An intrauterine device (IUD) is a small, T-shaped form of long-acting, reversible contraception placed inside the uterus. Two thin threads are attached to the base of the device and extend a short distance into the vagina after insertion. These IUD strings serve two main purposes: they allow a person to perform monthly self-checks to confirm the device is still in place, and they are used by a healthcare provider to remove the IUD.
Immediate Action When Strings Cannot Be Found
If you perform a self-check and are unable to feel your IUD strings, remain calm. This is a common experience, occurring in up to 18% of people with an IUD. Immediately begin using an alternative barrier method of contraception, such as condoms. This is a necessary precaution because the IUD may no longer be positioned correctly to prevent pregnancy.
You should avoid attempting to reach further into the vagina or using any instruments. Using fingers or tools to probe the cervix could inadvertently shift the IUD or introduce infection. Instead, contact your healthcare provider to schedule an appointment for a professional check. Be ready to inform your provider about any other symptoms you may be experiencing, such as changes in your period flow, new or worsening cramping, or unusual discharge.
Common Explanations for String Absence
The most frequent reason for not feeling the strings is that they have curled up or retracted into the cervical canal. This coiling can happen naturally, making the strings rest against the cervix or hide within a fold of vaginal tissue, placing them out of reach. This scenario is generally not a cause for concern regarding the IUD’s effectiveness.
The strings may also have been cut too short, making them consistently difficult to reach during self-checks. Additionally, the position of the cervix naturally shifts throughout the menstrual cycle. The cervix is typically lower and softer during menstruation and higher and firmer during ovulation. If the strings are merely retracted or short, you typically will not experience any other symptoms.
Over time, the texture of the strings can also soften, making them more difficult to feel. Furthermore, a change in menstrual bleeding patterns can sometimes be a subtle sign that the device has moved. If you have a hormonal IUD and your periods return to being heavier after previously becoming lighter, this could indicate that the IUD is no longer fully in place.
Professional Confirmation of IUD Placement
The process of confirming the IUD’s location begins with a physical examination. The provider will first use a speculum to visually inspect the cervix and look for the strings. If the strings are not visible, the provider may use a specialized soft brush, called a cytobrush, to gently sweep the endocervical canal. This simple, in-office procedure is often successful in making the strings reappear.
If the strings cannot be located, the next step is a transvaginal or transabdominal ultrasound. Ultrasound is the primary tool used to confirm if the IUD is still inside the uterine cavity and positioned correctly. If the ultrasound confirms the IUD is in the correct place, the strings were simply retracted, and no further action is necessary unless removal is desired.
The ultrasound may reveal that the IUD is malpositioned. If the IUD is not seen on the ultrasound, it suggests either that it was expelled without you noticing or, in rare cases, that it perforated the uterine wall and migrated outside the uterus. In this situation, an abdominal X-ray is ordered to check for the IUD in the pelvic or abdominal cavity.
The outcomes of this evaluation fall into three main categories. The IUD is correctly placed but the strings are retracted, which allows you to continue using the device. If the IUD is partially or fully expelled, it will be removed, and you may receive a replacement immediately. If the IUD has perforated the uterus, surgical removal is required, often through a minimally invasive laparoscopic procedure.