An intrauterine device (IUD) is a small, T-shaped form of contraception placed inside the uterus to prevent pregnancy. IUDs are highly effective, offering over 99% protection and lasting for several years, depending on the type. While reliable, an IUD can occasionally shift from its intended position. Recognizing signs of dislodgement is crucial for maintaining effectiveness and well-being.
Identifying Dislodgement
IUD movement can be recognized by changes in its strings or new bodily sensations. Regularly checking the IUD’s thin strings, which extend into the vagina, helps confirm proper placement. If the strings feel noticeably shorter, longer, or are absent, it indicates a shift. Additionally, feeling the hard plastic part of the IUD poking out of the cervix is a clear sign of dislodgement.
Beyond changes in the strings, several physical symptoms may suggest IUD movement. These can include sharp or sudden cramping, persistent abdominal pain or discomfort, or unusual vaginal discharge. Some individuals may also notice irregular vaginal bleeding or a significant change in their menstrual patterns, such as heavier or lighter bleeding than usual. Pain during sexual intercourse, which a partner might also feel, can be another indicator of a displaced IUD.
Reasons for Movement
An IUD can move for several reasons, though it is uncommon. Strong uterine contractions are a primary factor, particularly those experienced during menstruation or immediately after childbirth. These contractions can sometimes push the device out of place.
The likelihood of IUD movement is higher within the first three months following insertion. Factors such as the shape and size of the uterus can also influence an IUD’s stability; structural irregularities or a smaller-than-average uterine cavity may increase the chance of expulsion. Additionally, IUDs inserted immediately after a vaginal delivery or in individuals under 20 years old may have a higher expulsion rate.
What to Do Next
If you suspect IUD dislodgement, immediate action is necessary. First, avoid sexual intercourse or use a backup birth control method, such as condoms, as a displaced IUD may not prevent pregnancy. Do not attempt to adjust or remove the IUD yourself, as this could cause further injury or displacement.
Contact a healthcare provider as soon as possible to report your concerns. They will determine if the IUD has moved and advise on next steps. Prompt medical attention addresses potential risks, including unintended pregnancy or other complications. If you experience severe symptoms like heavy bleeding, fever, or pain that interferes with daily activities, seek immediate medical attention.
Consequences and Care
A dislodged IUD primarily risks reduced contraceptive effectiveness and unintended pregnancy. If pregnancy occurs with a dislodged IUD, there is also an elevated risk of an ectopic pregnancy, where the fertilized egg implants outside the uterus. It can also cause persistent pain, cramping, or abnormal bleeding. In rare instances, if the IUD partially or fully exits the uterus, it can lead to infection.
Upon suspected dislodgement, a healthcare provider typically performs a pelvic exam to check IUD strings. If strings are not visible or position is uncertain, a pelvic ultrasound confirms its exact location, revealing if it’s in the uterine cavity, shifted to the cervix, or expelled. In very rare cases where the IUD cannot be located by ultrasound, an X-ray may be used to determine if it has perforated the uterine wall and moved into the abdominal cavity.
Medical management depends on the IUD’s position and any associated symptoms. If the IUD is partially expelled into the cervix, it will typically need to be removed. If it has perforated the uterus and migrated outside, surgical removal, often via laparoscopy, may be necessary, though this is a rare complication. If the IUD is simply malpositioned but still within the uterus, the healthcare provider will discuss options, which may include removal and, if desired, immediate reinsertion of a new IUD. Patients with asymptomatic dislodged IUDs may sometimes be managed expectantly, especially with hormonal IUDs, but the decision to remove or replace the device is made based on individual circumstances and the risk of pregnancy.