IUD Expulsion: Is it as scary as it sounds?

During the first few months of having my IUD, there were some moments of discomfort that made me wonder if the IUD was in the right place. When I went to my doctor for a follow-up exam, I talked about the pain I had been experiencing and my fear that the IUD had been expelled. “Oh no,” she said. “You would most likely know.”

Most people notice when an IUD is completely expelled. But it’s possible for an IUD user not to be quite sure, especially if it’s a partial expulsion. Corinne Rocca, PHD, MPH says, “Expulsion is a fancy way of saying that an IUD has been pushed out of its ideal location at the top of the uterus. The uterus is one big muscle, so this sometimes happens.”

What causes IUD expulsion? Because the uterus is a muscle, it contracts like all of your other muscles. Big contractions in the uterus, like the ones that happen when you get your period, can nudge the IUD down into the cervix.

My follow-up visit turned out fine, but what if it hadn’t? The rates of IUD expulsion fall somewhere between 2-10%, though it can be higher in certain situations. There are a few different factors that can affect the possibility of expulsion, like your age, pregnancy history, and how long it’s been since the IUD was inserted. Even how well your health care provider inserted the IUD in the first place matters. There’s also a higher rate of expulsion if you’ve had a history of very heavy periods. Expulsion is most likely to occur during the first three months that you have the IUD.

Think your IUD may have expelled? Here’s what to do.

1. Stay calm: It is not fun, and the timing isn’t usually great, but expulsion is a potential risk when you have an IUD inserted. If you are in a lot of pain or feeling confused, take a deep breath. Stressing out may make you feel worse and make it harder for you to focus on getting the care you need.
2. Double-check: Being able to feel your IUD strings is totally normal. But if you can feel the hard part protruding from your cervix, the IUD isn’t where it’s supposed to be. For some people, it may be less noticeable if the IUD has come out. It’s definitely a good idea to make an appointment with your provider if you have any of the following symptoms: severe pain and cramping; heavy or abnormal bleeding; or strings that feel longer than usual. Some cramping in the first few days to weeks after insertion is normal, but if the pain intensifies or persists, it may be time to see your provider.
3. Take care: If you’re experiencing a lot of pain while the IUD is out of place, make sure to take extra care of yourself. Try to wait to have sex until you can meet with your provider. If the IUD isn’t where it’s supposed to be, you may not be protected from pregnancy. If you still want to go for it, make sure to use a back-up birth control method like a condom.
4. Call your provider. If you think your IUD is out of place, call your health care provider ASAP and ask for an appointment. You definitely want to talk to them if you have severe pain or notice any of the changes mentioned above. Getting in to see your provider might not be the easiest or the most convenient, but even if you’re not totally sure your IUD has been expelled, it’s worth it to take care of your health and make sure you’re covered against pregnancy.

Wondering if you should try the IUD again?

For people who have had an expulsion, the chance of it happening again is a little higher, but if you think the IUD is the right method for you, it may be worth trying again. Talk with your provider about your options. You may want to try a different kind of IUD–for example, a smaller IUD may be a better fit for some people. See if your provider can use different tools, like an ultrasound machine, to make sure the IUD is in the right place this time.

If you’ve experienced multiple expulsions or just really aren’t up for trying again, it may be time to explore other options. There are lots of birth control methods out there, and one of them is probably a great fit for you.