An intrauterine device (IUD) is a highly effective, long-acting form of reversible contraception placed within the uterus. The IUD has thin, plastic threads attached to its base that extend through the cervix and slightly into the vaginal canal. These strings allow the user to periodically check that the device is in the correct position and provide the healthcare provider with a means to safely remove the IUD. If you cannot feel these threads, it is understandable to be concerned. This situation, known clinically as nonvisualized strings, is common and requires assessment to ensure continued health and contraceptive protection.
Common Reasons the Strings Are Not Felt
The inability to locate the IUD strings is common, affecting nearly one in five IUD users. In most cases, the device remains properly seated in the uterus. The most frequent explanation is that the strings have simply coiled or curled up high against the cervix or within the endocervical canal, positioning them out of reach.
The strings may also have been cut very short by the clinician during insertion, making them difficult to feel, or they may be hidden in a fold of vaginal tissue. Furthermore, the position of the cervix naturally changes throughout the menstrual cycle. During certain phases, such as around ovulation, the cervix sits higher, pulling the strings further up and out of reach. These scenarios are not a cause for alarm, as the IUD is still functioning correctly.
Potential Complications Affecting Device Placement
While most reasons for missing strings are benign, their absence can signal a significant issue with the device’s placement, compromising its effectiveness. The most common complication is a partial or full expulsion, where the muscular contractions of the uterus push the IUD partially or completely out of the uterine cavity. This expulsion most frequently occurs within the first year after insertion and significantly increases the risk of unintended pregnancy.
A more serious, though much rarer, complication is uterine perforation, which happens when the IUD pokes into or through the wall of the uterus, typically during insertion. Perforation can cause the IUD to migrate outside the uterus into the abdominal cavity. When the IUD is not correctly positioned within the uterine cavity, whether due to expulsion or migration, its contraceptive protection is lost.
Immediate Steps and Precautions to Take
If you can no longer feel your IUD strings, immediately begin using a backup method of contraception, such as condoms or abstinence. This safety measure is necessary because the absence of strings means the device’s proper placement cannot be confirmed, and its effectiveness may be compromised. You should not attempt to retrieve the strings yourself, as this could inadvertently dislodge the IUD or cause injury.
Contact your healthcare provider promptly to schedule a clinical assessment. When you call, be ready to provide details about when you last felt the strings and any new or unusual symptoms, such as severe cramping, abnormal bleeding, or discharge. Documenting the date of your last successful string check provides valuable information to your medical team.
Clinical Assessment and Retrieval Procedures
The clinical assessment begins with a pelvic examination using a speculum to visualize the cervix. The healthcare provider will first look for the strings at the cervical opening. If the strings are not immediately visible, the provider may use a specialized tool, such as a cervical cytology brush or an IUD hook, to gently sweep the endocervical canal. This simple, office procedure is often successful in coaxing coiled strings back into view.
If this initial step fails, the next action is typically a transvaginal ultrasound. This imaging technique confirms the IUD’s location within the uterus and verifies that it is properly positioned and not embedded in the uterine wall. If the IUD is not seen on the ultrasound, an X-ray of the abdomen and pelvis may be ordered to check for uterine perforation and migration into the abdominal cavity. Once the IUD’s position is confirmed, if it is correctly placed, the provider can use specialized forceps for removal, or leave it in place.