What to Do If Your IUD Strings Seem to Be Missing

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The "strings" attached to intrauterine devices (IUDs) like Mirena and ParaGard run down the uterus and out the cervix. They come to rest somewhere high up in the vaginal canal.

The IUD strings let you know whether your IUD is still in place. There may be a few reasons why they aren't found, including if the IUD has been completely expelled. Other causes may be changes in the uterus, or movement of the strings or the IUD itself.

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.

Why can't I feel my IUD strings?

Verywell / Emily Roberts

Risk Factors for Expulsion

IUD expulsion, meaning that the device has come out of the uterus, is possible. It 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 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

Symptoms

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 the strings every few days. You should keep doing so for the first few weeks, as well as 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.

If you cannot see or feel your IUD strings, the next step is to call your healthcare provider. They will need to perform an exam to locate your IUD strings.

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.

Recap

A main cause for why you can't see or feel your IUD strings is because it's been expelled from the body. This may be more likely if you're a young person under age 20, or if you've had it happen before. Often, there are no symptoms and the missing strings are the only sign of a problem. You'll need to use another form of contraception until you're sure the IUD is there and it's working.

Diagnosis

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.

Recap

A healthcare provider will likely want to use ultrasound imaging to locate the IUD and confirm it is properly placed. They also can diagnose any rotation or movement of an IUD that's still in place.

Recovering the 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. The 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.

An X-ray may reveal that perforation has happened. This would need to be corrected as soon as possible before an infection starts or any damage occurs to nearby areas of the body.

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 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 the 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.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gehani M, Pal M, Arya A, et al. Potential for improving intrauterine device (IUD) service delivery quality: results from a secondary data analysisGates Open Res. 2020;3:1473. doi: 10.12688/gatesopenres.12997.3

  2. Madden T, McNicholas C, Zhao Q, Secura GM, Eisenberg DL, Peipert JF. Association of age and parity with intrauterine device expulsionObstetrics & Gynecology. 2014;124(4):718-726. doi: 10.1097/AOG.0000000000000475

  3. Melo J, Tschann M, Soon R, Kuwahara M, Kaneshiro B. Women's willingness and ability to feel the strings of their intrauterine device. Int J Gynaecol Obstet. 2017;137(3):309-313. doi:10.1002/ijgo.12130

  4. Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017;95(1):17-39. doi:10.1016/j.contraception.2016.10.006

  5. Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH. Ultrasonography of intrauterine devices. Ultrasonography. 2015;34(3):183-94. doi:10.14366/usg.15010

  6. Prabhakaran S, Chuang A. In-office retrieval of intrauterine contraceptive devices with missing strings. Contraception. 2011;83(2):102-6. doi:10.1016/j.contraception.2010.07.004

  7. Boortz HE, Margolis DJ, Ragavendra N, Patel MK, Kadell BM. Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics. 2012;32(2):335-52. doi:10.1148/rg.322115068

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