Intrauterine Devices (IUDs) are highly effective, long-acting reversible contraceptives. While they offer significant benefits, IUD expulsion, where the device partially or completely comes out of the uterus, is a rare but possible occurrence. Understanding the factors and signs of expulsion is important for IUD users.
Reasons an IUD Might Expel
Uterine shape and size can influence IUD expulsion risk. Very small uteruses or those with structural irregularities, such as a bicornuate or arcuatus uterus, may not provide enough space for the IUD. Uterine fibroids, which are benign growths, can also distort the uterine cavity, making IUD placement challenging and potentially raising the risk of expulsion.
Strong uterine contractions also contribute to IUD expulsion. Individuals experiencing heavy menstrual bleeding or severe cramping may have a higher risk, as the uterus contracts more forcefully. Conditions such as adenomyosis or large fibroids can lead to increased uterine activity and a higher expulsion risk.
IUD insertion timing relative to childbirth significantly affects expulsion rates. IUDs placed immediately after vaginal delivery or within the first few weeks postpartum carry a higher risk of expulsion. For instance, expulsion rates can range from 10% for immediate postpartum placements to less than 2% for interval placements (four weeks or more postpartum).
Incorrect initial IUD insertion can also increase expulsion risk. If the device is not positioned correctly at the top of the uterus (fundus), it may be more prone to shifting or expulsion. Healthcare providers use specific techniques, including measuring uterine depth, to ensure proper placement and minimize this risk.
Younger individuals and those who have not had children (nulliparous) might experience a slightly higher risk of IUD expulsion. This can be attributed to factors like a smaller uterine cavity or stronger uterine muscle tone. However, some studies suggest that nulliparous women may have equivalent or even lower expulsion rates with certain IUD types after accounting for other factors.
Signs of IUD Expulsion
A common indicator of IUD expulsion is a change in the length of the IUD strings. Individuals are advised to regularly check for these strings; if they feel shorter, longer, or are missing entirely, it suggests the IUD has shifted or expelled. The strings should be about 2-3 cm long, extending from the cervix into the vagina.
Feeling the IUD itself can be a clear sign of expulsion. If the plastic part of the device is felt at the opening of the cervix or within the vagina, it means the IUD is no longer correctly positioned. This indicates a partial or complete expulsion.
Abnormal pain or cramping can also signal an issue with the IUD’s placement. New or worsening pelvic pain, severe cramping, or discomfort during sexual activity may indicate the device has moved. While some cramping is normal after insertion, persistent or intensifying pain warrants attention.
Unusual bleeding patterns, such as unexpected spotting, heavier bleeding than usual, or a significant change in menstrual flow, can be a symptom. If a hormonal IUD user, who experiences lighter periods, notices a return to heavy bleeding, it could indicate expulsion. Similarly, a copper IUD user might experience unusually light periods if the device has moved.
If the IUD has expelled, it is no longer effective in preventing pregnancy. Therefore, signs of pregnancy, such as a missed period, could indirectly point to an IUD expulsion. In some instances, the IUD may be found completely outside the body, for example, when changing a tampon or during a bowel movement.
Steps to Take After Suspected Expulsion
If an IUD expulsion is suspected, avoid attempting to reinsert the device. Trying to push the IUD back into place can cause further displacement or injury. The device should be handled only by a healthcare professional.
Immediate use of backup contraception is necessary to prevent unintended pregnancy. Since an expelled IUD offers no protection, alternative methods such as condoms should be used during any sexual activity while awaiting medical evaluation.
Contact a healthcare provider immediately. An appointment should be scheduled for confirmation of expulsion and to discuss next actions. The healthcare provider can perform an examination and potentially use an ultrasound to determine the IUD’s location.
If the IUD has been found after expulsion, keep it and bring it to the healthcare appointment. This allows the provider to examine the device and confirm it is the IUD, aiding the diagnostic process.
The healthcare provider will then discuss future contraceptive options. This may include reinsertion of a new IUD, potentially a different type, or exploring other suitable birth control methods. Decisions regarding future contraception will consider the reasons for expulsion and individual preferences.