IUD Expulsion: A Closer Look at Signs and Complications

Rishabh Mehta
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Dr. Kaushal

Review medical content on WOW Rx Pharmacy, so that accurate drug use information is easily accessible to everybody.
Dr. Akansha is a licensed Clinical Pharmacologist. She possesses remarkable knowledge in Pharmacovigilance, prescription analysis, drug information, and drug safety services. Additionally, she is a keen learner and an educator.

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IUD Expulsion

IUD expulsion is described as partial or complete displacement of an IUD from the uterus. 

On average, it happens to 1 out of 20 IUD users, which is a significant number. 

Naturally, when the IUD moves or falls out of place, its efficiency in preventing pregnancy is affected. 

What’s worse is the complications like perforation that can follow up. 

To mitigate these risks, it is essential to keep checking an IUD and immediately report any signs of expulsion to a doctor. 

This article will help spot these signs of IUD expulsion, explaining in detail how to check if the IUD is in place and what to do if it’s not. 

Signs of IUD expulsion

Strings too shortSource: SOMNATH_MAHATA_from_GettyImages
Copper IUD

An IUD falling out from the uterus is a worrying event. 

Hence, noting the position of the IUD strings is very crucial for women during implantation by the doctor. 

The displacement or falling of the IUD can bring changes like shorter or longer than usual strings, uneven strings, and missing or misplaced strings. 

While these physical changes to the placement of the IUD may be noticed, more alarming IUD expulsion symptoms are:

  • Heavy bleeding
  • Abnormal vaginal discharge
  • Severe cramping or soreness in the lower belly
  • Fever and infection
  • Trouble breathing
  • You can feel the IUD

Do note that such symptoms should not be overlooked and be consulted for.

Fact:
Out of the factors associated with an increased risk of IUD expulsion, heavy menstrual bleeding is the strongest factor, according to a US cohort study. 

How to check for IUD expulsion

IUD has two strings about 1-2 inches long that come out of the cervix on top of the vagina. 

You must check them once a month to make sure that the IUD is still in place. 

The steps for checking an IUD are as follows:

  • Wash your hands with soap and water
  • Sit or stand in a comfortable position
  • Insert your middle finger till you reach the cervix, which feels like the tip of the nose
  • Check if the IUD strings are shorter or longer than when it was inserted
  • If you feel any changes in the length of strings, your IUD has moved. 
Recommended Article
When IUD strings are missing, it needs to be removed. To understand better the procedure that follows, read, How to Remove an IUD if Strings are Missing: Step-by-Step Guide for Safe Removal

Risk factors for IUD expulsion

menstrual cycles in womenSource: Mehaniq
Heavy menstrual bleeding

IUD expulsion is observed mostly around the first 3 months of insertion. 

However, some women might be at a higher risk of IUD expulsion. 

Certain factors, like the time of insertion and those related to the menstrual cycle, can be crucial in determining the rate of expulsion. 

Heavy menstrual bleeding

IUD expulsion is more likely to occur during periods. 

Moreover, heavy menstrual bleeding or (Menorrhagia) is not only common among females but also a risk factor for IUD expulsion. 

Not only this, it also increases the risk of perforation in comparison to women with lighter menses. 

Age

Younger women are more likely to experience IUD expulsion. 

A study by Tessa Madden found that women aged 14-19 had more expulsion than the older ones. 

Vaginal delivery

Vaginal delivery is more likely than cesarean sections to cause expulsion. 

According to a 2020 study, the total rate of IUD expulsion was found to be 28.8 percent. 

Out of these, women having vaginal delivery had four times higher chances of having IUD expulsion. 

Postabortal insertion

The time of IUD insertion may play a role in increasing the risk of expulsion. 

A review by Okusanya BO suggests that IUD insertion immediately after abortion had a higher expulsion chance when compared to interval insertion.

Other factors

Obesity and overweight are factors that are likely to increase the risk of expulsion. 

Moreover, ethnicity plays an important role, as Asian or Pacific Islander individuals had a higher risk of expulsion. 

They are followed by non-Hispanic Black, Hispanic Black, Hispanic White, Hispanic other, and multiple race women. 

Does IUD expulsion affect the chances of pregnancy

IUD expulsion affects the efficiency of pregnancy prevention of the contraceptive. 

When the IUD moves from its place, it can result in pregnancy. 

If you suspect IUD expulsion, contact your doctor immediately for guidance.

Use other sources of protection till you get the IUD reinserted by a professional, if suitable, or consider another contraceptive. 

Complications

IUD expulsion itself can cause uneasiness, but there can be other serious consequences as well. 

Perforated uterus

Uterine perforation is a rare complication, with 1 case per 1000 insertions. 

When the device completely enters the abdominal cavity, it is called complete perforation. 

If the device enters the uterine wall to some extent, it is partial perforation. 

During expulsion, the device moves out of place, which may result in perforation. 

Warning:
The risk of IUD perforation is highest during 12 weeks after giving birth while the patient is still lactating. It can cause abdominal pain and bleeding. In such cases, one must contact a doctor immediately to remove the device. 

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease, or PID, is an infection of the female reproductive organs. 

The use of an IUD increases the risk of PID by three to nine times. 

It is also more likely to occur in the starting period of insertion. 

The bacterial exposure during IUD insertion is high, which increases the chances of PID.

In such cases, if expulsion occurs, the infection can spread. 

Anemia

AnemiaSource: Pixedlimage
Anemia written on a blackboard

Due to IUD expulsion, sometimes heavy bleeding can occur. 

This can lead to Anemia (lack of red blood cells). 

Ectopic pregnancy

IUD expulsion not only increases the chances of unintended pregnancy but also ectopic pregnancy. 

It is a complication in which the fetus grows outside the uterus. 

So, any discomfort like abdominal pain or bleeding must not be ignored.

How to prevent IUD expulsion

Most of the factors leading to IUD expulsion cannot be controlled. 

However, you must get it inserted by an experienced medical expert to narrow the chances of error during insertion. 

Moreover, you can plan out the right time for getting an IUD inserted with your doctor. 

Since postabortal insertions have a higher risk of expulsion, you must consult a doctor for a suitable time to avoid such issues. 

If you experience heavy menstrual bleeding, consider another birth control method or ask your doctor if a hormonal IUD is suitable for you since it reduces heavy menstrual bleeding. 

By doing so, you may not eliminate the risk of IUD expulsion but lower it. 

When to see a doctor

Woman taking consultation from a doctorSource: Getty_images
Woman taking consultation from a doctor

If you suspect that your IUD has moved out of its place, you must see a doctor. 

Signs like missing, shorter, or longer strings of the IUD or symptoms like abdominal pain or fever must not be ignored. 

If IUD expulsion occurs, you will need to get it removed or replaced, whatever is suggested by the medical experts. 

They may conduct an ultrasound to check if the IUD is still in place and take the necessary decision if it’s not. 

Conclusion

IUD expulsion is the partial or complete displacement of an IUD from the uterus. 

If this happens, it no longer offers protection from pregnancy and may even result in ectopic pregnancy. 

Vaginal delivery, age, postabortal insertion, obesity, and ethnicity are some factors that can increase the chances of IUD expulsion. 

It can lead to complications like perforation, PID, and Anemia.

To ensure no such issues occur, consult a doctor if you see any symptoms like fever, abdominal pain, infection, or bleeding. 

Staying aware of the possibilities and symptoms and taking timely action can minimize the risks and consequences of IUD expulsion. 

Frequently Asked Questions

What are the odds of IUD coming out? 

IUD expulsion is not the most common issue faced with this contraceptive. However, one out of twenty IUD users can experience this complication. The chances of expulsion increase with factors like vaginal delivery, young age, postabortal insertion, and heavy menstrual bleeding. 

Is IUD expulsion dangerous? 

IUD expulsion may not cause much harm if reported on time. However, make sure not to ignore any signs, as it can be dangerous. It can cause issues like perforation, excessive bleeding, ectopic pregnancy, and Pelvic Inflammatory Disease. 

How do you know if your IUD fell out? 

You must wash your hands and insert the middle finger in the vagina. If the strings of the IUD are missing, shorter, or longer than before, it is likely that the IUD is displaced. Other possible signs are abdominal pain, bleeding, and fever. To confirm, a doctor may conduct an ultrasound. 

My IUD fell out should I get another? 

Whether or not to get an IUD after expulsion should be decided after consulting a doctor. Until then, you must use another birth control to prevent pregnancy. In case an IUD has caused extreme discomfort like bleeding or perforation, you should switch to another contraceptive. 

Citations:
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