Yes, you can take a pregnancy test while you have an IUD, and the result will be just as accurate as it would be without one. Neither hormonal nor copper IUDs interfere with the hormone that pregnancy tests detect. If you’re worried you might be pregnant despite your IUD, a standard home test from the drugstore will give you a reliable answer.
Why an IUD Doesn’t Affect Test Results
Pregnancy tests work by detecting a hormone called hCG, which your body only produces after a fertilized egg implants in the uterine lining. IUDs prevent pregnancy through completely separate mechanisms: copper IUDs create an environment toxic to sperm, and hormonal IUDs thicken cervical mucus and thin the uterine lining. None of these actions involve hCG or anything chemically similar to it, so there’s nothing about an IUD that would cause a false positive or mask a true positive.
A study that tested IUD users with a highly sensitive hCG assay across 107 menstrual cycles found only one instance of detectable hCG elevation. That research confirmed the IUD’s primary contraceptive effect happens before implantation would even occur, meaning hCG rarely enters the picture at all. But if it does, a test will pick it up.
When Testing Gets Tricky
The harder question isn’t whether the test works. It’s knowing when to take one. Many hormonal IUDs reduce or completely stop your period over time. Around half of users with the highest-dose hormonal IUDs stop having periods altogether after a few years. When you’re used to not having a period, the most obvious early pregnancy signal disappears.
If you don’t get a regular period with your IUD, pay attention to other early pregnancy signs: nausea, breast tenderness, unusual fatigue, or light spotting that feels different from your norm. The challenge is that some of these overlap with common IUD side effects, particularly cramping, spotting, and breast changes. When several of these symptoms show up together or feel noticeably different from your usual experience, that’s a reasonable time to test.
For people without a regular cycle due to their IUD, taking a test every four to six weeks can provide peace of mind if you’re concerned. If a test comes back negative but you still feel something is off, repeating it three to four weeks later helps catch a pregnancy that may have been too early to detect the first time.
How Often IUDs Actually Fail
Pregnancy with an IUD is uncommon, but it’s not impossible. Failure rates vary by type:
- Mirena (hormonal, 52 mg): 0.2% failure rate in the first year, rising to about 0.7% cumulative over five years.
- Kyleena (hormonal, 19.5 mg): 0.16% in the first year, about 1.45% cumulative over five years.
- Paragard (copper): 0.8% in the first year, roughly 1.9% cumulative over ten years.
- Skyla (hormonal, 13.5 mg): 0.41% in the first year, about 0.9% cumulative over three years.
These are among the lowest failure rates of any contraceptive method, but they aren’t zero. Over several years of use, a small number of people do become pregnant. The risk is slightly higher if the IUD shifts out of its correct position in the uterus, which can happen without you noticing.
What a Positive Test Means With an IUD
A positive pregnancy test with an IUD in place calls for prompt medical attention, not because of emergency danger, but because two things need to be assessed quickly. First, pregnancies that occur with an IUD carry a higher risk of being ectopic, meaning the embryo implants outside the uterus, typically in a fallopian tube. An ectopic pregnancy can’t develop normally and needs treatment. Symptoms include sharp or severe pain on one side of your abdomen, dizziness, fainting, shoulder pain, or heavy vaginal bleeding.
Second, if the pregnancy is developing normally inside the uterus, leaving the IUD in place significantly raises the odds of complications. A systematic review found that miscarriage rates with a retained IUD ranged from 48% to 77%, and preterm delivery rates ranged from 7% to 25%. Other risks included infection and placental problems.
IUD Removal During Pregnancy
When someone wants to continue a pregnancy that occurred with an IUD, current medical guidance supports removing the device as early as possible. Removing it in early pregnancy substantially improves outcomes. The best available evidence shows miscarriage rates dropping from about 54% with the IUD left in place to roughly 20% after removal. Preterm delivery rates also improve, falling from 17% to 18% down to 4% to 14%, though they don’t quite return to baseline levels.
If the IUD strings are visible, removal is straightforward and can be done in a regular office visit. When the strings aren’t visible or reachable, which sometimes happens as the uterus grows, specialists can retrieve the device using ultrasound guidance or a small camera procedure. Complication rates for these methods are reported to be low, and pregnancy outcomes after removal are comparable regardless of how the IUD was taken out.
After confirming a positive test, the typical first step is an ultrasound to verify the pregnancy is in the uterus, confirm it’s viable, and locate exactly where the IUD is sitting. From there, your provider can plan the safest approach for removal.