If you have an intrauterine device (IUD), you may have wondered whether or not it's in the right place. To ease your mind, here's a guide on how to tell if your IUD is correctly placed in your uterus, if your IUD fell out, or if the IUD moved — and what to do about it. ‍

3 signs your IUD is out of place‍

If your IUD has only slightly moved, you may not notice any symptoms. However, if the IUD becomes displaced, the following signs and symptoms are common. 

1. Can’t feel IUD strings.‍

According to the board-certified gynecologic surgeon, Dr. Julia Arnold VanRooyen, the most common sign that an IUD might be out of place is missing "strings." After an IUD is inserted, one or two threads or "strings" can be seen and felt at the cervix. If you're unable to feel these strings or you can feel the plastic of your IUD, you should reach out to your doctor for further evaluation. Note that sometimes these strings can be retrieved during a pelvic exam from up in the cervix, so not being able to feel them doesn't always mean the IUD is out of place (1, 2).‍

2. Severe cramping or lower abdominal pain.‍

It's normal to experience mild cramping and lower abdominal pain during and following an IUD insertion, but this should go away within a few days. If you notice persistent pain following the procedure, you should contact your OB GYN for advice as it could be a sign your IUD is out of place (3, 4).‍

3. Heavy vaginal bleeding.‍

Bleeding after the insertion of an IUD is common and can last a few days to weeks. Some individuals may experience heavy or irregular bleeding for up to six months after the IUD is placed. According to the American College of Obstetricians and Gynecologists (ACOG), this is particularly true for those who choose the copper IUD (Paragard) as their contraceptive method. If you experience excessive or unusually heavy bleeding, you should follow up with your doctor as it could also be a sign of infection (pelvic inflammatory disease or PID occurs in up to 1% of IUD users) or uterine perforation which Dr. Arnold VanRooyen says is rare (2, 4).

"IUDs can perforate or poke through the uterus at the time of insertion; they can 'migrate' from their original position through the uterus after being placed in the proper position," says Dr. Arnold VanRooyen. "Perforation is rare, occurring with 0.1-0.6% of insertions (5). Migration or movement of the IUD through the uterine wall happens much less frequently and due to uterine contractions, forcing the IUD through the tissue. "

Additional symptoms to watch out for include abnormal vaginal discharge and pain with intercourse. If your partner is able to feel your IUD during sex involving vaginal penetration, it could also be a sign that it's out of place.‍

What can cause your IUD to move?‍

IUD malposition or displacement is relatively common. According to a 2022 study published in OBG Management, IUD malposition occurs in 10% to 20% of patients (6). ‍

Your IUD may move out of place if:

• It's inserted by an inexperienced provider. Failure rates for IUD insertions range from 1% to 18% (7). Although there's more research to be done, evidence suggests that certain patient characteristics such as age, obesity, and a person's anatomy (small uterine cavity, for example) may affect IUD insertion success. That said, clinician training and experience are two of the most important factors when it comes to ensuring successful IUD placement.
• You have a tilted uterus. A retroverted or "tilted" uterus refers to a uterus that leans towards the spine, rather than forward toward the pubic bone. According to the Cleveland Clinic, an estimated 25% of women have a tilted uterus. Generally, having a tilted uterus shouldn't prevent you from getting an IUD; however, the insertion procedure might take a bit longer. According to one study, utilizing ultrasound to install an IUD in those with tilted uteruses was connected with reduced pain and complications, such as bleeding (8).
• You have a small uterine cavity. Having a smaller-than-average uterine cavity can also make it more difficult to insert an IUD. In nulliparous women (a woman who's never given birth), the uterine cavity is typically not wide enough to accommodate traditional IUDs, which can cause uncomfortable side effects including bleeding, pain, and expulsion (when the IUD falls out on its own) (9).

Can an IUD fall out?‍

An IUD can fall out of place for several reasons. 

Expulsion is more likely to happen if:

• you've never been pregnant
• you are younger than 20 years old
• you have a family history of painful or heavy periods

IUD expulsion happens infrequently, with a rate of between 2% and 10%. (1)‍

How to check if your IUD moved‍

If you're concerned your IUD may have shifted, you can perform a self-check at home. To do this, wash your hands and find a comfortable place to sit or squat. Then insert your middle or index finger into your vagina and locate your cervix. (The cervix feels firm, sort of like the end of your nose.) You should be able to feel the IUD strings protruding from the cervix. Do not tug or pull on the strings! Instead, gently ease your finger up and down the length of the strings until you can feel the coils and backing of the IUD.

"A person can check to see if their IUD is in the right place by feeling for the string that's attached to it," OB GYN and fertility specialist, Dr. Hrishikesh Dattatraya Pai, tells O.school. "If a person's IUD is in the right place, the string will feel smooth, like a piece of thread. If the person's IUD has fallen out, the string will feel like a knot. If a person's IUD has moved, the string will feel crinkly or bunched up."‍

Will I be harmed if my IUD is out of place?‍

Don't panic if you're unable to locate your strings on your own. Just be sure to make an appointment with your doctor. Depending on your situation, your doctor may decide to leave it where it is and closely monitor you for any signs of trouble, or they may recommend surgical removal to reduce the risk of complications down the road.

"Even if an IUD perforates the uterus, it very rarely leads to serious sequelae," Dr. Arnold VanRooyen tells O.school. "Extremely rarely, the IUD could perforate bowel or bladder or cause scar tissue inside the abdomen. To avoid these potential problems, laparoscopy is generally recommended to retrieve the IUD. Once it is located, it can usually be removed through the laparoscope, using one or two other very small incisions."‍

What to do if you think your IUD is out of place‍

If you're worried that your IUD is out of place, make an appointment to see your doctor. Be sure to use another reliable form of birth control until your appointment date to avoid any unwanted pregnancies in the meantime.

During your appointment, your doctor will perform a pelvic exam to check your IUD placement. If they're unable to feel the strings, you may be asked to do a vaginal ultrasound to double-check your IUD's location. This is a quick and painless procedure that involves placing a small device into your vagina to get a clear view of the uterus.‍

The bottom line ‍

Serious complications from IUDs are rare but can happen. If you're experiencing severe pelvic pain, unusual or heavy bleeding, or are unable to feel your IUD strings, give your doctor a call. They'll be able to help you figure out what's going on and advise the best course of action to take moving forward. If you’re experiencing issues with your IUD, consider exploring other birth control methods to find what works best for you.