The inability to feel your intrauterine device (IUD) strings is a common experience that can cause significant worry. These thin, flexible threads hang from the cervix into the top of the vagina. They serve two primary functions: allowing you to perform a monthly self-check to confirm the device is in place and providing a way for a healthcare provider to remove the IUD. When the strings are not palpable, the device’s position cannot be verified, raising concerns about its continued effectiveness. Approximately 18% of people with an IUD experience this issue, but in many cases, the cause is not serious.
Common Reasons Strings Are Not Palpable
Often, the strings are not palpable for reasons that do not indicate a problem with the IUD itself. The strings soften over time and may simply curl up, retracting into the endocervical canal, the passage between the vagina and the uterus. This coiling action hides the strings from your fingertip, but the IUD remains correctly positioned inside the uterine cavity, providing full contraceptive protection.
The natural positioning of the uterus and cervix can also change throughout the menstrual cycle, especially during or immediately after menstruation. This temporary shift in anatomy can move the strings further out of reach or hide them in the folds of the upper vagina. If the strings were trimmed short during insertion, they may simply be beyond the length of your finger, even when attempting positions like squatting or elevating one leg. If a careful self-check does not locate the strings, contact a healthcare provider for an in-office examination.
Understanding the Risks of a Missing IUD
While benign reasons are common, the absence of palpable strings can also signal one of three medical complications that compromise contraceptive efficacy. The first is partial expulsion, where the IUD has begun to shift downward out of the uterus, with part of the device now sitting in the cervix. This movement significantly reduces the IUD’s effectiveness and is often accompanied by symptoms such as new or increased cramping or abnormal bleeding.
The second risk is complete expulsion, which occurs when the IUD falls out of the uterus entirely, sometimes unnoticed, especially during a heavy menstrual period. If the IUD has fallen out, contraceptive protection is lost completely, and the risk of unintended pregnancy becomes immediate. The third, though rare, concern is perforation, where the IUD has pushed through the uterine wall into the abdominal cavity, usually occurring during insertion.
Perforation is a serious condition that requires surgical intervention for removal, though it happens in only about one to two per 1,000 insertions. In all three scenarios—partial expulsion, complete expulsion, or perforation—the IUD is no longer reliably preventing pregnancy. Any inability to locate the strings warrants medical investigation to confirm the device’s location and function.
Immediate Safety Measures and Next Steps
The moment you realize you cannot feel your IUD strings, immediately use a barrier method of birth control, such as condoms, or abstain from intercourse. This ensures protection against pregnancy while the device’s location is unknown, since its contraceptive effect cannot be guaranteed. Schedule an appointment with your healthcare provider as soon as possible to have the IUD checked.
While waiting for your appointment, monitor yourself for concerning symptoms that could indicate a more serious issue. Seek urgent medical attention if you experience severe or persistent cramping, a fever or chills, or unusual vaginal discharge or heavy bleeding. Avoid the use of tampons and refrain from internal sexual activity until a clinician confirms the IUD is correctly positioned. This minimizes the risk of inadvertently pushing a partially expelled device further out of place.
The Clinical Process for Locating the IUD
When you visit your healthcare provider, the initial step is a pelvic examination to visualize the cervix. If the strings are not immediately visible, the clinician uses a small, soft instrument, such as a cytobrush, to gently sweep the endocervical canal. This attempts to coax coiled strings into view. If the strings are recovered, the provider confirms the IUD’s position, and no further action is necessary unless removal is desired.
If the attempt to retrieve the strings is unsuccessful, the next step is a transvaginal ultrasound. This imaging technique is the primary tool used to confirm whether the IUD is located correctly within the uterine cavity. If the ultrasound confirms correct placement, the IUD is left in place and remains effective.
If the ultrasound shows the IUD is not in the uterus, the most likely conclusion is that it was expelled. However, a plain abdominal X-ray is often ordered to definitively rule out the rare possibility of perforation and migration into the abdominal cavity. If the IUD is found to be partially expelled, it is removed and can often be replaced with a new device during the same visit. If migration is confirmed by X-ray, the device requires surgical removal, typically through a minimally invasive procedure like laparoscopy.