Written by Michelle No
The number of women and people who menstruate who use an IUD (or coil) has increased dramatically in the last decade. And it’s no surprise — IUDs are incredibly effective at preventing pregnancy and require little maintenance.
Read on for our guide to getting an IUD and what to do if yours falls out (also known as “expulsion”). Remember: Your health care professional is the best first point of contact for all things contraception, so book an appointment as a starting point.
Let’s start with the basics: An intrauterine device (IUD) or coil is a small, T-shaped device that is placed inside the uterus to prevent unplanned pregnancy. There are two different types to choose from: a non-hormonal IUD that’s covered in copper and a hormonal IUD that releases progestin (a synthetic form of the hormone progesterone).
IUDs have become hugely popular for people who use contraception, in part because they’re hassle-free, long-lasting, and 99 percent effective at preventing pregnancies when professionally inserted. It’s a win-win-win situation.
The two types of IUDs may look similar, but they actually work in pretty different ways.
A non-hormonal copper IUD works by releasing copper ions, which repel sperm and keep them from reaching an egg.
On the other hand, a hormonal IUD prevents pregnancy in several ways. It thins the lining of your uterus, which makes it harder for a fertilized egg to attach, and it thickens the mucus around your cervix (the lower end of the uterus), making it harder for sperm to get through. On top of all that, the progestin released by the IUD also stops ovulation, meaning your ovaries won’t release an egg that could potentially be fertilized. The hormonal IUD is also approved by the Food and Drug Administration (FDA) for treatment of heavy menstrual bleeding. Pretty cool.
If you’ve ever seen an IUD, you’ve probably noticed the two small pieces of string dangling from the bottom. Those strings are actually an essential part of the IUD’s design. They help you check that your IUD is in place and help the doctor remove it when the time comes. Think of them like the strings on a tampon.
IUD insertion starts off like many trips to the gynecologist. To begin, a nurse or doctor will ask you about your medical and sexual history. They might also perform a pelvic examination, which might include using a swab to collect a sample of cervical cells. If this is the case, your doctor should explain the examination beforehand so you understand what it entails and can fully consent.
Then, they’ll use a speculum to gently open the walls of your vagina and a tool called a tenaculum to stabilize the cervix. Before they can insert the IUD, they’ll need to measure your uterus so that they can insert the IUD correctly. Then they’ll use another tool to guide the IUD into the uterus. When the IUD reaches the correct depth (indicated by uterine sound), the IUD is pushed out of its tube and allowed to open into the “T” shape you’re familiar with. Stabilizing the cervix, measuring the uterus, and inserting the IUD can all cause cramping. For some people, it’s a walk in the park, but for others, it can hurt quite a lot (but only very briefly!). Some doctors recommend taking a pain reliever before your appointment, just in case.
Your body is unique, so how you feel after an IUD insertion might vary a lot from how someone else feels. You might not feel any side effects at all, or you might experience cramps or backaches. Spotting is also a common side effect. All of these sensations are completely normal.
Additional side effects depend on what kind of IUD you had inserted. If you had a copper IUD inserted, then your period might get heavier and your cramps more intense. Alternatively, if you opted for a hormonal IUD, you might have lighter periods or find your period stops altogether. Again, this is normal.
Now, IUDs are pretty reliable — that’s why so many people opt for them. But hey, things happen, and your IUD could fall out. If your IUD’s strings feel longer or shorter than usual, or you can’t feel the strings at all, it’s possible that your IUD has moved or fallen out. But don’t freak out: It’s also possible that the strings have folded on themselves and simply aren’t within reach or that the IUD has moved a little higher.
The only way to be sure is to make an appointment to get it checked out. Just remember that, generally speaking, if your IUD has moved or been expelled, then it won’t prevent pregnancy. If it’s shifted to a lower part of your uterus, then it may still be effective. However, if you suspect it’s moved, it’s a good idea to consult your doctor. Until your appointment, you should use a backup form of birth control (such as condoms) while you wait for your doctor to give you the all-clear.
These are some signs your IUD has moved or been expelled:
- Discomfort during sex
- A change in menstrual bleeding
- Increased cramping
While most IUDs never move, IUD expulsions (when IUDs fall out) do occur in 2–10 percent of patients. And it’s quite easy to see why they happen when you consider that the uterus is a muscle that contracts.
Dr. Barbara Levy, Clinical Professor of Obstetrics and Gynecology at the George Washington University School of Medicine and Health Sciences (and Flo Medical Board member), explains that “for some, this muscle contracts very, very firmly.” That’s often when expulsions happen because the uterus contracts around the IUD and pushes it toward the cervix.
As logic follows, people with heavy bleeding or heavy cramping or people who might have an uneven uterine surface might be more likely to expel their IUD. In these cases, the muscles are either contracting harder than usual or aren’t able to hold the IUD in place, she says.
According to Dr. Levy, another factor that can determine whether you might be more likely to expel your IUD is if your body has a greater production of prostaglandin, which is the chemical that causes the uterus to contract.
That said, people who are most likely to have their IUDs fall out are patients aged 14–19 years.
It’s rare, says Dr. Levy, but it’s possible to pass your IUD through a blood clot — without even realizing it — if you’re someone who has a very heavy flow. The key word here is “rare.”
Generally, if your IUD falls out, you’ll feel the plastic or the strings of the IUD or experience some cramping. “It’s more likely that you’ll feel some symptoms associated with the expulsion,” says Dr. Levy.
To check that your IUD hasn’t prematurely left your uterus or moved, you should try to regularly check your IUDs strings in the first few months after it’s been inserted. Just remember not to pull on the strings, or you could accidentally remove it yourself!
To check if your IUD is still in place, wash your hands, squat or sit down, then slowly insert a finger into your vagina. You might not feel the strings right away, in which case, you might want to reach a little higher. If you still don’t feel the strings, then schedule an appointment with your health care professional to make sure everything is in the right place. And again: Just be sure to use another method of contraception (such as condoms) until you get the all-clear.
If you’ve checked for strings and gone to a doctor for an ultrasound, and you and your doctor still can’t locate your IUD, then the next step might be to do an X-ray. Perforation of the uterus with an IUD is extremely rare, but it does happen. Given just how rare it is, though, Dr. Levy recommends not worrying too much about the possibility.