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If an IUD has slipped into the cervix, is visible, or is coming out, it may be partially expelled and should not be assumed to provide reliable contraception. Contact a sexual-health clinic, gynecologist, or other clinician promptly. Use condoms or another dependable method until the device has been checked, and do not push it back in or pull it out yourself.
Missing or changed strings do not prove that an IUD has moved: strings can curl upward. A clinician may need an examination, pregnancy test, and ultrasound to establish the device’s position. Severe or worsening pelvic pain, very heavy bleeding, fever, foul-smelling discharge, or a possible pregnancy requires urgent medical advice.
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What to do first
- Stop relying on the IUD until its position is confirmed. Use condoms or another effective contraceptive method. If you recently had sex without reliable contraception, ask a clinician or pharmacist promptly whether emergency contraception is appropriate. The right option depends on how long ago sex occurred, your device type, and local guidance.
- Arrange a prompt clinical check. Contact a sexual-health service, gynecologist, family doctor, or other qualified clinician if you can feel or see the device, the strings are missing or noticeably different, or you have new bleeding or pelvic pain that raises concern.
- Leave the device alone. Do not pull on the threads, trim them, push the IUD upward, or try to remove it. Removal and replacement decisions depend on the device’s location and your circumstances.
- Use emergency pathways for severe symptoms. Go to urgent or emergency care for severe or worsening lower-abdominal or pelvic pain, very heavy bleeding, fever, unusual or bad-smelling discharge, fainting, or a possible pregnancy with concerning pain or bleeding.
An IUD that has moved is not something you can diagnose reliably by touch or symptoms alone. Prompt assessment protects against an unrecognized pregnancy, infection, or injury while avoiding unnecessary removal of a device that may still be correctly positioned.
What “moved” or “partially expelled” means
An intrauterine device is intended to sit at the top, or fundus, of the uterus. A partial expulsion occurs when part of the device has passed down through the cervix. If the device is in the cervix or vagina, it is considered partially expelled. A complete expulsion means the device has come entirely out; some people notice it in underwear or the toilet, while others do not see it happen.
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A device can also be described as low-lying when it sits lower in the uterine cavity but remains above the internal opening of the cervix. That is not the same as a device in the cervix. The distinction matters because clinical guidance is clearer for a cervical device than for an asymptomatic device that is merely low in the uterus.
Some IUDs found low soon after placement move toward the fundus during the following months. That observation does not make it safe to ignore a new symptom or to decide on your own that a device is secure. Position has to be interpreted with the examination findings, the type of device, pregnancy priorities, and symptoms.
Signs that justify a position check
You can feel or see hard plastic
The strings are flexible threads designed to extend through the cervix. Feeling the actual plastic stem or arms in the vagina, or seeing the device at the cervical opening, is different from feeling strings and warrants prompt assessment. Do not grasp it or attempt to push it back into the uterus.
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Strings can curl into the cervical canal or uterus, so their absence does not by itself establish expulsion. A noticeable change can also occur if the device has shifted. A clinician can inspect the cervix and decide whether ultrasound is needed.
New pain or bleeding
Cramping, pelvic pain, or bleeding can occur for many reasons and cannot identify the IUD’s exact location. New, persistent, or worsening symptoms should be discussed with a clinician, particularly when they occur with changed strings or after a recent insertion.
A positive pregnancy test
Pregnancy with an IUD is uncommon, but an ectopic pregnancy must be considered. A positive test requires prompt medical evaluation rather than waiting for a routine appointment.
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Why location changes the decision
| Finding | What it means | Typical clinical approach |
|---|---|---|
| Device in the cervix or visible in the vagina | ACOG defines this as partial expulsion. Contraceptive protection cannot be assumed. | Removal by a clinician is recommended; a new device can be placed if you want one and it is medically appropriate. |
| Device low in the uterus but above the internal os, with no symptoms | This is not the same as cervical expulsion. The best management is less certain. | Shared decision-making considers location, symptoms, device type, pregnancy goals, and the risks of removal versus leaving it in place. |
| Strings not visible or not safely retrievable | Strings may have curled up, or the device may have moved, been expelled, or perforated the uterine wall. | After examination and a pregnancy check, ultrasound may be considered to locate the device. A clinician should not pull blindly. |
| Pregnancy with an IUD in place | Ectopic pregnancy is a serious concern that needs evaluation. | Management depends on pregnancy intent, symptoms, string visibility, and whether the device can be removed safely. |
ACOG cautions that removing an asymptomatic low-lying device without promptly starting another effective method can itself leave someone exposed to pregnancy. That is why a clinician, rather than a home decision based on a scan report or string length, should guide the plan.
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How a clinician checks the IUD
- History and symptom review: The clinician asks when the device was inserted, which type it is, whether bleeding or pain has changed, whether the strings were previously checked, and whether sex occurred while protection was uncertain.
- Pregnancy testing: A urine or blood test may be used when pregnancy is possible. A positive result changes the urgency and the next steps.
- Speculum examination: The cervix and strings are inspected. If the device is in the cervical canal, it may be removed during the visit when appropriate.
- Ultrasound when needed: If the strings cannot be seen or safely retrieved, ultrasound can help determine whether the IUD is inside the uterus and where it sits. The CDC’s 2024 U.S. Selected Practice Recommendations state: “If ultrasonography is available, consider performing or referring for ultrasound examination to determine the location of the IUD.”
- Further evaluation if the device is not found: If ultrasound does not show an IUD in the uterus, the possibilities include unnoticed expulsion or perforation through the uterine wall. The clinician decides whether additional imaging or treatment is necessary.
These steps are assessment, not instructions for self-removal. Trying to retrieve a device without seeing it can cause injury and does not establish whether it is still providing contraception.
Contraception while the position is uncertain
Until a clinician confirms that the device is correctly placed and suitable to remain, use another contraceptive method. Condoms are one option; choose a method you can use consistently and that fits your circumstances.
If you had sex recently without a reliable method, contact a clinician or pharmacist promptly about emergency contraception. Timing, the type of IUD or hormonal IUS, medications, and local protocols can affect which option is recommended. Do not assume that a device suspected of expulsion can be counted as emergency contraception or ongoing protection.
Keep using backup contraception until a clinician gives you a clear plan. If the device is removed and you do not receive a replacement immediately, ask when your chosen method becomes effective and whether additional condoms are needed during the transition.
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Arrange prompt medical care, even if you feel well. A pregnancy that occurs with an IUD in place needs evaluation for ectopic pregnancy, which develops outside the uterus and can become life-threatening.
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CDC guidance directs clinicians to assess for ectopic pregnancy and then discuss management according to pregnancy intent and whether the device can be safely retrieved. If the strings are visible, or the device can be safely reached in the cervical canal, removal is advised for an ongoing pregnancy. When strings cannot be safely retrieved, ultrasound may be used to determine the device’s location. These are clinician decisions; never attempt removal yourself.
Seek emergency help immediately for severe one-sided or generalized abdominal pain, shoulder-tip pain, dizziness or fainting, heavy bleeding, or weakness with a positive pregnancy test.
When symptoms need urgent care
Contact emergency services or follow your local urgent-care pathway if you have:
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- Severe, sudden, or steadily worsening lower-abdominal or pelvic pain
- Very heavy vaginal bleeding, especially with light-headedness or weakness
- Fever, chills, or feeling acutely unwell
- Unusual or foul-smelling vaginal discharge
- A positive pregnancy test with pain, bleeding, dizziness, or fainting
- A device visibly hanging from the vagina with significant pain or bleeding
Less dramatic symptoms still deserve a prompt appointment when they are new or persistent. Waiting for symptoms to become severe is not a safe way to determine whether an IUD has moved.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Copper IUD and hormonal IUS: what differs
“IUD” is often used as a general term. Copper devices are commonly called copper IUDs or copper coils, while hormone-releasing devices are often called IUSs or hormonal coils. Both can be expelled or sit low, and the need for an examination is the same.
Advice about emergency contraception and ongoing backup can differ by device type and by local recommendations. Tell the clinician exactly which device you have, when it was inserted, and whether you know its expiration date. Do not transfer instructions for one device to the other without checking.
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Common misunderstandings
“I cannot feel the strings, so the IUD must be gone.”
Not necessarily. Strings can curl upward or sit inside the cervical canal. Missing strings need checking, but they are not proof of expulsion.
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A change in length is a reason for assessment, not a reason to reposition the device. Pushing or pulling can injure tissue and makes the clinical situation harder to interpret.
“Any low-lying IUD has failed.”
A device in the cervix is treated as partially expelled. An asymptomatic device above the internal os is a different and less certain case. A clinician must weigh its location and your pregnancy priorities before deciding whether to remove or observe it.
“A home pregnancy test shows where the IUD is.”
A pregnancy test can indicate pregnancy but cannot locate an IUD or distinguish an intrauterine pregnancy from an ectopic one. Location requires clinical assessment and, when indicated, ultrasound.
What removal or replacement may involve
If the IUD is in the cervix, a clinician can generally remove it during an examination. You can discuss immediate replacement if you want continued intrauterine contraception and there is no medical reason to delay. If the device is low but above the internal os and you have no symptoms, the clinician may discuss observation, removal and replacement, or another method. The choice should account for the chance of pregnancy during any gap in contraception.
If the device cannot be found on examination or ultrasound, the clinician will explain whether further imaging is needed to distinguish expulsion from perforation. Do not schedule a replacement until its location and any pregnancy risk have been addressed.
Questions to bring to your appointment
- Is the device in the cervix, low in the uterus, correctly positioned, or not visible?
- Do I need a pregnancy test or ultrasound?
- Should I use condoms, and for how long?
- Was my recent sex protected, and do I need emergency contraception?
- If removal is recommended, can a replacement be inserted at the same visit?
- What symptoms should make me seek urgent care?
The key distinction is whether the device has entered the cervix. A cervical IUD is considered partially expelled and is generally removed by a clinician; an asymptomatic device that remains above the internal os requires individualized discussion. Until that assessment is complete, treat contraceptive protection as uncertain and avoid manipulating the device.
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