“A correctly positioned IUD should be located at the fundus of the uterus, with the arms fully expanded and extending toward the uterine cornua. The vertical portion of the “T” should extend straight down in the uterine corpus. When noted on US, malpositioned IUDs may be described as:
· located in the lower uterine segment or cervix
· embedded in the myometrium
· partially expelled (if an IUD is low enough in the cervix that the hub extends through the external os), or
· protruding through the uterine serosa or completely outside the uterus and within the abdominal cavity. (This is how a perforated or partially perforated IUD may be described.)
What damage can IUD malpositioning cause?
For many women, a malpositioned IUD may have minimal or no adverse consequences. The most common negative sequelae of women with a malpositioned IUD, however, include an increase in bleeding or pain, compared with women with fundally positioned IUDs.
The bowel can suffer, though on rare occasion. The rarest, though most serious form of IUD malpositioning, is the IUD that has perforated the uterine corpus and is intraperitoneally located. Studies suggest that approximately 15% of these perforated IUDs cause injury or damage to surrounding organs, primarily the bowel. Management of intraperitoneal IUDs generally involves laparoscopy or laparotomy for removal and exploration of the surrounding structures.
What about risk of pregnancy?
“For the asymptomatic patient, your biggest concern often is whether a malpositioned IUD poses an increased risk of pregnancy. Though data are limited, the available literature suggests that malpositioned, specifically cervically located, copper IUDs may pose an increased risk of pregnancy.
Think your IUD may have expelled? Here’s what to do.
1. Stay calm. It isn’t pleasant or convenient, but expulsion is a potential risk when you have an IUD inserted. If you are in a lot of pain or feeling confused, take a deep breath. Stressing out may make you feel worse and make it harder for you to stay calm enough to get the care you need.
2. Double check. Being able to feel your IUD strings is totally normal (here’s a handy how-to). But if you can feel the hard plastic protruding from your cervix, the IUD isn’t where it’s supposed to be. For some people, it may be less noticeable if the IUD has expelled. It’s definitely a good idea to make an appointment with your provider if you have any of the following symptoms: severe pain and cramping; heavy or abnormal bleeding; abnormal discharge; and/or fever. (This may also be a sign of infection.) Some discomfort in the first few days after insertion is normal, but if the pain intensifies or persists, it may be time to see your provider.
3. Take care. If you’re experiencing a lot of pain while the IUD is out of place, make sure to take extra care of yourself. Try to wait to have sex until you are able to meet with your provider. Plus, if the IUD isn’t where it’s supposed to be, you may not be protected from pregnancy. If you still want to go for it, make sure to use a back-up birth control method.
4. Call your provider. If you think your IUD is out of place, call your health care provider asap and ask for an appointment. You definitely want to talk to them if you have severe pain, cannot find your strings, notice the strings are shorter or longer than normal, or can feel the IUD poking out. Getting in to see your provider might not be the easiest or the most convenient, but even if you’re not totally sure your IUD has been expelled, it’s worth it to take care of your health and make sure you’re covered against accidental pregnancy. If you just had the IUD inserted, a routine check-up after six weeks is a good idea anyway to make sure everything is a-okay.”