Intrauterine devices (IUDs) are a highly effective form of reversible birth control, offering long-term pregnancy prevention. An IUD can sometimes shift from its intended position within the uterus. Understanding why an IUD might move, recognizing the indicators of such a change, and knowing the appropriate steps to take are important for anyone relying on this contraceptive method.
Types of IUD Displacement
IUD displacement refers to several distinct scenarios where the device is no longer correctly positioned within the uterine cavity. One common type is partial expulsion, where the IUD begins to exit the uterus, with part of the device potentially visible at the cervix or in the vagina. This is distinct from complete expulsion, in which the IUD fully exits the uterus and falls out of the body.
Another form of displacement is embedment, where a portion of the IUD, often an arm, becomes lodged or embedded into the muscular wall of the uterus (myometrium) without fully puncturing through it. This can create discomfort or pain. A more serious, though rare, complication is uterine perforation, where the IUD punctures completely through the uterine wall, potentially moving into the abdominal cavity. This situation requires immediate medical attention.
Factors Contributing to Displacement
Several factors can increase the likelihood of an IUD moving from its correct placement, with many occurrences happening within the first three months after insertion. Strong uterine contractions are a primary cause, particularly those experienced during menstruation. The uterus may react to the IUD as a foreign object, attempting to expel it through these contractions.
The technique used during IUD insertion also plays a role; improper placement, such as not positioning the device high enough in the uterine fundus, can contribute to displacement. An individual’s unique uterine anatomy, including a uterus that is unusually shaped or has a smaller-than-average cavity, can also increase the risk. Conditions like uterine fibroids or a uterus arcuatus or bicornus, which are structural irregularities, can create an environment where the IUD does not fit optimally, leading to expulsion.
Recent childbirth is another significant factor influencing IUD stability, as the uterus undergoes substantial changes in size and tone postpartum. For IUDs placed immediately after vaginal delivery, the risk of expulsion is significantly higher than for IUDs placed later. Breastfeeding may decrease the risk of expulsion.
Age can also be a factor, with younger individuals, particularly those aged 14-19, having a higher rate of IUD expulsion compared to older women. This increased risk in younger individuals may be linked to a smaller uterine cavity and potentially more challenging insertion. Heavy menstrual bleeding or severe cramping can contribute to displacement, as the increased uterine activity may push the device out. A history of previous IUD expulsion also elevates the risk of recurrence.
Recognizing the Signs
Recognizing the signs of a displaced IUD is important for ensuring continued contraceptive effectiveness and addressing potential complications.
One of the most common indicators is a change in the IUD strings. Individuals may find they cannot feel the strings at all, or they may feel them to be significantly shorter or longer than usual. The strings, typically 1-2 inches long and positioned just through the cervix, should remain consistent in length.
New or worsening pain and cramping, particularly if severe or persistent, can also signal that the IUD has moved. While some cramping is normal after insertion, pain that interferes with daily activities may warrant investigation. Abnormal bleeding or spotting, especially if it deviates from typical menstrual patterns or includes unusually heavy flow, can be another symptom.
In some instances, an individual might feel the IUD itself, such as a hard, plastic part protruding from the cervix, which should not happen if the device is correctly in place. A partner might also feel the IUD during sexual intercourse. Finally, any symptoms of pregnancy, such as a missed period, could indicate that the IUD is no longer effective in preventing conception.
Taking Action
If an IUD is suspected to have moved, prompt action is necessary. The first step is to immediately contact a healthcare provider for an evaluation. It is important to use a backup method of contraception, such as condoms, as the IUD may no longer be effective in preventing pregnancy.
Individuals should never attempt to adjust or remove the IUD themselves, as this could cause further displacement or injury. A healthcare provider can perform a pelvic examination to check for the strings and may use a cytobrush to locate them if they are not immediately visible. To confirm the IUD’s position, an abdominal or transvaginal ultrasound is often utilized. If the IUD cannot be located via ultrasound, an X-ray of the abdomen and pelvis may be performed.
Depending on the findings, the healthcare provider will discuss options, which may include removal of the displaced IUD and insertion of a new one, or exploring alternative contraceptive methods. Early detection and intervention are important for addressing any potential complications and ensuring continued protection against pregnancy.