You’re sitting on the couch, or maybe you’re at work, and suddenly there’s a sharp twinge. Or maybe it’s nothing that dramatic. Maybe you just have this weird, nagging feeling that something isn’t quite right "down there." When you have an intrauterine device, that tiny piece of plastic is supposed to be your set-it-and-forget-it best friend for the next three to ten years. But let’s be real: your uterus is a muscle. It’s a powerful, shifting organ designed to push things out. Sometimes, it tries to do exactly that to your birth control. Knowing the signs iud is out of place isn't just about avoiding an unplanned pregnancy; it’s about making sure you aren't dealing with a perforation or an infection that could mess with your health long-term.
It happens more than you’d think. Research published in The Lancet and various gynecological journals suggests that IUD expulsion occurs in about 2% to 10% of users. That’s a wide range, honestly. It usually happens in the first few months after insertion, often during a period when the cervix is slightly more open and the uterus is contracting.
The Strings Are the Biggest Giveaway
Checking your strings is the first thing your doctor told you to do, but let’s be honest—hardly anyone does it regularly. You should. Your IUD has two thin, plastic monofilament strings that hang through the cervix and into the vaginal canal. They usually feel like thin fishing line or a coarse hair.
If you suddenly can’t find them, don't panic immediately. Sometimes they just tuck themselves up behind the cervix. However, if the strings feel significantly longer than they used to, or if they’ve disappeared entirely, that is one of the most common signs iud is out of place. Conversely, if you feel something hard or plastic poking out of your cervix, that’s the actual device. That is a partial expulsion. Don't try to pull it out yourself. Seriously. You could cause a tear or an infection.
The length change is subtle. You might notice it while showering or during sex. Some partners actually report feeling the "poke" of the plastic during intercourse, which is a massive red flag. Normally, a partner might feel the strings, but they shouldn't feel a hard plastic tip. If they do, the IUD has likely slipped down into the cervical canal.
Unusual Pain and Cramping
Cramps are normal. We get them. If you just got your IUD (especially a copper one like Paragard), you expect some "adjustment" pain. But there’s a specific kind of "this isn't right" pain that signals trouble.
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We are talking about severe, localized cramping that feels different from your typical period. If the IUD shifts and begins to poke the uterine wall—or worse, starts to embed itself—the pain can be sharp and constant. This isn't just a dull ache. It's a signal. Some users describe it as a "stabbing" sensation that doesn't go away with ibuprofen.
Bleeding Patterns That Don't Make Sense
If you have a hormonal IUD like Mirena, Kyleena, or Skyla, you probably expect your period to lighten up or disappear. If you’ve had a light period for a year and suddenly you’re spotting heavily or having a full-blown "clotty" period, your IUD might have moved.
Bleeding is one of the most misunderstood signs iud is out of place. When the device isn't sitting high up in the fundus (the top of the uterus), the hormone delivery isn't as localized or effective, and the physical irritation of the device being in the wrong spot can cause the uterine lining to shed irregularly. If you’re using the copper IUD, you’re already used to heavier flow, but a sudden, massive increase in bleeding combined with pelvic pressure usually means the device has shifted toward the cervix.
When It Becomes an Emergency: Perforation and Infection
This is the scary part. It's rare, but it happens. An IUD can perforate—basically poke a hole through—the uterine wall. This usually happens during insertion, but it can happen later if the device migrates.
If the IUD has moved and caused a perforation, or if it has moved and allowed bacteria to travel where it shouldn't, you might develop Pelvic Inflammatory Disease (PID). You need to watch for:
- Fever or chills.
- Flu-like exhaustion.
- Vaginal discharge that smells... well, bad. Foul. Different.
- Pain during sex that makes you want to hit the ceiling.
Dr. Mary Jane Minkin, a clinical professor at Yale University School of Medicine, often notes that while IUDs are incredibly safe, any sign of infection combined with pelvic pain needs an immediate ultrasound. You can't "wait and see" with a fever.
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Why Did It Even Move?
Honestly, it's often just bad luck. Your anatomy plays a huge role. If you have a highly tilted uterus (retroverted or anteverted), the IUD might have a harder time staying put. If you have fibroids that distort the shape of your uterine cavity, there’s less room for the device to sit comfortably.
Age and pregnancy history matter too. People who have never been pregnant sometimes have a higher rate of expulsion because the uterus is smaller and more "irritable." On the flip side, getting an IUD inserted immediately after giving birth also carries a higher risk of it falling out because the uterus is still shrinking back to its original size. It’s a bit of a "Goldilocks" situation—everything has to be just right.
The Displacement Spectrum
It isn't always a total "it fell out into the toilet" situation. Displacement exists on a spectrum.
- Rotation: The IUD is still in the uterus but has turned sideways. This might not cause symptoms, but it can decrease effectiveness.
- Downwards Displacement: The device has moved into the lower segment of the uterus or the cervix. This is where you start feeling those sharp pains.
- Partial Expulsion: It's halfway out. You can feel the plastic tip.
- Total Expulsion: It’s gone. You might find it in a pad or the toilet, or you might not notice it at all if it happens during a heavy flow.
- Perforation: The IUD has migrated into the uterine wall or even into the abdominal cavity. This requires surgery to fix.
What to Do If You Suspect Trouble
If you see these signs iud is out of place, your first move is a backup plan. Stop relying on it for birth control immediately. Grab some condoms.
Call your OB-GYN or a clinic like Planned Parenthood. Tell them you suspect a "malpositioned IUD." This usually gets you an appointment faster than a standard check-up. They will likely do a speculum exam first to look for the strings. If they can't see them, the next step is a transvaginal ultrasound. This is the gold standard. It lets the doctor see exactly where the device is sitting in relation to your uterine wall.
If it’s just slightly low, some doctors might try to "nudge" it back or, more likely, they’ll pull it and insert a new one. If it’s perforated the wall, you’re looking at a laparoscopic procedure—a small surgery with a camera—to go in and find it.
Actionable Steps for IUD Owners
Don't just wait for something to go wrong. Being proactive is basically the only way to catch a shift before it becomes a problem.
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- The Monthly String Check: Pick a date—maybe the day your period ends—and check your strings. Squat down, use a clean finger, and feel for that "fishing line." If the length changes, call the doctor.
- Track Your Pain: Use an app like Clue or Flo to note when you have random sharp pains. If you notice a pattern of "poking" sensations after exercise or sex, it’s worth a scan.
- Know Your Flow: If your light periods suddenly become heavy and "crampy" after months of stability, don't assume it's just stress.
- Listen to Your Partner: If they mention feeling something sharp, believe them. It’s one of the most common ways a displaced IUD is discovered.
- Keep a Backup: Always have a box of condoms or a backup contraceptive method in your cabinet. If your strings go missing on a Saturday night, you shouldn't have to wing it until the doctor’s office opens on Monday.
An IUD is one of the most effective forms of birth control available, boasting a success rate of over 99%. But it's still a foreign object in a very active part of your body. Trusting your gut when something feels "off" is the best tool you have for staying healthy. If you’re even 10% worried that your IUD has moved, get the ultrasound. The peace of mind is worth the office visit.
Next Steps for Your Health
If you are currently experiencing sharp pelvic pain, heavy bleeding that is not normal for you, or if you can feel the plastic of your IUD poking through your cervix, contact a healthcare provider immediately or visit an urgent care center. Use a backup method of contraception like condoms until a professional confirms the device is properly positioned via a physical exam or ultrasound. Avoid attempting to move or remove the device yourself, as this can lead to uterine trauma or infection. Only a trained medical professional should handle IUD adjustments or removals.