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If an intrauterine device (IUD) slips into the cervix, becomes partly visible, or comes out, it may no longer provide dependable contraception. Arrange a prompt check with a sexual-health clinician, gynecologist, or other qualified clinician; use another contraceptive method until its position is confirmed; and do not pull on the strings or push the device back. Missing strings do not prove expulsion, because they can curl upward, but they do warrant assessment when their usual length or feel has changed.
What “moved” and “partially expelled” mean
An IUD (including a copper IUD) or hormonal intrauterine system (IUS) is intended to sit inside the uterine cavity. A partial expulsion occurs when part of the device passes down through the cervix. If the device comes completely out, it has been expelled. A device that sits lower than expected but remains entirely above the internal opening of the cervix is described as low-lying; that is not automatically the same as partial expulsion.
Position cannot be diagnosed reliably from symptoms alone. A device felt in the vagina or cervix, a new change in thread length, or new bleeding or cramping can be a clue, but each can have other explanations. Examination, and sometimes ultrasound, establishes where the device is.
Signs that should prompt a position check
What you may notice
- You can feel hard plastic at the cervix or in the vagina, or you can see part of the device.
- The threads suddenly feel much longer, much shorter, or different from their usual position.
- You cannot feel the threads at all. They may have curled into the cervical canal or uterus, but the device may also have moved, been expelled, or (rarely) perforated the uterine wall.
- New or persistent pelvic pain, cramping, bleeding between periods, or bleeding after sex.
- A positive pregnancy test or symptoms that could indicate pregnancy.
These findings are reasons to contact a clinician rather than a diagnosis of displacement. NHS guidance for both copper IUDs and hormonal IUS devices advises using another method until missing or changed threads have been checked, because contraceptive protection may be uncertain.
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Why the exact location changes management
Device in the cervix
The American College of Obstetricians and Gynecologists (ACOG) classifies an IUD located within the cervix as partially expelled. Its clinical guidance recommends removal by a clinician. If you still want an IUD, a replacement can be discussed after removal and an assessment of your circumstances.
Device low in the uterus but above the internal os
A device that is low-lying but remains above the internal cervical opening is a different clinical problem. For an asymptomatic patient, ACOG says the best management is less certain. The decision may depend on the device type, its measured position, symptoms, pregnancy priorities, and whether an alternative contraceptive can be started immediately. Shared decision-making is important because removing a device without promptly starting another effective method can itself create a pregnancy risk.
Some devices identified as low soon after insertion move toward the uterine fundus during the following months. That observation does not make it safe to ignore new symptoms or to assume a device is correctly positioned without an examination.
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- Contact a clinician promptly. Call the service that inserted the device, a sexual-health clinic, gynecology service, primary-care clinician, or another qualified provider. Explain whether you can see or feel the device, whether the threads changed, your symptoms, and when the change began.
- Use backup contraception. Condoms or another reliable method can reduce pregnancy risk while the position is unknown. Follow the clinician’s advice about when your regular method can be relied on again.
- Ask about emergency contraception if relevant. If you had sex recently without reliable contraception, contact a clinician or pharmacist as soon as possible. The suitable option depends on timing, whether the device is copper or hormonal, your medical history, and local guidance.
- Leave the device alone. Do not pull on the threads, grasp the device, or attempt to push it upward. Removal and any replacement should be performed by a trained professional.
- Record useful details. Note the date of insertion, the last time the threads felt normal, bleeding or pain, intercourse without backup, and any pregnancy-test result. This helps the clinician decide how urgently to examine you.
How a clinician checks an IUD that may have moved
History and pregnancy testing
The clinician will ask about insertion, symptoms, thread changes, intercourse and pregnancy possibility. A pregnancy test is commonly used when pregnancy is possible or the device cannot be located.
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Speculum and pelvic examination
A speculum examination can show whether the threads are present and whether the device is in the cervical canal. If the device is visible or safely reachable, the clinician can discuss removal. Do not try to make it reachable yourself.
Ultrasound when threads are absent or the position is uncertain
If the threads are not visible and the device cannot be safely retrieved, the U.S. Centers for Disease Control and Prevention (CDC) 2024 Selected Practice Recommendations say: “If ultrasonography is available, consider performing or referring for ultrasound examination to determine the location of the IUD.” Ultrasound can show whether the device is inside the uterus, low in the cervix, or not seen. If it is not located, clinicians consider expulsion and, less commonly, perforation; further imaging or evaluation depends on the findings.
If a pregnancy test is positive
Seek prompt medical advice rather than waiting for a routine appointment. Pregnancy with an IUD is uncommon, but an ectopic pregnancy must be considered because it can be life-threatening. ACOG advises immediate evaluation, and CDC guidance directs clinicians to assess for ectopic pregnancy.
For an ongoing pregnancy, CDC guidance recommends removal when the threads are visible or the device can be safely retrieved from the cervical canal. If the threads cannot be safely retrieved, ultrasound may be considered to determine the device’s location. These are clinician-management recommendations, not instructions for self-removal. The plan also depends on your pregnancy intentions and the risks and benefits discussed with your clinician.
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When symptoms require urgent care
Use your local urgent-care or emergency pathway for any of the following:
- Severe, sudden, or worsening lower-abdominal or pelvic pain.
- Very heavy bleeding, faintness, or weakness.
- Fever, chills, or unusual or foul-smelling discharge.
- A positive pregnancy test, suspected pregnancy, shoulder-tip pain, dizziness, or fainting.
- A device that is hanging from the vagina or causing intense pain.
These symptoms can indicate complications such as infection, significant bleeding, perforation, or ectopic pregnancy and should not wait for a standard appointment.
Copper IUD and hormonal IUS: what differs
NHS patient guidance uses separate advice for copper IUDs and hormonal IUS devices. The immediate response to missing or changed threads is similar—assume protection may be uncertain and arrange a check—but emergency-contraception choices and timing can depend on which device you have. Tell the clinician the exact device type if you know it; your insertion record can help if you do not.
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|---|---|
| Threads visible and device in the cervical canal | ACOG considers this partial expulsion; a clinician generally removes it and discusses replacement. |
| Device low but above the internal os, no symptoms | Management is less clear; location, device type, pregnancy priorities and shared decision-making guide the plan. |
| Threads missing or not safely retrievable | Missing threads do not prove expulsion. Ultrasound may be used to locate the device; clinicians also consider expulsion or perforation if it is not seen. |
| Pregnancy confirmed | Prompt evaluation for ectopic pregnancy is required; safe removal is considered when the device is visible or retrievable. |
What is known about risks and frequency
ACOG’s patient information reports that uterine perforation occurs in about 1 in 1,000 IUD placements. That figure refers to perforation during placement; it is not an expulsion or displacement rate and cannot predict what happened in an individual case.
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The available guidance does not provide a single current displacement rate that can be responsibly applied to every device, age group, or setting. Risk varies with factors such as insertion circumstances, time since placement, uterine anatomy and postpartum timing. A clinician can interpret your situation from the examination and imaging rather than from a population percentage.
Common misconceptions to avoid
“Missing strings mean the IUD fell out.”
Not necessarily. Threads can curl upward or sit inside the cervical canal. A device that is still inside the uterus can therefore have no palpable threads. Conversely, a missing-thread finding can occur after expulsion or, rarely, perforation, so checking is important.
“Any low-lying IUD has failed.”
A device in the cervix is treated as partially expelled, but an asymptomatic device above the internal os is a separate situation. Do not assume either failure or safety without professional assessment.
“I can fix it by pushing it back.”
No. Repositioning or pulling can injure tissue, introduce infection, or leave fragments behind. Only a trained clinician should remove or replace the device.
“Pain proves exactly where it is.”
Pain and bleeding can accompany displacement, but they also occur with infection, pregnancy, menstruation and other gynecologic conditions. Symptoms indicate the need for evaluation, not the precise location.
Questions to prepare for your appointment
- When was the IUD or IUS inserted, and was it a copper or hormonal model?
- When did you last feel the threads at their usual length?
- Can you see or feel plastic, or only a thread change?
- Have you had pain, bleeding, fever, discharge, or a positive pregnancy test?
- When was your last intercourse without dependable backup contraception?
- Do you want to continue with an IUD, change methods, or avoid pregnancy immediately?
Bottom line
An IUD in the cervix is considered partially expelled and usually needs clinician removal; a low-lying device that remains above the internal os requires an individualized decision. Missing or changed threads are clues rather than proof of expulsion. Until a clinician confirms the position, use backup contraception, ask promptly about emergency contraception if recent sex creates a risk, and never pull on or push the device. Severe pain, heavy bleeding, fever, unusual discharge, or possible pregnancy needs urgent medical attention.
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