How to Check Your IUD Strings

Make Sure Your Birth Control Is In Perfect Working Order

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

The IUD also is associated with few problems, but one that does sometimes arise is what may appear to be "missing strings"—meaning that you can't see the string that's attached to the IUD (sort of like a tampon).

Usually, this just means that the strings have drawn back into the cervical canal or uterus and can be easily swept back into view by your doctor during a pelvic exam using a device called a cervical cytology brush.

In very rare instances, however, IUD strings seem to disappear for other reasons. One of these is pregnancy. The IUD is highly effective, but not perfect. Another is uterine perforation, which is when a hole forms in the uterus. 

Finally, missing IUD strings literally may be missing, if the entire device comes out of the uterus—what's known as IUD expulsion. This puts you at risk of becoming pregnant, of course. More important, because the loss of an IUD doesn't cause symptoms, checking to make sure the strings are still there is a key component of using an IUD.

How to Check Your IUD Strings

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

When your doctor inserts the IUD, the plastic device will be left inside the uterus, but the strings of the IUD (which are made of plastic threads) will fall out of the cervix, ending up high in the vaginal canal.

When checking your IUD strings, first wash your hands. Then while either sitting or squatting, insert your index or middle finger into your vagina until you touch the cervix, which will feel firm and rubbery, like the tip of your nose.

Feel for the IUD string ends that should be coming through your cervix. If you feel the strings, then your IUD is in place and should be working.

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 instance, it will need to be put back in place by your doctor. Do not try to push the IUD back yourself. Also, never pull on your IUD strings—this may make it move out of place or even come out.

If you're worried your IUD has moved, use a backup birth control method until you can get see your doctor. She may have you take a pregnancy test if you haven't already. If your doctor cannot locate the strings during a pelvic exam, she may order imaging tests like a pelvic ultrasound to confirm the location of the IUD (assuming it hasn't been expelled).

How Often Should I Check for My IUD Strings?

If your IUD is going to move out of place, it will most likely happen in the first few months after it's been inserted or during your period. Generally, it's best to check your IUD strings a few times a week for the first few months after you get your IUD

You should then check for your strings once a month, between periods.

Because there is a greater chance that your IUD can slip out during your period, check your pads or tampons just to make sure that your IUD hasn't come out.

Important IUD Considerations

  • If your IUD becomes partially expelled, you need to schedule an appointment to have it removed. Do not remove it yourself. 
  • Most unplanned pregnancies happen to IUD users when it slides out without them realizing it. Even though the chance of pregnancy while an IUD is in place is extremely low, if it does happen, you should have the IUD removed as soon as you are aware that you're pregnant.
  • Women who choose to be pregnant with an IUD in place must have close medical supervision throughout their pregnancy because there is an increased risk of pelvic infection, ectopic pregnancy, miscarriage, early labor, and delivery.
  • You may choose to have the IUD strings cut shorter if they can be felt by your sexual partner. Keep in mind that sometimes the IUD strings are cut so short that you may not be able to actually check for them. Make sure to have regular IUD checkups at the same time as your periodic gynecological exam.
  • Some women 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, regardless of how many sexual partners you have.

Sources:

American College of Obstetrics and Gynecologists. "Committee Opinion: Clinical Challenges of Long-Acting Reversible Contraceptive Methods." Sept 2016.

Prabhakaran S, Chuang A. "In Office Retrieval of Intrauterine Contraceptive Devices With Missing Strings." Contraception. Feb 2011;83(2):102-6.