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 some of the pain I had been experiencing and my fear that the IUD had been expelled. “Oh no,” she said. “You would know.”
This would be true if it had been completely expelled, but it’s also possible for an IUD to be expelled and for its user not to be quite sure. That’s called a partial expulsion. As it turns out, the IUD can move inside the uterus depending on the time of the month. As Corinne Rocca says in her article about the Mirena IUD, “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.” (In fact, becoming familiar with the position of the cervix is one aspect of some fertility awareness methods.)
My follow-up visit turned out fine, but what if it hadn’t? The rates of IUD expulsion fall somewhere between .05% and 8%. There are a few different factors that can affect the possibility of expulsion, like your age and pregnancy history, how long it’s been since the IUD was inserted, and even how well your health care provider inserted the IUD in the first place. There’s a higher rate of expulsion during your period, so you’ll want to make sure to check your strings regularly. 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 isn’t pleasant or convenient, 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 stay calm enough to get the care you need.
2. Double check. Being able to feel your IUD strings is totally normal (here’s a handy how-to). But if you can feel the hard plastic 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 expelled. 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; abnormal discharge; and/or fever. (This may also be a sign of infection.) Some discomfort in the first few days 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 are able to meet with your provider. Plus, 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.
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, cannot find your strings, notice the strings are shorter or longer than normal, or can feel the IUD poking out. 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 accidental pregnancy. If you just had the IUD inserted, a routine check-up after six weeks is a good idea anyway to make sure everything is a-okay.
Wondering if you should try the IUD again?
For women 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, try a different provider, or see if your provider can use extra tools to make sure the IUD is in the right place this time.
If you’ve expelled multiple times or just really aren’t up for trying again, it may be time to explore other options. Fortunately there are lots of birth control methods to choose from.