Signs Your IUD Is Out of Place—and What To Do

Soon after Melinda Nichols delivered her youngest son in 2007, she decided to have an intrauterine device (IUD) implanted in her uterus to prevent future pregnancies. But when Nichols returned for a checkup just a few weeks later, her healthcare provider said the IUD was nowhere to be found.

Nichols' healthcare team told her the device must have been expelled from her body without her knowledge, according to an article in the New York Post. So imagine her surprise when more than a decade later, the tiny T-shaped device reappeared in an unrelated X-ray of her midsection—all the way into her upper abdomen.

"It's been in me 11 years," Nichols wrote in a December 2018 Facebook post. "The doctors told me it fell out." The post included a photo of the X-ray with the outline of her IUD circled in red, near her lower spine. A lower yellow circle indicated where the IUD should have been, in her uterus.

While Nichols' case may be disturbing, it's important to know that migrating IUDs are rare. But, they can fall out of your uterus entirely, get stuck in the uterine wall, or break through the wall and travel elsewhere in your body.

How Often Do Problems Happen?

The failure rate for IUDs is low, according to the Centers for Disease Control and Prevention (CDC). For every 1,000 women who receive one, about four women on average will have a problem with the device not staying put and working properly.

It is also uncommon for an IUD to perforate (pierce) the uterine wall and make its way out of the uterus and into the abdominal cavity—a phenomenon that was first described in the 1930s, according to a 2016 article in the Open Access Journal of Contraception. This "wandering IUD" scenario has an incidence rate of about one in 1,000.

It was originally thought that uterine contractions were responsible for IUDs migrating to other parts of the body. But it's now believed that it's much more common for IUDs to be "forced into or through the uterine wall at the time of insertion," sometimes by inexperienced providers, according to the article.

Other factors may put you at risk of having your IUD migrate out of your uterus. A study published in 2015 in the journal Contraception showed that breastfeeding at the time of IUD insertion increased the odds of a wandering IUD by six times.

Also, if it has been fewer than six months since you had a baby or you have had a high number of abortions, you may be at increased risk for IUD issues, according to the Journal of Contraception report. Having fewer deliveries may also hike the risk of a wandering IUD.

Yes, They Can Fall Out

IUDs may become dislodged and make their way out of the body, which is known as expulsion. This is a rare event, but it is most likely to happen during your period. You might find your IUD when you remove your tampon or change your pad. It could also be flushed down the toilet without your noticing at all.

Adolescents and teens may be more likely than older women to experience expulsion, according to a 2017 study published in Contraception.

If an IUD is expelled only partially, it may become lodged in the cervix or vaginal canal, which can cause pain, discomfort, or heavy bleeding. Instead of trying to move the device back into place yourself, call your healthcare provider right away.

Check That Your IUD Is in the Right Place

After an IUD is inserted, see your healthcare provider the following month for a "string check," Christine Greves, MD, an ob-gyn with Orlando Health System in Florida, told Health. Your physician will feel for the two strings that hang down from the bottom of the IUD, through your cervix, and into your vagina. If the strings are in place, so is the device.

You can also check yourself by feeling for these thin strings every month, after your period, or if you feel unusual cramping during your period. You should feel just the strings and not the device itself. Your partner should not be able to feel the device during sex, either. If you can't find the strings, make an appointment with your healthcare provider.

"If a woman comes back and we can't feel those strings, we perform an ultrasound," said Dr. Greves. "And if we still don't see it on an ultrasound, and the patient doesn't remember it falling out, an X-ray can usually find it if it's made its way to the abdominal cavity."

If an IUD moves, it usually occurs within the first few months after it's implanted.

Signs of a Misplaced IUD

Many women with a misplaced IUD are asymptomatic and have no idea their IUD has gone rogue, but others may notice signs.

If you have an IUD and can't find your strings, are having abdominal pain, abnormal bleeding (which can also occur during the first few months after having an IUD inserted), or other symptoms that cannot be directly attributed to something else, see your healthcare provider to make sure your IUD is still in place.

Health Complications From Misplaced IUD

It's possible for an IUD that migrates to the abdominal cavity to stay there for years without being noticed or causing any harm said Dr. Greves. (In one case, a woman's missing IUD wasn't found for 43 years.) "But other times, if it's entangled in the bowel or it's near a vital organ, for example, that can be a concern."

It's also possible that an out-of-place IUD could cause scar tissue to form around it or trigger an infection. It could also continue to release chemicals into the body for longer than intended, said Dr. Greves, though the level of hormones released by these devices decreases every year, making it less of a concern. (That's why the Mirena IUD, for example, must be replaced after seven years.)

A 2018 study published in Gynecological Surgery reports that uterine perforation from an IUD may cause complications including pain, bowel or bladder perforation, and the formation of a fistula (an abnormal connection between body parts).

Nichols, by the way, was fine after she had the IUD removed. She underwent laparoscopic surgery—involving a tiny incision and a small camera to guide doctors—to locate and remove her misplaced IUD. She said she occasionally had strange stomach pains over the previous decade, which may or may not have been related to her IUD, but otherwise had no signs that something was amiss.

Consider the Risks and the Benefits

IUDs are highly effective at preventing pregnancy and, unlike oral contraceptives, you don't have to remember to take a pill every day or pick up your prescription from the pharmacy every month. They are effective for from three to 10 years and can be removed at any time. IUDs may also come with other perks, like fewer cramps and lighter periods.

"Everything in medicine is risks vs. benefits vs. alternatives, and it's important people know that the benefits of IUDs far exceed the risks for most women," said Dr. Greves.

IUD usage has gone up in recent years, which means that doctors have become more experienced with insertion and more familiar with their usage. "We have more strategies in place to deal with complications," said Dr. Greves, "and to make sure that women are having a good experience and making the best choice for them."