Intrauterine devices (IUDs) are popular and effective forms of birth control. Most IUDs stay in place after insertion, but some occasionally shift or fall out. This is known as expulsion.

Learn about IUD insertion and expulsion, and find information on the types of IUDs and how they work.

The IUD insertion process

The IUD insertion process usually takes place at a doctor’s office. Your doctor should discuss the insertion procedure and its risks before insertion occurs. You may be advised to take an over-the-counter pain reliever such as ibuprofen or acetaminophen an hour before your scheduled procedure.

The IUD insertion process consists of several steps:

  1. Your doctor will insert a speculum into your vagina.
  2. Your doctor will thoroughly clean your cervix and
    vaginal areas with an antiseptic.
  3. You may be given numbing medication to lessen
  4. Your doctor will insert an instrument called a
    tenaculum into your cervix to stabilize it.
  5. Your doctor will insert an instrument called a uterine
    sound into your uterus to measure the depth of your uterus.
  6. Your doctor will insert an IUD through the cervix.

At some point during the procedure, you’ll be shown how to find the IUD strings. The strings hang into your vagina.

Most people resume normal activities after the insertion procedure. Some doctors advise avoiding vaginal sex, hot baths, or tampon use for a couple of days after insertion to reduce the risk of infection.

What to do if your IUD is expelled

Expulsion occurs when your IUD falls out of the uterus. It may fall out partially or completely. It’s not always clear why an IUD is expelled, but the risk of it happening is higher during your period. If an IUD is expelled to any degree, it must be removed.

Expulsion is more likely for women who:

  • have never been pregnant
  • are younger than 20 years old
  • have heavy or painful periods
  • have the IUD inserted after an abortion during the
    second trimester of pregnancy

You should check your IUD strings each month after your period to make sure the IUD is still in place. You should contact your doctor right away if any of the following events occur:

  • The strings seem shorter than usual.
  • The strings seem longer than usual.
  • You can’t locate the strings.
  • You’re able to feel your IUD.

Don’t attempt to push the IUD back in place or remove it on your own. You should also use an alternative method of birth control, such as a condom.

To check your IUD strings, follow these steps:

  1. Wash your hands.
  2. While you’re sitting or squatting, put your finger into
    your vagina until you touch your cervix.
  3. Feel for the strings. They should be hanging through
    the cervix.

If your IUD has become partially dislodged or expelled completely, you may feel pain or discomfort. Other symptoms associated with expulsion include:

  • severe cramping
  • heavy or abnormal bleeding
  • an abnormal discharge
  • a fever, which may also be a symptom of an infection

About IUDs

An IUD is a small, T-shaped device that can prevent pregnancy. It’s made of flexible plastic and used for long-term pregnancy prevention or emergency birth control. Two thin strings are attached to help you make sure the IUD is in place and to assist your doctor with removal. There are two types of IUDs.

Hormonal IUDs, such as Mirena, Liletta, and Skyla brands, release the hormone progestin to prevent ovulation. They also help thicken cervical mucus, making it harder for sperm to reach the uterus and fertilize an egg. Hormonal IUDs work for three to five years.

A copper IUD called ParaGard has copper wrapped around its arms and stem. It releases copper to help prevent sperm from reaching an egg. It also helps change the lining of the uterus. This makes it harder for a fertilized egg to implant into the uterine wall. The ParaGard IUD works for up to 10 years.

Mirena vs. ParaGard vs. Skyla: Choosing the Right IUD


Cost of an IUD

Special considerations for IUD use

Common IUD side effects include spotting between periods, cramping, and back pain, especially for a few days after IUD insertion. Risk of pelvic infection increases for a few weeks after insertion. Less than 1 percent of IUD users experience uterine perforation, which is when the IUD pushes through the uterine wall.

In the case of ParaGard, your periods may be heavier than normal for several months after IUD insertion. Hormonal IUDs may cause periods to be lighter.

Some women shouldn’t get an IUD. Talk to your doctor if:

Sometimes, specific IUDs aren’t recommended if you have certain conditions. Mirena and Skyla aren’t advised if you have acute liver disease or jaundice. ParaGard isn’t advised if you’re allergic to copper or have Wilson’s disease.

Choosing the right birth control

You may find the IUD to be a perfect fit for you. However, after trying it, you may realize that it’s not exactly what you want. Talk to your doctor about all of your options for birth control.

When sifting through your options, you should consider the following factors:

  • Do you want to have children in the future?
  • Are you at risk of contracting HIV or another sexually
    transmitted disease?
  • Will you remember to take birth control pills daily?
  • Do you smoke or are you over the age of 35?
  • Are there negative side effects?
  • Is it easily available and affordable?
  • Are you comfortable inserting a birth control device,
    if applicable?

The takeaway

An IUD is one of the most effective forms of birth control. In most cases, it stays in place and you can forget about it until it’s time to have it removed. If it does fall out, use backup birth control and call your doctor to determine if the IUD should be reinserted. If you try the IUD and don’t feel it’s the best choice for you, talk with your doctor about other birth control options available to you.