a hormonal or copper IUD.2PubMed. Association between intrauterine device type and risk of perforation and device expulsion: results from the Association of Perforation and Expulsion of Intrauterine Device study So while expulsion is not extremely common, it is not rare either, and the strings feeling abnormally long is one of the first clues.
What to Do Right Now
If you notice your strings hanging lower than usual or can feel the device itself at your cervix, there are a few things to do immediately and a few things to avoid.
- Use backup contraception: Until a provider confirms the IUD is still properly placed, treat yourself as unprotected. Condoms are the simplest option.
- Don’t pull on the strings: Tugging on them could cause the device to shift further or come out in a way that causes cramping, bleeding, or even minor injury to the cervical canal.
- Call your provider: Most offices can fit you in for a quick check within a day or two. Describe what you are feeling so they can prioritize appropriately.
- Note any symptoms: Unusual cramping, heavy bleeding, pain during sex, or a change in your period pattern are all worth mentioning when you call.
If the IUD has come out completely and you can see the whole device, save it to bring to your appointment. Your provider will want to confirm it is intact and that no fragments remain inside. If you had unprotected intercourse recently and the device has shifted, mention this to your provider so they can discuss emergency contraception options if needed.
Why the IUD May Have Moved
Several factors increase the chance that an IUD will shift out of place. Uterine anatomy plays a significant role. Fibroids, adenomyosis, or congenital variations in the shape of the uterus can prevent the device from settling properly. One case report described how adenomyosis in particular can distort the uterine cavity enough that the IUD migrates from its intended position.3PubMed Central. The lost intrauterine levonorgestrel-releasing system in women with adenomyosis: A case report A clinical review similarly noted that severe uterine distortion from fibroids or congenital malformations like a bicornuate uterus may prevent proper positioning and contribute to displacement.4Clin Obstet Gynecol Reprod Med. Malposition and displacement of intrauterine devices–diagnosis, management and prevention
Age and whether you have previously given birth also matter. A study of over 90,000 IUD insertions found that expulsion rates did not differ meaningfully between hormonal and copper devices, but younger age was associated with higher expulsion risk.5PubMed Central. Association of Age and Parity With Intrauterine Device Expulsion Timing of insertion after delivery matters too. A study of postpartum IUD insertion in Uganda found that devices placed more than ten minutes after delivery had a much higher risk of expulsion, as did prolonged postpartum bleeding lasting fifteen days or more.6PubMed Central. Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study
Heavy periods and strong uterine contractions during menstruation can also nudge the device downward, which is one reason expulsion is more commonly noticed during or just after a period. If you have always had heavy, crampy periods, it is worth checking your strings a bit more frequently.
Menstrual Cups and IUD Strings
If you use a menstrual cup, it is worth paying extra attention to how you remove it. Because menstrual cups form a suction seal inside the vagina, pulling the cup out without first breaking that seal can tug on the IUD strings. A randomized trial of copper IUD users who also used menstrual cups found that the removal process could pull on the strings, and while participants were advised to break the seal before removing the cup, researchers noted they could not confirm whether a specific removal technique actually lowered the risk.7Contraception. Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial
The practical takeaway: always pinch the base of the cup to release the vacuum before pulling it out, and check your IUD strings afterward. If you notice the strings seem longer following cup removal, that is worth a call to your provider. Some people with IUDs choose to use discs instead of cups, since discs do not rely on suction in the same way, though evidence specifically comparing disc-related and cup-related expulsion risk is limited.
How Your Provider Will Check the IUD
When you go in for an evaluation, your provider will typically start with a pelvic exam to see whether the IUD strings are visible at the cervix and whether the device itself can be felt. If the strings are present and the right length, a quick exam may be all that is needed. If the strings seem too long or the device feels low, the next step is usually an ultrasound.
Transvaginal ultrasound is the standard tool for confirming IUD position. A study evaluating both transabdominal and transvaginal ultrasound for a levonorgestrel IUD found that both approaches could detect the device and confirm whether it was in the correct fundal position at the top of the uterus.8Acta Obstetricia et Gynecologica Scandinavica. Transabdominal and transvaginal ultrasound detection of levonorgestrel IUD in the uterus However, ultrasound is not perfect. An earlier study comparing ultrasound with hysteroscopy (a camera placed inside the uterus) found that about 9 percent of malpositioned IUDs were not detected by ultrasound alone.9PubMed. How accurate is ultrasonography in monitoring IUD placement? Hysteroscopy also allowed providers to spot associated conditions like polyps and endometrial changes that ultrasound missed.
In practice, if ultrasound shows the IUD sitting low in the uterus or partly in the cervical canal, your provider will recommend removal. If the device appears to be in a normal position despite the strings feeling different, they may simply trim the strings and have you follow up if anything changes. Occasionally, a provider might order an X-ray if the IUD cannot be seen on ultrasound at all, to determine whether it has perforated through the uterine wall into the abdominal cavity, a rare but serious complication.
Does a Shifted IUD Still Prevent Pregnancy?
A malpositioned IUD is less reliable than a properly placed one, but the picture is more nuanced than a simple yes-or-no. A study comparing women with malpositioned IUDs to those with correctly placed devices found that the malpositioned group had roughly twice the rate of pregnancy within two years, about 19 percent versus 11 percent. Critically, though, every pregnancy in the study occurred after the IUD had been fully expelled or removed; none happened while a malpositioned IUD was still known to be inside the uterus.10PubMed. Malpositioned intrauterine contraceptive devices: risk factors, outcomes, and future pregnancies
That finding suggests a malpositioned IUD may still offer some protection as long as it physically remains in the uterus, but the higher pregnancy rate in that group reflects the greater likelihood that those devices eventually fell out or needed removal. The bottom line: if your strings are longer than usual, you should use backup contraception until your provider confirms the device’s location. If it has partially expelled, it should be removed, and you can discuss whether to have a new one inserted.
What Happens If You Need a New IUD After Expulsion
If the IUD has to come out, reinsertion is an option, but you should know that having one device expelled raises your odds of expelling the next one. A study tracking 124 women who had a copper IUD reinserted after expulsion found that about 22 percent expelled the replacement within six months, and by one year the cumulative expulsion rate reached roughly 31 percent.11PubMed. Performance of copper intrauterine devices when inserted after an expulsion That is substantially higher than first-time expulsion rates and is something your provider should discuss with you before placing a second device.
This does not mean a new IUD is a bad choice. For many people, the benefits of long-acting contraception outweigh the elevated expulsion risk, especially when they are aware of the possibility and check their strings regularly. Some providers may suggest trying a different size or shape of IUD, or they may discuss alternative long-acting options like the contraceptive implant, which goes in the arm and avoids the uterine cavity altogether. The conversation should be tailored to your anatomy, your reproductive goals, and how much inconvenience you are willing to tolerate.
Should You Try to Remove It Yourself?
When the device is already partly out and you can feel the frame at your cervix, it can be tempting to just pull it the rest of the way. Online forums are full of people sharing their experiences with self-removal, and research analyzing those discussions found that many IUD users turned to self-removal because they could not get a timely appointment or faced high costs for a provider visit.12Contraception. “$231 … to pull a string!!!” American IUD users’ reasons for IUD self-removal: An analysis of internet forums That frustration is understandable, and in a straightforward partial expulsion where the device is already sitting at the cervical opening, the physical act of pulling it out is usually uncomplicated.
That said, there are real reasons to let a provider handle it when you can. A provider can check that the device comes out in one piece, evaluate whether the uterus looks healthy, discuss your contraceptive plan going forward, and screen for rare complications like cervical perforation by the IUD strings, which has been documented in case reports.13PubMed Central. Perforation of the Cervix by the Strings of an Intrauterine Device (IUD): a Novel Case and Systematic Review of the Literature If you cannot get an appointment and the device is visibly protruding, pulling it out gently is unlikely to cause harm, but you should still follow up for contraceptive counseling and to confirm nothing was left behind.
Copper Versus Hormonal IUDs and Expulsion Risk
People sometimes wonder whether one type of IUD is more likely to shift than another. The evidence on this is reassuring in that the differences are small enough to be clinically unimportant for most people. One large study found that the three-year cumulative expulsion rate was about 10 per 100 users for both hormonal and copper devices.5PubMed Central. Association of Age and Parity With Intrauterine Device Expulsion A separate analysis of over 200,000 IUD insertions found a slightly lower adjusted risk of expulsion for hormonal devices compared to copper ones, but the absolute numbers were so similar that the researchers concluded the difference may not matter in practice.2PubMed. Association between intrauterine device type and risk of perforation and device expulsion: results from the Association of Perforation and Expulsion of Intrauterine Device study
If you have expelled one type, switching to the other is unlikely to solve the problem. The factors driving expulsion are more about your uterine anatomy, the timing and technique of insertion, and perhaps your menstrual patterns than about which brand of IUD you choose. A conversation with your provider about whether an IUD is still the right fit for you is more productive than simply swapping types.
When Strings Disappear Instead of Getting Longer
The opposite scenario, where you cannot find the strings at all, is actually a more common clinical puzzle than strings hanging too low. Missing strings can happen for benign reasons: the threads sometimes curl up around the cervix or retract into the cervical canal, especially as they soften over time. But missing strings can also signal that the IUD has perforated through the uterine wall or has been expelled without you noticing. A systematic review noted that the most frequent reasons for absent strings include retraction into the cervix or uterus, uterine perforation, and unnoticed expulsion.13PubMed Central. Perforation of the Cervix by the Strings of an Intrauterine Device (IUD): a Novel Case and Systematic Review of the Literature
If your strings were once palpable and now you cannot find them, the evaluation path is similar to what was described above: pelvic exam, ultrasound, and possibly X-ray if the device is not visible. The key difference is that missing strings sometimes mean the IUD is still in perfect position but the strings have simply tucked themselves out of reach, whereas strings that are hanging much lower almost always indicate the device is migrating outward.
How Often to Check Your Strings
Most providers recommend checking your strings once a month, ideally after your period ends. You squat or put one foot up on the toilet, insert a clean finger, and feel for the threads at the cervix. It takes about ten seconds once you know what you are looking for. The goal is not to measure the exact length each time but to notice if something has changed. If you checked last month and felt short threads, and this month you feel something longer or harder, that is your cue to call.
Some people find string checks anxiety-inducing or just forget. If you are not someone who checks regularly, pay attention to indirect signs instead: a sudden increase in cramping, heavier bleeding, pain during intercourse, or the feeling of something hard in your vagina. Any of these should prompt a visit. And if you have risk factors for expulsion, like a history of previous expulsion, fibroids, or a uterine shape variation, consider checking more diligently than once a month, especially in the first few months after insertion when most expulsions happen.