An intrauterine device (IUD) is a highly effective, long-acting reversible contraceptive device placed inside the uterus. The device is T-shaped, with two thin, flexible strings attached to the base that extend through the cervix into the upper part of the vagina. These strings allow a healthcare provider to confirm the device’s placement and facilitate removal. Finding them unexpectedly long or hanging lower than usual can be a source of concern.
Understanding String Migration
The perception of longer IUD strings can be caused by normal physiological changes or device displacement. The cervix changes position throughout the menstrual cycle, typically sitting lower and becoming more accessible during menstruation. This normal movement can make the strings seem longer or more prominent, even if the IUD remains correctly positioned high within the uterine fundus.
The strings can also feel longer because the IUD has partially moved out of the uterus, known as partial expulsion. If the device begins to descend into the cervix or vaginal canal, the strings will naturally protrude further. Partial expulsion means the device is no longer providing reliable contraception and may cause symptoms like increased cramping or bleeding. This movement is most likely to occur within the first few months after insertion.
Immediate Steps to Take
If you notice your IUD strings are hanging out or feel significantly longer, focus on preventing further movement and avoiding unintended pregnancy. Do not pull on the strings, as this can worsen displacement or cause complete expulsion. Also, avoid attempting to push the device back into place, which can lead to injury or uterine perforation.
You must begin using a backup barrier method of contraception, such as condoms, immediately, as the device is likely no longer effective. Abstain from sexual intercourse or inserting anything into the vagina until a healthcare provider confirms the IUD’s position. Simultaneously, check for concurrent symptoms, including unexplained fever, severe cramping, heavy bleeding, or unusual vaginal discharge. These symptoms indicate a potential complication and require urgent medical attention.
Contact your healthcare provider’s office right away to schedule an urgent assessment appointment. Clearly describe that your IUD strings feel longer or are visible to ensure your concern is treated with appropriate urgency. Even if you feel no discomfort, the loss of contraceptive protection requires prompt professional confirmation of the device’s status.
Assessing IUD Status and Next Care
Once at the clinic, the healthcare provider will first perform a visual examination using a speculum to inspect the cervix and the strings. If the strings are visible, the provider assesses their length and determines if the hard, plastic tip of the IUD is protruding from the cervical opening. A gentle pelvic exam will follow to feel the uterus and cervix and check for signs of pain or tenderness.
The definitive diagnostic tool is usually a transvaginal ultrasound, which provides a clear image of the uterus and confirms the IUD’s exact location. The ultrasound shows whether the device is properly seated in the uterine fundus or if it has migrated downward into the lower uterine segment or cervical canal. If the ultrasound cannot locate the device, a plain X-ray of the abdomen and pelvis may be ordered to check for a rare translocation outside the uterus.
If the device is found to be partially expelled, it must be removed to prevent infection. Removal is typically a quick, simple procedure performed in the office. Depending on your preference and the clinical findings, a new IUD can often be inserted immediately during the same visit. If the IUD is correctly placed but the strings were cut too long, the provider can trim them to a comfortable length.