IUD Strings: What To Do If They're Missing

When you get an intrauterine device (IUD) such as Mirena or ParaGard, your healthcare provider lets two IUD strings hang from your cervix into your vaginal canal. IUD strings make it so that your healthcare provider can pull the IUD out of your uterus when the time comes. IUD strings also allow you to check that your IUD is in place.

If you can't feel your IUD strings when you check for them, there may be a few reasons why. While it's possible that the IUD has fallen out of your uterus (expulsion), the IUD strings may have simply curled up against your cervix and will fall back in place during your next period.

This article explains how and why your IUD strings may feel like they're missing. It discusses what to do if you think there's a problem with your IUD and how healthcare providers treat this issue.

Risk Factors for Expulsion

IUD expulsion, in which the IUD comes out of the uterus, is not common, but a study of 10,747 people in India found that 4% had IUD complications. Three-fourths of this group reported the problem as either expulsion or missing IUD strings.

Some of the risk factors for IUD expulsion may include:

• Nulliparity (never having given birth)
• Menorrhagia (heavy menstrual bleeding)
• Severe dysmenorrhea (menstrual cramps)
• Prior IUD expulsion
• Under 20 years of age
• IUD insertion immediately after an abortion or if you are postpartum

Checking Your IUD Strings

Many women may show no symptoms of IUD expulsion. This makes it all the more important for you to know how to check your IUD strings. It may be the only way to tell for sure if your IUD has come loose or has moved out of place.

When you first have your IUD inserted, you should be checking for your IUD strings every few days. You should keep doing so for the first few weeks. You should also check for your IUD strings between periods.

If you can't see or feel the IUD or the IUD strings, a full expulsion may have taken place. If this happens and you don't have a backup method of birth control, you are no longer protected against pregnancy.

In some cases, you may be certain that your IUD has come out. This will typically happen during the first few months of IUD use. Your IUD is most likely to slip out of place during your period. Check your pads and tampons each time you remove them to be sure that your IUD has not been expelled.

What Do IUD Strings Feel Like?

Each IUD string is typically one to two inches long. If you stick a clean finger into your vaginal canal, you should be able to feel the tip of both IUD strings hanging from your cervix. IUD strings are made of very thin plastic that softens and may curl over time.

When the IUD is in its proper place, you shouldn't be able to feel it. If you feel your IUD strings poking you, the strings may be too long or the IUD may have moved in your uterus. Either way, if you feel your IUD strings poking you, you should schedule an appointment with your healthcare provider.

Reasons for Missing IUD Strings

There are two very common reasons for missing IUD strings. One is that the IUD has come out of the uterus. The other is that perforation has occurred during IUD insertion. This means that the IUD has been pushed through the uterus wall.

This can be a serious complication. Generally, though, it is quickly noted and it can be corrected right away.

If either of these situations happens to you, make sure to use a backup birth control method to protect against pregnancy. This is because the IUD will not be of much help when it's out of place.

Another scenario that can cause the IUD strings to be pulled back up into the uterine cavity is if you have some type of uterine swelling or enlargement. This may be due to fibroids or pregnancy.

When this happens, the IUD is still in the uterus. Further investigation would be needed, however. Most healthcare providers would use ultrasound imaging to try to find the IUD, and/or to rule out that you are pregnant.

The results may bring good news. If the ultrasound confirms that the IUD is in its proper position within the uterus, you can continue to use it. This is true even though you cannot find the IUD strings.

When this happens, healthcare providers recommend an ultrasound once a year for the first few years. This is because of the higher risk that it may be expelled during that time. The images will help to make sure your IUD is still in place.

There's also a chance that the IUD is still in the correct position but, for whatever reason, the IUD strings have coiled and bent back into the endocervical canal. This is the passage between your cervix and your uterus. It's also possible that the strings could have broken off.

Finally, the IUD may have rotated. This can happen either during or after insertion. The turning of the device could cause IUD strings to retract up higher in your body. If this is the case, the good news is that the IUD is still working and in place. The issue is just with the strings.

How Healthcare Providers Locate IUD Strings

If it's confirmed that the IUD is in place and you are not pregnant, then there are several ways to try to recover your IUD strings. Healthcare providers use a special brush called a cytobrush. It looks like a long mascara brush and is used to try to coax out the IUD strings. This usually works.

If the cytobrush doesn't work, there are other options. Your healthcare provider may use various tools to dilate (open) the cervix and measure your uterus. They'll then get a precise view of the endocervical canal. This makes it possible to see if the IUD may be in the process of expulsion.

If this is the case, the IUD strings tend to become more visible. IUD strings can also become twisted and out of view, though. If the IUD has been partially expelled into the cervix, the healthcare provider will typically remove it. They can replace it with a new IUD at the same time, if you want it.

If all of these efforts fail to locate the IUD, a healthcare provider may order X-rays of your abdomen and pelvis. If your IUD does not show up on the X-ray film, expulsion can be confirmed. At this time, you can also get a new IUD inserted if you wish.

Summary

An IUD has strings on it so that you can tell that it's still in place in your uterus. Sometimes people report that they can't find their IUD strings. This may well mean that your IUD has been expelled and is no longer working to provide contraception. It's not common but this can happen.

There are other reasons for why IUD strings might "go missing." They may simply be twisted and bent back up into the body where you can't feel them. Or the IUD itself is rotated within the uterus.

Your healthcare provider can find out what's going on. If the IUD is missing entirely, they can place a new one. If the IUD is still there but the device is not inserted properly, they can remove it and replace it. In most cases, the IUD problem is not serious. But you'll need to use backup birth control until your healthcare provider confirms that you have a working IUD (and its strings) safely in place.

A Word From Verywell

It can be stressful and upsetting to think your IUD has gone missing if you can't find your IUD strings. Still, there's no cause for panic until you learn the reason for what's going on. Try to stay calm and call your healthcare provider for guidance.