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Can you provide the signs and symptoms of an IUD expulsion? #1234/9
What are the signs and symptoms of an IUD expulsion?

Possible signs and symptoms of an IUD expulsion are: longer strings, uterine cramping or pain, spotting, vaginal discharge, vaginal pain, presence of hard plastic at the opening of the cervix or in the vagina, a missed period and pregnancy (and symptoms of pregnancy).


Here is some additional information from the 19th edition of Contraceptive Technology:


Intrauterine Devices (IUDs) by David A. Grimes, MD

Cramping and Pain

Discomfort may be felt at the time of IUD insertion and may be followed by cramping pain over the next 10 to 15 minutes. One approach is preventive therapy with oral non-steroidal anti-inflammatory drugs, local anesthesia, or both. Prophylactic administration of a non-steroidal anti-inflammatory drug around the time of insertion has not been found to be helpful. The most common analgesia approach used for insertion in the United Kingdom is intrauterine anesthesia with a solution of 2% lidocaine (Instillagel), which is not commercially available in the United States.  For paracervical anesthesia, use of a long-acting local anesthetic, such as bupivacaine, may be preferable to shorter-acting drugs, such as lidocaine. Should a woman have pain or vasovagal symptoms immediately after insertion, a paracervical block can be placed at that time. Rarely, the IUD needs to be removed at the insertion visit. Pain that develops later may reflect threatened or partial expulsion, dislodgment, infection, or a complicated pregnancy.


Between 2% to 10% of IUD users spontaneously expel their IUD within the first year. An IUD expulsion can occur without the woman detecting it. Nulliparity, an abnormal amount of menstrual flow, and severe dysmenorrhea are risk factors for Cu T 380A expulsion. A woman who has expelled one IUD has a 30% chance of subsequent expulsions.


The symptoms of an IUD expulsion include unusual vaginal discharge, cramping or pain, intermenstrual spotting, postcoital spotting, dyspareunia (for the man or the woman), absence or lengthening of the IUD string, and presence of the hard plastic of the IUD at the cervical os or in the vagina. If the menstrual period is delayed, check for IUD strings. A missed period may be the first indication of a “silent” expulsion. If the woman is not pregnant, another IUD can be replaced immediately.


Perforation of the uterus can occur at the time of IUD insertion; no evidence supports that notion that IUDs “migrate” outside the uterus thereafter. The most important determinant of the risk of perforation is the skill of the person doing the insertion (“the magic is in the magician and not in the wand”). In experienced hands, this risk is 1 per 1,000 insertions or less.


Copper-bearing IUDs found to be outside the endometrial cavity should be removed promptly. Copper in the peritoneal cavity induces adhesion formation, which may involve the adnexa, omentum, and bowel. Laparoscopy is the preferred approach for removal. In contrast, non-medicated and progestin-bearing devices do not evoke similar intraperitoneal adhesions. No clear medical indication exists for removal of T-shaped IUDs not containing copper, although this is commonly done.


If a woman becomes pregnant with an IUD in place, confirm that the pregnancy is intrauterine and not ectopic. Remove the IUD promptly, regardless of her plans for the pregnancy. Early removal reduces the risk of spontaneous miscarriage or preterm delivery should the woman plan to continue the pregnancy.  If the woman plans to continue the pregnancy, she should be alerted to look for symptoms of an influenza-like syndrome, which might be manifestations of a septic spontaneous abortion. A copper or non-medicated IUD in place during pregnancy carries no known risk of teratogenesis. If the woman plans to have an induced abortion, remove the IUD promptly rather than wait for removal at the time of abortion.



Key words:  signs, symptoms, IUD expulsion, longer strings, cramping, pain, spotting, pregnancy band pregnancy, Contraceptive Technology, Intrauterine Devices, Dr. David A. Grimes, perforation, pregnancy



Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J, Nelson AL. et al Contraceptive Technology 19th edition, pages 123-125: Ardent Media Inc. 2008

Posted 1-2-2010, Updated 1-14-2010, Updated 2-9-2010

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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