Regularly checking for IUD strings is a routine part of using an intrauterine device (IUD) for contraception. Many IUD users experience a common concern when they cannot feel their IUD strings. This situation is a frequent occurrence. This article will explore why this happens, when to be concerned, and what steps to take.
Understanding IUD Strings
IUDs are small, T-shaped contraceptive devices inserted into the uterus. Attached to the base of the IUD are one or two thin, plastic threads, commonly referred to as “strings.” These strings typically hang through the cervix and into the upper part of the vagina.
The strings serve two main purposes: they allow for self-checking to confirm the IUD’s position, and they are used by a healthcare provider for safe and easy removal. Healthcare providers recommend monthly self-checks to ensure the IUD remains correctly in place and continues to provide effective contraception.
Why Strings Might Be Hard to Feel
It is common for individuals to have difficulty locating their IUD strings, and often, this is not a sign of a serious problem. Up to 18% of IUD users report being unable to feel their strings at some point. One frequent reason is that the strings may have curled up or moved higher into the cervical canal or uterus, making them difficult to reach during a self-check. This coiling can happen naturally or due to the cervix’s position changing throughout the menstrual cycle.
Another possibility is that the strings were initially cut very short during insertion, making them challenging to locate with a finger. Over time, the strings can also soften and become less noticeable to the touch. Additionally, individual anatomical variations or the technique used during self-examination can affect one’s ability to feel the strings. These scenarios mean the IUD remains correctly positioned and fully effective.
When Missing Strings Are a Concern
While often benign, the absence of IUD strings can sometimes indicate a more significant issue with the device’s position, which could compromise its contraceptive effectiveness. One such concern is partial or complete expulsion, where the IUD moves out of the uterus. This can occur partially, with the device still within the cervical canal, or completely, where it falls out of the body entirely, sometimes unnoticed during menstruation.
Another possibility is displacement, where the IUD shifts from its optimal position within the uterus. A dislodged IUD might not effectively prevent pregnancy. Symptoms such as sharp, sudden cramps, irregular vaginal bleeding, unusual vaginal discharge, or pain during sexual activity can accompany displacement or expulsion. Rarely, the IUD might perforate the uterine wall, a serious complication that can also result in missing strings and requires immediate medical attention.
Immediate Steps to Take
Upon discovering that IUD strings cannot be felt, maintaining calm is important. The first step involves carefully re-attempting the self-check, ensuring hands are clean and in a comfortable position, such as squatting or sitting. It is crucial to refrain from pulling on any strings if they are found, as this could dislodge the IUD.
Until a healthcare provider confirms the IUD’s correct placement, it is essential to use a backup method of contraception, such as condoms. This precaution is necessary because if the IUD has moved, its effectiveness in preventing pregnancy may be reduced or absent. Promptly contacting a healthcare provider to schedule an appointment is the appropriate next action.
Medical Consultation and Resolution
When IUD strings cannot be located, a healthcare provider will conduct an examination to determine the cause and the IUD’s position. This begins with a physical pelvic exam, where the provider will try to locate the strings. If the strings remain elusive, an ultrasound is the next diagnostic step. Ultrasound imaging is effective and safe for confirming the IUD’s location within the uterus.
If the ultrasound shows the IUD is still correctly in place, but the strings are simply not accessible, no further action may be needed other than continued self-monitoring. If the IUD is found to be displaced or partially expelled, the provider will likely remove it. In cases of complete expulsion, a new IUD can be inserted during the same visit if desired. If perforation is suspected, further imaging like an X-ray might be used, and surgical removal may be necessary.