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Photography by Megan Madden; Prop Styling by Sara Schipani

If you have an intrauterine device (IUD), you may have heard horror stories about it moving around (displacement), or worse — falling out completely (expulsion).

This may have led you to wonder whether anything you put inside your vagina has the potential to pull out your IUD.

Naturally, people tend to be concerned about period products — particularly tampons.

But although both tampons and IUDs enter the body in the same way, they don’t end up in the same place and shouldn’t affect each other.

Here’s everything you need to know about safely using tampons if you have an IUD.

According to Dr. Elle Rayner, an obstetrician, gynecologist, and the founder of The Maternity Collective, people with an IUD can “absolutely” use tampons.

“Your IUD sits inside the uterus, whereas a tampon is inserted into the vagina, so neither will interfere with each other,” Rayner explains.

But it’s best to avoid using tampons immediately after your IUD is inserted.

“You’re advised to use pads for 48 hours [after],” says Dr. Deborah Lee, a sexual and reproductive healthcare specialist at Dr Fox Online Doctor and Pharmacy. “You shouldn’t insert anything into the vagina during this time to minimize the risk of infection.”

Most healthcare professionals agree that tampons shouldn’t be used until at least 4 weeks after IUD insertion.

It’s “very rare” for people to report dislodging an IUD with a tampon, notes Lee.

And there isn’t much research into it either.

What’s believed to be the first study in this area found no evidence between tampon use and higher rates of early IUD expulsion.

In 2019, further research found no association between concurrent tampon use and IUD expulsion.

However, more research is needed to fully explore the potential effects of period products on IUD placement.

Of course, other factors can make expulsion more likely, says Lee, including:

  • having heavy, painful periods
  • not having delivered a baby vaginally
  • insertion immediately after a surgical abortion or delivery of a baby
  • the skill of the inserter

There isn’t much evidence — either anecdotal or scientific — to prove that tampons can cause IUDs to move around or fall out.

But theoretically, the only way this could happen is if you accidentally catch the strings of the IUD when pulling out your tampon.

Your IUD strings shouldn’t be long enough for this to be an issue, though.

Plus, your tampon strings hang outside your body, meaning you shouldn’t have to reach inside to remove it.

If your tampon doesn’t have a string, take care to only pull at the portion of the tampon closest to the vaginal opening.

Before booking an appointment for IUD insertion, it’s a good idea to speak with your doctor about any period-related concerns.

For example, your doctor can help you choose the best type of IUD for your body.

Hormonal versions tend to make periods lighter or stop them completely, meaning you may not need to use certain period products as much or at all.

Doctors can also recommend alternative menstrual products if you have a tilted uterus.

Although it’s perfectly possible to use tampons with a tilted uterus, some people find them difficult to insert.

Don’t forget to let your IUD inserter know which period products you’re likely going to be using, too.

“They may recommend trimming the [IUD] strings a bit shorter to reduce the chance of displacement,” Rayner says.

In the first few weeks after IUD insertion, “there’s a slight increased risk of vaginal infections,” Rayner says.

To reduce the risk of infection, many experts advise avoiding tampons for the first month.

Depending on the timing of your periods, this may mean you’ll need to use different products like pads for your first period after getting an IUD.

Lee also notes that “it may be sensible to delay using tampons” until after your IUD follow-up appointment.

This is generally recommended 6 weeks after insertion, as “the highest risk of the IUD being expelled is in the first 6 weeks after fitting,” Lee explains.

Checking that you can still feel your IUD strings after each period will help reassure you that your IUD is still in place.

As your cervix can change position throughout your menstrual cycle, it’s also a good idea to feel for the strings at different times of the month so you get to know where they are.

Of course, if you’ve had your strings cut short, this may be difficult.

Below, Lee explains how to check the strings are still in place:

  1. Wash and dry your hands. Remove your underwear and sit down comfortably on a chair, or the edge of a bed.
  2. Insert your second and third fingers in your vagina and feel downward and backward, then upward and round the bend, and you should find your cervix. (It’s hard and rubbery, and said to feel like the tip of your nose.)
  3. Feel for the strings. The IUD threads feel like pieces of fishing twine — hard and metallic. Don’t worry about whether you can feel one thread or two. As long as you feel them and they seem the usual sort of length, that’s all you need to know.

The easiest way to know if your IUD has fallen out is if you notice it. It could fall in the toilet, for example.

“The worst case scenario is an unnoticed expulsion,” Lee says. “If you’re really unlucky, the first you know about it is a shock positive pregnancy test.”

That’s why checking the strings after each period is vital.

(If the entire IUD has dislodged, you may even be able to feel the coil protruding from the cervix.)

“If you’re worried you can’t feel your strings, or you feel [the IUD] may have become dislodged or fallen out, it’s important you get checked to confirm straight away,” Rayner says.

“If you’re using an IUD for contraception and you have had unprotected sexual intercourse, you may need emergency contraception,” she adds. “If it’s incorrectly placed, or not in situ, you could be at risk of unplanned pregnancy.”

You should also use an alternative method of contraception until a healthcare professional has checked your IUD.

Try not to panic if the above happens.

“Most often, the threads will be there,” Lee says. “They may have tucked themselves around the cervix and are lying flush with the surface, so [may] just not be very easy to feel.”

According to Lee, “if the threads can’t be found, [the doctor] will send you for an ultrasound scan to see if the coil is in the uterine cavity.”

But, she says, “if this is the case, the IUD can be left alone until time for removal.”

In rare cases, Lee continues, “absent coil threads mean the IUD has perforated, meaning the device has passed through the wall of the uterus and into the pelvic cavity. You’ll need a laparoscopy — keyhole surgery — to remove it.”

If you’re uncomfortable with the idea of using tampons, there are plenty of other period products on the market.

Some people find menstrual cups and discs more comfortable than traditional tampons.

But one recent study did find a potential link between menstrual cup use and IUD expulsion.

Therefore, the only “risk-free” products are ones that don’t require insertion, such as pads and period underwear.

Although it’s theoretically possible for a tampon to dislodge or pull out an IUD, cases are extremely rare. So there’s really little need to worry.

If you’re concerned, just remember to check your IUD strings each month.

And if it makes you feel more comfortable, use other period products when your period comes around.

Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraines, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.