How to tell if the IUD has moved and what to do

Intrauterine devices (IUDs) are a highly effective form of long-acting reversible contraception (LARC). Although most IUD users experience safe and successful protection from unintended pregnancy, displacement, partial expulsion, or rare uterine perforation can occur. Being informed about the signs of IUD movement, appropriate self-check techniques, and the correct steps to take if you suspect displacement helps preserve contraceptive effectiveness and reduce the risk of complications.

This article explains how IUDs are positioned, what “movement” can mean medically, the symptoms that may signal a problem, how clinicians diagnose displacement, and evidence-based recommendations for evaluation and management. Information is drawn from clinical guidance and authoritative sources including the American College of Obstetricians and Gynecologists (ACOG), the U.S. National Institutes of Health (NIH), the Mayo Clinic, and the Cleveland Clinic.

Types of IUDs and how they work

There are two general categories of IUDs in current clinical use:

Hormonal IUDs (levonorgestrel-releasing), such as Mirena, Kyleena, Liletta, and Skyla. These release a small, localized dose of progestin (levonorgestrel) into the uterine cavity. They reduce endometrial growth and thicken cervical mucus; some also suppress ovulation in some users. Hormonal IUDs commonly reduce menstrual bleeding and cramping over time.
Copper IUDs (non-hormonal), such as the ParaGard T380A. Copper acts as a spermicidal agent and creates an intrauterine environment that reduces sperm motility and fertilization. Copper IUDs can lead to heavier or longer menstrual bleeding and increased cramping in some users.

Both types are highly effective contraception options, with pregnancy rates typically less than 1% per year in clinical trials when properly placed and retained [ACOG; Mayo Clinic].

Sources for further reading:

ACOG Practice Bulletin — Long-Acting Reversible Contraception (LARC) (summary guidance) [ACOG]
Mayo Clinic: IUD overview and side effects [Mayo Clinic]

What “movement” of an IUD means — definitions

When clinicians discuss an IUD that has “moved,” they mean one of several possible events:

Expulsion: The IUD has partially or completely passed out of the uterus into the cervical canal or vagina. Complete expulsion means the device is outside the uterus. Partial expulsion means one arm or the body of the device is protruding into the cervix or lower uterine segment.
Displacement (malposition): The IUD remains inside the uterus but is not in the expected fundal position; it may be lower in the uterine cavity or at an abnormal angulation. A displaced device may still be intrauterine but less effective or associated with symptoms.
Perforation and migration: A rare event in which the IUD perforates the uterine wall at the time of insertion (or, less commonly, later) and partially or completely moves through the myometrium into the abdominal cavity. Perforation may require surgical removal [ACOG; Cleveland Clinic].

These categories have different clinical implications for symptoms, contraceptive effectiveness, and management.

How common is movement?

Expulsion: Rates vary with device type, timing of insertion, age, parity and breastfeeding status. Typical expulsion rates are approximately 2–10% within the first year for many populations. Expulsion risk is higher when the IUD is inserted immediately postpartum and in some younger users [CDC; ACOG].
Perforation: Uterine perforation is uncommon. Estimates from large series indicate about 1–2 perforations per 1,000 insertions (0.1–0.2%) — less than 1% overall, but the actual rate depends on provider experience and clinical circumstances [ACOG; NCBI review].
Displacement: True malposition that remains intrauterine is detected variably depending on imaging indications — some displaced devices are found incidentally on ultrasound during evaluations for bleeding or pain.

Even though these events are uncommon, users should be educated about signs and symptoms and recommended follow-up.

Common signs and symptoms that an IUD may have moved

Symptoms of IUD movement vary. Some people are asymptomatic and the issue is identified by routine exam or ultrasound. Others report one or more of the following:

Change in string length or inability to feel the strings: Strings that are longer or shorter than usual, or strings that you cannot feel at all, may reflect partial expulsion, complete expulsion, or that the device has been pushed higher into the uterus. Not feeling strings alone is not diagnostic but warrants clinical evaluation [ACOG; Mayo Clinic].
New or increased pelvic pain or cramping: Persistent or severe pelvic pain or sudden sharp pain — especially soon after insertion — can indicate partial expulsion, perforation, or another complication. Severe abdominal pain requires urgent assessment.
Abnormal vaginal bleeding: A sudden change in bleeding pattern (heavier bleeding with copper devices; persistently heavier bleeding or new bleeding with a hormonal IUD) may indicate displacement. Note that some irregular bleeding is common in the first 3–6 months after hormonal IUD insertion.
Sensation of the device in the vagina: If you can feel the device itself (not just the strings) inside the vaginal canal, the IUD may have been expelled or partially expelled.
Positive pregnancy test or signs of pregnancy: If pregnancy occurs with an IUD in place, the device may not be correctly positioned or its effectiveness has been compromised. Pregnancy with an IUD in situ requires prompt evaluation due to increased risk of ectopic pregnancy and a higher risk of complications.
Signs of infection: Fever, chills, unusual or foul-smelling vaginal discharge, or pelvic tenderness could suggest pelvic inflammatory disease (PID) or an infected displaced device and require prompt medical evaluation.

Note: Minor discomfort and spotting immediately after insertion are expected. Distinguishing typical post-insertion symptoms from those that indicate movement is a clinical judgment best made with a provider.

How to perform a safe self-check of IUD strings

Providers often advise IUD users to become familiar with their device string position by performing periodic self-checks. A simple and safe technique:

Wash your hands thoroughly.
Assume a comfortable position (sitting on the toilet with knees apart or squatting).
Insert a clean finger gently into the vagina and feel toward the cervical opening (os).
You may detect two fine, flexible strings extending from the cervix into the upper vagina. The strings typically feel like thin, soft threads. Do not attempt to pull on the strings.
If you feel only the strings and no hard plastic, no device is protruding into the vaginal canal.

Routine self-check frequency recommendations:

Check once a month, for example at the end of a menstrual period, or any time you suspect a change.
Also check if you experience new pelvic pain, abnormal bleeding, or any sign of pregnancy.

Important cautions:

Do not attempt to reposition the device yourself.
Do not cut the strings.
If you cannot feel the strings but have no symptoms, contact your healthcare provider for evaluation rather than attempting invasive measures.

Sources: ACOG patient education materials; Mayo Clinic guidance.

When to see a healthcare provider — urgent versus non-urgent

Seek urgent medical care (same day or emergency department) if you have any of the following:

Sudden, severe abdominal or pelvic pain.
Heavy vaginal bleeding that soaks through a pad in an hour or causes faintness.
Fever, chills, or signs of systemic infection.
Symptoms of pregnancy (missed periods, nausea, breast tenderness) with positive pregnancy test.
Device protruding visibly from the vagina.

Schedule prompt outpatient evaluation (within days) if you:

Cannot feel your IUD strings but have no other symptoms.
Notice that the strings feel longer or appear shorter than usual.
Experience new or persistent pelvic pain or a change in bleeding pattern that is bothersome.

If the IUD has been expelled (you can see it or find it in sanitary products), it is not protecting against pregnancy and you should discuss contraception options and re-insertion as appropriate.

Clinical evaluation: what your provider will do

When you see a clinician because you suspect IUD movement, the usual steps include:

Focused history:

Date and type of IUD insertion.
Symptoms: onset, severity, bleeding pattern, fever, or pregnancy signs.
Recent events: postpartum insertion, breastfeeding status, recent pelvic procedures, or trauma.

Physical and pelvic examination:

Speculum exam to visualize the cervix and confirm string position or visible device.
Bimanual exam to assess uterine size, position, and tenderness.

Pregnancy testing:

A urine or serum pregnancy test is typically performed before any imaging or further management if pregnancy is possible.

Transvaginal ultrasound:

First-line imaging to confirm intrauterine position, identify partial expulsion, or assess for perforation. Ultrasound is highly sensitive for intrauterine IUD location but may not identify an IUD that has migrated outside the uterus.

Radiographic imaging (abdominal/pelvic X-ray) if needed:

If an IUD is not visualized within the uterus on ultrasound and perforation or migration is suspected, an abdominal x-ray (usually a plain pelvic x-ray) can help locate a radiopaque device. This is particularly relevant for copper and some hormonal IUDs that are radiopaque.

Specialist consultation and management planning:

If the device has perforated the uterus or migrated outside the uterine cavity, gynecologic surgery (often laparoscopy) may be required for removal.

Recommendations and next steps will depend on the findings and the user’s desire for ongoing contraception.

References: ACOG clinical guidance; Cleveland Clinic procedural guidance.

What imaging shows and how it guides management

Transvaginal ultrasound: Best initial test. An IUD in the expected position will be seen at the uterine fundus with the stem oriented vertically. A displaced device may be lower in the cavity, tilted, or partially embedded in myometrium. Ultrasound can also identify early pregnancy and evaluate for signs of ectopic pregnancy.

Plain pelvic X-ray or abdominal radiograph: Useful if ultrasound fails to locate the device but clinical concern for perforation or migration exists. A radiopaque IUD will be visible on x-ray and can be localized.

CT or MRI: Rarely necessary for localization but may be used in complex cases or when adjacent organ involvement is suspected.

Management decisions (observation, removal, surgical retrieval) rest on combining imaging results with symptoms, pregnancy status, and contraceptive goals.

Sources: Mayo Clinic; Cleveland Clinic; ACOG.

Management options based on findings

Management varies by the type of movement and symptoms:

Complete expulsion: If the IUD is expelled and the user does not wish to be pregnant, a new device may be inserted at a follow-up visit or sooner, depending on clinical assessment. Interim contraception (e.g., barrier methods or combined contraceptives) should be used if reinsertion is delayed.

Partial expulsion: If part of the IUD is protruding into the cervical canal or vagina, removal is usually recommended because of the increased risk of infection and decreased contraceptive efficacy. If pregnancy is not desired, a replacement IUD may be offered after removal.

Displacement but intrauterine and asymptomatic: Some displaced IUDs that remain fully intrauterine and are not causing symptoms may be managed expectantly with counseling about reduced effectiveness and close follow-up. Many clinicians recommend removal and replacement if the device is clearly malpositioned, particularly if the user is symptomatic or the device is the copper IUD (which has no systemic drug effects).

Perforation and migration: Surgical removal is generally recommended for an IUD that has perforated the uterine wall and is partially or completely in the abdominal cavity. Laparoscopy is the preferred approach in most cases. The timing and urgency depend on symptoms and imaging findings.

Pregnancy with IUD in place: If an intrauterine pregnancy occurs with the IUD in situ, ACOG advises removing the IUD if the strings are visible and removal can be accomplished without disrupting the pregnancy. If the strings are not visible, and the IUD cannot be removed safely, counseling and careful monitoring are required because of an increased risk of miscarriage, preterm birth, and infection.

Reference: ACOG LARC guidance; CDC clinical guidance.

Risks and complications associated with displacement

Reduced contraceptive effectiveness: A malpositioned or expelled IUD offers less reliable protection against pregnancy.
Ectopic pregnancy: Although overall pregnancy risk with IUDs is low, pregnancies that occur with an IUD in place are more likely to be ectopic than intrauterine.
Infection: Partial expulsion or manipulation of strings increases the risk of pelvic infection and pelvic inflammatory disease (PID), especially in the first 20 days after insertion.
Perforation: May require surgical removal; can be associated with injury to adjacent organs in rare cases.
Bleeding and pain: Displacement may produce abnormal bleeding patterns and pelvic pain.

These risks emphasize the importance of timely evaluation when concerns arise.

Risk factors for IUD expulsion or perforation

Certain factors increase the likelihood of expulsion or perforation:

Timing of insertion: Immediate postpartum insertion (especially within 10 minutes of placenta delivery) and insertion during lactation have higher expulsion rates and a slightly increased perforation risk.
Uterine anatomy: Significant uterine anomalies or very small uterine cavities can predispose to malposition.
Provider experience and insertion technique: Skilled, experienced providers have lower rates of complications.
Age and parity: Younger age and nulliparity may be associated with differing rates of expulsion in some studies.
Early insertion-related pain or resistance can be associated with increased risk of perforation if excessive force is used.

Providers take these factors into account when counseling patients and planning insertion.

Source: NCBI review of IUD safety; ACOG.

Preventive measures and recommended follow-up

To reduce the likelihood of unrecognized displacement:

Follow insertion instructions: Many clinicians recommend a check 4–6 weeks after insertion to verify position and address concerns. This timing can vary by practice and patient needs.
Routine annual exams: During routine gynecologic care, providers can confirm IUD strings and evaluate for new symptoms.
Monthly self-checks: Users should be instructed on safe monthly string checks and to report any changes.
Prompt evaluation for symptoms: New pelvic pain, abnormal bleeding, inability to feel strings, or any suspicion of pregnancy should prompt timely clinical assessment.

These measures enable early detection and management of device movement.

Alternatives and interim contraception if the IUD is removed or expelled

If the IUD is removed or completely expelled and the user desires ongoing contraceptive protection, consider:

Insertion of a new IUD at the same visit if criteria are met.
Short-term contraception while awaiting a scheduled replacement: combined oral contraceptives, progestin-only pills, injectable contraception, transdermal patch, or condoms (barrier method).
For emergency contraception: If unprotected intercourse occurred after expulsion, consider emergency contraception options (levonorgestrel or ulipristal acetate) per clinical indications.

Counseling about the full range of contraceptive options and the relative efficacy, side effects, and timing of initiation should be individualized.

Practical FAQs

Q: I cannot feel my IUD strings. Does that mean it has moved?

A: Not necessarily. Strings can retract into the cervical canal or the uterus and become difficult to feel. Clinical evaluation with a speculum exam and often ultrasound is required to determine device position.

Q: If my IUD strings are longer, does that mean it is expelled?

A: Longer strings can indicate partial expulsion or that the strings have been pulled. Any change in string length should prompt evaluation.

Q: Can I pull on the IUD strings to reposition the device?

A: No. Pulling on the strings risks dislodging the device, introducing infection, or causing injury. Do not attempt to reposition the IUD yourself.

Q: How soon after IUD insertion should I check the strings?

A: Your provider may advise a check at 4–6 weeks post-insertion and then routine monthly self-checks. Follow your clinician’s instructions.

Q: Is it safe to leave a displaced IUD in place if I have no symptoms?

A: Management depends on the degree of displacement, device type, and individual contraceptive needs. Many clinicians recommend removal and replacement if the device is clearly malpositioned or if the user is symptomatic. Discuss individualized options with your provider.

When a device has perforated or migrated — red flags and surgical considerations

Perforation is uncommon but may present with persistent pain, inability to visualize the device in the uterus on ultrasound, or detection of the device on radiography outside the uterine silhouette. If perforation is confirmed:

Referral to a gynecologic surgeon is usually necessary.
Laparoscopy is typically the preferred method for retrieval; laparotomy is rarely needed.
Management includes evaluation for damage to adjacent organs and treatment of any associated infections.

Timely diagnosis and surgical management minimize morbidity.

References: Cleveland Clinic; ACOG.

Key takeaways

IUDs are highly effective forms of contraception; however, displacement, expulsion, and rare perforation can occur.
Common signs that an IUD may have moved include changes in string length, inability to feel the strings, new pelvic pain, abnormal bleeding, or pregnancy symptoms.
Do not attempt to reposition or pull on IUD strings. Perform gentle monthly self-checks, and seek clinical evaluation for any concerning changes.
Clinical assessment typically includes a history, pelvic exam, pregnancy test, and transvaginal ultrasound. X-ray may be used if the device is not visualized and perforation is suspected.
Management ranges from expectant management for some asymptomatic intrauterine malpositions to removal and replacement or surgical retrieval in cases of expulsion, symptomatic malposition, or perforation.
Immediate medical attention is warranted for severe pain, heavy bleeding, fever, or signs of pregnancy with an IUD in place.

If you have concerns about your IUD or suspect displacement, contact your healthcare provider promptly so they can arrange appropriate evaluation and management personalized to your situation.

References and resources

American College of Obstetricians and Gynecologists (ACOG) — Practice Bulletin and patient education on long-acting reversible contraception and IUDs: https://www.acog.org
Centers for Disease Control and Prevention (CDC) — Contraception basics and clinical guidance for IUDs: https://www.cdc.gov/reproductivehealth/contraception/
Mayo Clinic — Intrauterine device (IUD) overview, side effects, and risks: https://www.mayoclinic.org/tests-procedures/iud/about/pac-20384721
Cleveland Clinic — IUD complications including expulsion and perforation: https://my.clevelandclinic.org/health/treatments/10988-intrauterine-device-iud
U.S. National Library of Medicine / PubMed Central — Reviews of uterine perforation and IUD safety literature: https://www.ncbi.nlm.nih.gov

(For specific clinical questions or urgent symptoms, seek direct care from your healthcare provider or an emergency department.)