An intrauterine device (IUD) is a small, T-shaped piece of plastic inserted into the uterus by a healthcare provider to prevent pregnancy. The strings attached to the IUD are thin, plastic threads that extend through the cervical opening into the top of the vagina. These strings allow for periodic self-checks to confirm the device is in place and are used by a medical professional for safe removal. While individuals often worry about string position, a change in perceived length usually indicates a normal physiological process rather than a problem with the device itself.
Normal Causes of String Position Changes
The position of the cervix, the lower, narrow part of the uterus, shifts naturally throughout the monthly cycle, directly influencing how the IUD strings feel. During the phase just before and during menstruation, the cervix typically sits lower and feels firmer, which can make the strings seem longer or more easily accessible. This downward movement brings the strings closer to the vaginal opening, leading to the perception that the IUD has slipped.
Conversely, during the ovulatory phase, the cervix rises higher and softens, which can cause the strings to feel shorter or even temporarily unlocatable. The strings may also coil up around the cervix, making them harder to find even if the cervix has not moved significantly. These fluctuations are normal and do not indicate that the IUD has shifted out of its position inside the uterus.
The strings are made of a flexible material and can also move directionally within the vaginal canal. Physical activities, such as recent sexual intercourse or strenuous exercise, can temporarily alter the cervical position or the way the strings lie against the vaginal wall. Regular self-checking at the same point in the monthly cycle, such as after the end of the menstrual flow, helps establish a baseline to distinguish between normal variation and actual movement.
Indicators of IUD Migration or Expulsion
While many string changes are harmless, a change in string length can sometimes signal that the device itself has moved. IUD migration refers to the device shifting from its optimal placement, which can lead to reduced effectiveness in preventing pregnancy. Expulsion occurs when the IUD partially or completely slips out of the uterus, often during a menstrual period in the first few months after insertion. A partial expulsion means the hard plastic part of the IUD is either entering or protruding through the cervix.
A truly displaced IUD is often accompanied by distinct physical symptoms that go beyond string position alone. Individuals may experience severe cramping or pelvic pain that is significantly worse than typical menstrual discomfort and is not relieved by over-the-counter pain medication. Abnormal bleeding is another frequent indicator, manifesting as unusually heavy or prolonged periods, or spotting between cycles.
In rare cases, uterine perforation can occur, where the IUD moves through the wall of the uterus, sometimes into the abdominal cavity. While this is most likely to happen during insertion, symptoms like persistent, sharp abdominal pain, fever, or chills can indicate this issue. Feeling the hard, plastic part of the IUD itself at the cervical opening, or having a partner feel it during intercourse, strongly indicates the IUD has moved out of correct placement and requires professional attention.
Action Steps When Strings Seem Different
If you notice a change in the IUD strings, remain calm and avoid attempting to adjust the device yourself. Immediately use a backup method of contraception, such as condoms, until a healthcare provider confirms the IUD is correctly positioned. This step is necessary because any displacement can compromise the device’s ability to prevent pregnancy.
To check the strings, wash your hands thoroughly and assume a comfortable position, such as squatting or sitting. Gently insert one or two fingers into the vagina until you locate the cervix, which feels firm and rubbery like the tip of a nose. The goal is to feel the two thin strings coming through the opening of the cervix without pulling on them. If the strings feel drastically shorter, longer, or are completely missing, schedule an appointment with a healthcare provider immediately.
Even if you cannot find the strings, it does not always mean the IUD has been expelled; sometimes, the strings have just curled up inside the cervix. A healthcare professional can use a speculum and specialized tools to determine the IUD’s location and status. If the IUD cannot be seen, an ultrasound is typically performed to confirm whether the device is still in the uterus or if it has moved.