The thin, plastic threads of an intrauterine device (IUD) are intentionally left hanging through the cervix into the top of the vagina after insertion. The strings allow you to physically confirm the IUD remains correctly positioned inside the uterus and serve as the mechanism for a healthcare provider to safely remove the device. While not finding the strings is common, affecting up to 18% of IUD users, it requires attention because it may signal the device has moved and its effectiveness could be compromised.
Immediate Steps for Self-Checking
If you cannot locate the strings, perform a thorough self-examination. Wash your hands meticulously with soap and water, cleaning underneath your fingernails, to prevent introducing bacteria. Find a comfortable position, such as squatting or sitting on the edge of a tub, which makes the cervix more accessible.
Gently insert your index or middle finger deep into the vagina until you feel the cervix, which has a firm, rubbery texture. Once you locate the cervix, you should feel the fine, thread-like ends of the IUD strings protruding slightly. If you cannot feel them, try sweeping your finger across the surface of the cervix to ensure the strings have not simply curled up against it. Factors like your menstrual cycle can temporarily alter the cervix’s position, sometimes making the strings harder to reach.
Common Reasons the Strings Disappear
Most often, the strings are simply retracted or coiled, which is the most frequent reason for their disappearance. They may have curled back into the endocervical canal, the passage connecting the vagina and the uterus, making them too short to be felt. This situation does not typically mean the IUD has moved or that its contraceptive function is affected.
The strings may also have been trimmed short during the initial insertion procedure, making them consistently difficult to feel even if the device is properly placed. However, a missing string can also signal partial or complete expulsion, meaning the IUD has shifted or fallen out of the uterus. This is concerning because contraceptive protection is lost. In rare instances, the strings disappear because the IUD has migrated or perforated the uterine wall, an uncommon complication.
When to Contact Your Healthcare Provider
If you cannot locate the strings after a careful self-check, immediately contact your healthcare provider to schedule an appointment. Until a professional confirms the IUD’s correct position, use a backup contraceptive method, such as condoms, because the device’s efficacy cannot be guaranteed.
Certain accompanying signs necessitate a more urgent consultation, as they could indicate complications like infection or significant displacement. Seek prompt medical attention if you experience any of the following symptoms:
- Severe or persistent cramping.
- Abdominal pain not relieved by over-the-counter medication.
- Feeling the hard plastic part of the IUD itself.
- Abnormal vaginal discharge.
- A fever.
- Unusual, heavy bleeding.
Prepare for your appointment by noting when you last felt the strings and detailing any recent changes to your menstrual cycle or pain level.
Locating and Addressing a Missing IUD
At the medical office, the first step is usually a pelvic examination using a speculum to visualize the cervix. The provider may attempt to locate the strings within the cervical canal using a specialized tool, such as a cytobrush or grasping forceps. This procedure is often successful in retrieving strings that have simply coiled up.
If the strings cannot be located during the visual examination, the next step is typically an ultrasound to confirm the IUD’s location within the uterine cavity. An ultrasound determines if the device is correctly positioned, partially expelled, or migrated. If the IUD is confirmed to be in the uterus but the strings remain inaccessible, and removal is desired, the provider may use instruments like an IUD hook or specialized forceps to grasp the device.
If the IUD cannot be visualized by ultrasound within the uterus, an abdominal X-ray may be ordered to check for migration outside the uterine cavity, which signals uterine perforation. If perforation is confirmed, the IUD is usually removed through a minimally invasive laparoscopic procedure. The focus remains on safe removal and then discussing options for new contraception.