How to Check Your IUD Strings

As a birth control method, the intrauterine device (IUD) has lots of advantages. For one thing, once in place, it can last for several years. It's also reversible: When you're ready to start a family, your healthcare provider can remove it.

The IUD has few downsides. But one problem that does sometimes occur is "missing strings." That means that you can't see the string that's attached to the IUD (sort of like a tampon).

This article will help you learn how to check your IUD strings to ensure your IUD stays in place.

Why Do IUD Strings Disappear?

You may have difficulty finding your IUD strings for several reasons, such as:

• The strings have moved: Usually, when IUD strings are missing, it just means that the strings have drawn back into the cervical canal or uterus. You don't need to do anything about this, but the strings can be easily brought back into view during a pelvic exam. Your healthcare provider will use a special tool called a cervical cytology brush to locate the strings and move them back into place.
• Pregnancy: The IUD is highly effective but not perfect. In very rare instances, IUD strings can disappear due to pregnancy.
• Uterine perforation: A perforated uterus is a hole in the uterus. It is an uncommon but serious complication that can occur with IUD use.
• IUD expulsion: IUD strings may be missing if the entire device comes out of the uterus. IUD expulsion puts you at risk of becoming pregnant. Since the loss of an IUD doesn't always cause symptoms, occasionally checking to make sure the strings are still there can be helpful.

How to Check Your IUD Strings

An IUD is a small, plastic device shaped like a T. The device is either wrapped in copper (for example, ParaGard) or contains the hormone progestin (for example, Mirena).

When your healthcare provider inserts the IUD, the device is left inside the uterus and the strings of the IUD (which are made of plastic threads) will hang out of the cervix, resting up high in the vagina.

When checking your IUD strings, follow these steps:

1. Wash your hands.
2. Locate the cervix: While either sitting or squatting, insert your index or middle finger into your vagina until you touch the cervix. Your cervix will feel firm and rubbery, like the tip of your nose.
3. Feel for the IUD strings: They should be coming through your cervix. If you feel the strings, then your IUD is in place and should be working.
4. Determine if the strings have moved: If the strings feel longer or shorter than the last time you checked them, or if you feel the hard part of the IUD against your cervix, your IUD may have moved. In this case, it will need to be put back in place by your healthcare provider.
5. Use backup birth control: If you're worried your IUD has moved, use a backup birth control method until you see your healthcare provider. They may have you take a pregnancy test if you haven't already. If your healthcare provider cannot locate the strings during a pelvic exam, they may order an imaging test. A pelvic ultrasound is often used to locate the IUD (if it hasn't been expelled).

How Often to Check

IUDs that move out of place often do so in the first few months after insertion or during a menstrual period.

You can check your strings once a month, between periods. Since there is a greater chance that your IUD can slip out during your period, check your pads or tampons to make sure that your IUD hasn't come out.

Important IUD Considerations

If your IUD comes part of the way out, you'll need to schedule an appointment to have it removed. Do not remove it yourself.

Pregnancy

Most unplanned pregnancies that happen to IUD users occur if the IUD slides out unnoticed.

The chance of pregnancy with an IUD in place is extremely low. However, if it does happen, you should have the IUD removed as soon as you know that you're pregnant.

Pregnant people who choose to keep their IUD in place must have close medical supervision throughout their pregnancy. That's because there is an increased risk of pelvic infection, fetal death, poor fetal growth, miscarriage, and early labor and delivery.

Shortening the Strings

You may request to have your IUD strings cut shorter if your sexual partner can feel them. Keep in mind that sometimes the IUD strings are cut so short that you may not be able to check for them. Make sure to have your IUD checked by your healthcare provider at your regular gynecological exam.

Removal Myth

Some people mistakenly believe that they need to have their IUD removed if they switch sexual partners. This is a myth. Your IUD will continue to work just as effectively, no matter how many sexual partners you have.

Summary

IUDs are a safe, reliable form of birth control. However, there are risks and downsides to all methods of birth control. One of the concerns with an IUD is that they occasionally can move out of place. Routinely checking your IUD strings can help you know if your IUD has moved.

If you can't find your IUD strings, or if the strings seem to be in a different place than the last time you checked, contact your healthcare provider to have it checked out. Never try to remove or re-insert your IUD yourself. And until you can get in to see your healthcare provider, be sure to use a backup method of birth control.