Missed IUD Strings

There are many causes that IUD stages may appear to be missing, of those:

Curled strings
Sometimes, the strings dangling from the IUD can curl up on themselves. They may be resting against the cervix, which could make them difficult or impossible to feel.

A fold of vaginal tissue may also hide the strings. Either way, a curled string can be challenging to reach.

Having curled or coiled strings will not lead to any signs and symptoms.

Strings too short
In some cases, a person may be unable to reach the IUD strings. It may be that the healthcare professional has cut the strings too short, or the person’s fingers may not be long enough to reach up to the strings.

A person whose IUD has short strings will not experience any signs and symptoms as a result.

IUD fell out
Although it is not common, a person’s IUD may fall out of their cervix partially or completely. Doctors refer to this as expulsion.

If expulsion occurs, the IUD may not fall out entirely, which means that a person would not find it in the toilet or their underwear. Instead, they may feel pain, experience severe cramping, or notice bleeding or discharge. If  you think that your IUD might have fallen out, please call to make an appointment with Dr. Azer today.

Perforation of cervix or uterus
Rarely, the IUD may puncture the uterus or the cervix. According to the ACOG (American Congress of Obstetrics and Gynecology) this occurs in:

• 1 in every 1,000 nonhormonal Copper IUD insertions
• 4 in every 1,000 hormonal IUD insertions

Women who have recently given birth or are breastfeeding have a higher risk of perforation.

Perforation of the cervix or uterus can cause severe pelvic pain, bleeding, and pain during sex.

If you cannot locate your IUD strings, please call to make an appointment as soon as possible with us to double-check the IUD status. As a precaution, you should use alternative birth control methods until you can confirm that the IUD is in place.

If you are using a hormonal IUD, in most cases you will start to see your periods getting lighter over time. However, if your periods start to get heavier again, this could be a sign that the IUD has fallen out or is no longer in place.

Symptoms and signs to discuss as soon as possible with your doctor include:

• fever or chills
• long lasting or severe cramps
• an unusual odor coming from the vagina
• abnormal bleeding or discharge from the vagina
• Issues with your bladder or bowel function

To locate missing IUD strings, the doctor will usually start by performing a pelvic exam. During the exam, they may use either a colposcope or a cytobrush.

A colposcope is a magnifying instrument that helps doctors look closely at the cervix, while a cytobrush is a long cotton swab that healthcare professionals often use during a Pap smear.

If the doctor cannot locate the IUD using these methods, they may use an ultrasound device to search for it.

If they cannot find the IUD with an ultrasound, the IUD may have discharged from the vagina without the person noticing. The doctor is likely to order an X-ray to make sure that the IUD did not penetrate the uterus.

If your IUD has penetrated your uterus, it will need to be removed. This can be done from below using the hysteroscope (a device with a camera inserted into your uterus), or by using a laparoscope ( a device with a a camera inserted into your belly to locate and remove the IUD).

At Advanced Gynecology Practice, Dr. Azer is an expert in removing a misplaced,  and/or perforating IUD, using both tools (hysteroscope and laparoscope). In fact, he  receives referrals from 14 other clinics for those patients with perforating IUDs who have had unsuccessful office removal.