Choosing a contraceptive method is very important, both for your health and for your comfort. We must take sexual habits into account when choosing the option that best suits us, and it is important to know its pros and cons. The IUD has become one of the most popular precisely thanks to this comparison. To know if the IUD is the most appropriate method for you, the first thing is to know how it works. The IUD is a T-shaped metal and plastic device that is placed inside the cervix to prevent pregnancy. The copper IUD works purely mechanically, while the Mirena IUD incorporates the progressive release of hormones to regulate the menstrual cycle.

Check if the IUD string is in place

  • If you have decided to use the IUD for birth control, the first step is to know how to insert it. For this you must first go to the gynecologist, who will carry out the necessary analyzes and will indicate the most appropriate moment for its placement, which is usually during menstruation. When inserting the IUD, some threads remain loose that are used to carry out the necessary checks on its position, as well as to remove it if necessary.
  • The IUD strings are left as a guide so that you can regularly check that the IUD has not moved. It must be done after each menstruation, and for this you must follow this process: with very clean hands, squat down and insert a finger until it touches the cervix, where the threads should be. It is important to do it carefully and only touch them, but without pulling them.
  • If you do not notice any changes, no further measures are necessary to ensure the effectiveness of the IUD, apart from the usual gynecological check-ups. However, it is necessary to go to the gynecologist if any of these situations occur: not finding the threads, noticing them longer than usual or finding other parts of the IUD when palpating, as it will be a sign that it has moved and lost its effectiveness, so that will have to be repositioned or removed.
## How insertion is done — what to expect (step-by-step, practical advice) As a gynecologist I always tell patients that knowing the procedure reduces anxiety and improves cooperation during the insertion. Below is a practical, clinician-level walk-through of what happens at the appointment and how you can prepare. - Before the visit - Medical history and pregnancy test: Your provider will review your contraception goals, menstrual history, prior STIs, pelvic infections, and allergies. A same-day urine pregnancy test is routine if there is any chance of pregnancy. - Timing: Many clinicians schedule insertion during menstruation because the cervix is slightly softer and pregnancy is unlikely. If you are switching from another method or are sure you are not pregnant, your provider may insert at any point in your cycle. - Medication: For patients with significant anxiety or pain with prior procedures, a premedication protocol can be discussed. Options include NSAIDs (ibuprofen) taken 1 hour before the visit and, rarely, a short-acting oral analgesic or local cervical anesthetic in clinic. Routine sedation is not required. - STI screening: If there is any risk for STIs, some clinicians will test before insertion or use a "test and treat" strategy because active cervical infection increases the small risk of pelvic infection after insertion. - The insertion appointment — step-by-step 1. Consent and explanation: You will sign informed consent and your provider will explain the device type (copper vs levonorgestrel), duration, and what to expect. 2. Positioning: You lie on the exam table in the lithotomy position (feet in stirrups) so the provider has access. 3. Speculum exam: A sterile speculum is inserted to visualize the cervix. The cervix is cleansed with antiseptic. 4. Measurement: A sterile instrument called a uterine sound measures the length and orientation of the uterine cavity. This ensures correct IUD placement and reduces perforation risk. 5. Placement: The IUD is loaded into an applicator and passed through the cervical canal into the uterine cavity; then the device is released and the applicator withdrawn. The provider trims the strings to an appropriate length (usually leaving about 2–3 cm protruding into the vagina) and checks final position. 6. Post-insertion check: Your provider may perform a speculum and vaginal exam to ensure the strings are visible and may palpate for uterine tenderness. 7. Observation: You may rest briefly before going home. Expect cramping and light bleeding for 24–72 hours. - Immediate aftercare (practical tips) - Expect cramping similar to a heavy period for a day or two; use NSAIDs and heat as needed. - Avoid inserting anything into the vagina (tampons, menstrual cups, or intercourse) for 24–48 hours or follow your provider's specific instruction. - If your IUD was inserted at a time when it is not immediately effective (usually for hormonal IUDs placed outside of days 1–7 of a cycle), use backup contraception for 7 days as instructed. - Keep the appointment for a 4–12 week check (your provider will advise), and then check the strings monthly afterwards. Real example: A 29-year-old patient with heavy periods chose Mirena. We inserted during menses; she took ibuprofen beforehand, tolerated the procedure well, and used a heating pad for cramps that evening. We scheduled a 6-week check and she returned with no problems. ## Self-checking the IUD string correctly — step-by-step, timing, and troubleshooting The short advice in the original article is accurate; here I expand with stepwise and troubleshooting detail so you can check confidently and know when to act. - When to check - First check: best done after your first period following insertion (if insertion was during menses you can check sooner, per your provider). - Routine checks: once a month is reasonable — for many people this becomes part of their post-period self-care. For Mirena and other levonorgestrel devices, the string may become softer and less noticeable over time. - After events: check if you experience heavy bleeding, severe cramps, any sensation of device movement, after intercourse that seemed to pull at the strings, or if your partner reports feeling the string. - How to check, step-by-step 1. Wash your hands thoroughly with soap and warm water; dry completely. 2. Find a comfortable position: squat, sit on the toilet with knees apart, or place one foot on a raised surface. Some women find using a mirror helpful to visualize the cervix. 3. Gently insert the index or middle finger (nail short, smooth) into the vagina until you touch the cervix — it feels firm and round with a small dimple (the os). 4. Feel for the strings — they usually feel like soft nylon threads. **Only touch them**; do not pull. 5. Note length and quality: typical string length from cervix to vaginal introitus is about 2–3 cm. If you feel extra-long strings, or a hard plastic object instead of thin threads, stop and contact your provider. - Practical tips to make it easier - Trimmed nails and a relaxed pelvic floor help — take slow diaphragmatic breaths to relax. - A lubricating water-based gel can make insertion of a finger easier if you have vaginal dryness (avoid flavored or irritating products). - If you can’t feel the strings but had no symptoms, it may be because the strings have curled up into the cervical canal or the manufacturer uses softer strings (especially with Mirena). This is common and not always a problem. - Troubleshooting common findings - Can’t feel any strings: - If you have no pain, bleeding, or pregnancy symptoms: don’t panic. Many times the strings have curled upward and your provider can retrieve or confirm position on exam. - If you are sexually active and may be pregnant, take a pregnancy test immediately and contact your provider. - The provider will perform a speculum exam, and if strings are still not visualized they may do a pelvic ultrasound to confirm the IUD location. If ultrasound is inconclusive and suspicion is high that the device is missing, an abdominal X-ray can locate a non-radiolucent device. - Strings feel longer than before: - This can happen if the IUD has shifted lower in the uterine cavity or partially expelled. Contact your provider; do not attempt to push the IUD back into place. - Partner feels the strings during intercourse: - Often the strings can be tucked upwards by your provider. If persistent, the strings can be trimmed slightly shorter (still leaving adequate thread for safe removal). Some providers also reorient the strings during an office visit. - You feel a hard plastic piece: - This may indicate the device itself is low enough to be felt and requires immediate evaluation. Real example: A patient called because she couldn’t find her strings three months after Mirena insertion. She had no pain or bleeding and a negative pregnancy test. In clinic, the speculum exam did not show strings; pelvic ultrasound showed the device correctly positioned with strings curled into the cervical canal. I trimmed the strings and taught her how to check again; we scheduled the usual follow-up. ## When to contact your gynecologist — warning signs and emergency steps Knowing which symptoms are normal and which are not is essential. Contact your provider immediately if you experience any of the following: - Sudden, severe lower abdominal pain (worse than usual cramps) — could indicate partial expulsion, uterine perforation (rare), or another acute pelvic condition. - Heavy, abnormal bleeding that soaks a pad in an hour or is much heavier than your normal menses. - Fever, chills, unusual or malodorous vaginal discharge, or pain with intercourse — signs that suggest infection. - Missing strings combined with pregnancy symptoms (missed period, nausea, breast tenderness, positive pregnancy test) — pregnancy with an IUD in place is uncommon but has a higher risk of being ectopic; contact your provider urgently. - If the device is partially expelled — you may feel the hard plastic or the device at the cervical os — do not attempt to push it back. Use backup contraception (e.g., condoms) and seek same-day care. Emergency steps to take - If you suspect pregnancy with an IUD in place: get a pregnancy test and contact your provider immediately. If pregnancy is confirmed and IUD strings are visible, removing the IUD early reduces miscarriage risk. - If you suspect perforation (severe pain at insertion or afterwards with persistent pain and no strings): seek urgent evaluation. Uterine perforation is rare (about 1–2 per 1,000 insertions) but requires imaging and often surgical management. - For suspected infection: antibiotics and pelvic exam are required. Practical advice: Keep an IUD card in your wallet with the insertion date, model, and provider contact — this speeds up care in emergencies. ## Preventing and managing common issues - Reducing insertion pain and anxiety - Use NSAIDs before the appointment (400–600 mg ibuprofen one hour prior unless contraindicated). - Ask about cervical softening (misoprostol is sometimes used but not routine). - Discuss local anesthetic options or short-acting oral analgesics if you have had painful exams previously. - Managing cramping and bleeding changes - Copper IUDs can increase menstrual bleeding and cramps for the first 3–6 months. NSAIDs are effective; tranexamic acid is an option for heavy bleeding but requires prescription and discussion with your provider. - Mirena typically reduces bleeding over months and often leads to lighter periods or amenorrhea in many users. - Avoiding expulsions - Expulsion rates are highest in the first 3 months (overall roughly 2–10% depending on device and patient population). Risk factors include insertion immediately postpartum, heavy menses, and younger age. - Follow up at the recommended interval and check strings monthly to detect early displacement. - Fertility after removal - Fertility generally returns quickly after IUD removal — ovulation can occur within weeks. If you plan to conceive, talk with your provider about timing and preconception care. For more on contraception choices and what to expect with each device see [related topic](/blog). If you need supplies like pH-balanced lubricants or menstrual care products to make self-checks more comfortable, check our [shop](/shop). ## FAQ ### Can I remove my IUD at home if I can feel the strings? No. Even if you can feel the strings protruding into the vagina, I do not recommend attempting removal yourself. Pulling on the strings without sterile technique or proper visualization can break the string, leave parts of the device behind, or cause bleeding and infection. IUD removal should be performed by a trained clinician in a clean setting. If you feel the strings and want the device removed, call your provider to schedule a removal appointment. If the strings are protruding far and causing symptoms (discomfort during intercourse), your provider may remove or trim them based on clinical assessment. ### How often should I check my IUD strings? A monthly check is sufficient for most people. Many patients choose to check after each menstrual period as part of their routine self-care. If you notice any new pain, bleeding, or if your partner feels something during sex, check sooner and contact your provider. Routine clinic follow-ups (usually at 4–12 weeks after insertion and then yearly or per your provider's recommendation) remain important. ### My partner feels the strings during sex; what can we do? This is a common complaint. First, confirm whether the strings are the cause — your partner feeling the string is usually harmless but can be uncomfortable. Your provider can: - Trim the strings shorter (still leaving enough to safely remove later). - Tuck the strings upward into the cervical canal during an office visit. - If trimming and repositioning don’t help, consider replacing the device with another contraceptive method. Do not cut the strings yourself. ### I can't feel my IUD strings — does that mean it's gone? Not necessarily. The strings may have curled up into the cervical canal or become extremely soft and hard to detect (especially with levonorgestrel devices such as Mirena). If you have no pain, heavy bleeding, or signs of pregnancy, call your provider for an exam. Your clinician will look with a speculum; if the strings are not visible they will perform a pelvic ultrasound to confirm the device is in the correct place. Only if the device is not located will further imaging (e.g., X-ray) be required. ### What are the signs of IUD expulsion or perforation and how common are they? - Partial or complete expulsion can present with increased cramping, heavier bleeding, or the feeling of the device at the vaginal entrance. Expulsion rates are highest in the first 3 months and vary by population and device type (roughly 2–10% in studies). - Uterine perforation is rare (about 1–2 per 1,000 insertions) and typically occurs at insertion. Symptoms include severe pain during insertion or persistent severe pain afterwards, sometimes with abnormal bleeding. Perforation may require imaging and surgical management. If you have sudden severe pain, heavy bleeding, fever, or can feel the device in the vagina or at the cervix, seek urgent evaluation. --- If you have additional questions about insertion, follow-up timing, or need a referral to a clinician experienced with IUD care, consult your local gynecologist or family planning clinic. For detailed guides on other contraceptive methods and practical decision tools visit [related topic](/blog) or browse recommended self-care supplies at our [shop](/shop).