Most often these occur during or soon after insertion and are related to the skill of the inserter and the care with which the risks of using an IUD have been assessed.
Explusion Contractions of the uterus can sometimes push an IUD partly or completely out through the cervical canal into the vagina. This is most likely to happen soon after insertion, especially if the device was inserted during menstruation. Subsequent expulsions are most likely to occur during a period. Sometimes expulsion may not be noticed. This is why women are advised to check pads and tampons, and at the end of each period to feel for the strings at the cervix.
The expulsion rate varies from 5 to 20 per hundred in the first year of use. Different rates depend mainly on the size and type of device used, the size and shape of the uterus and whether the IUD has been correctly inserted.
Lost strings Sometimes the strings can’t be felt or seen at the cervix, even though the IUD may still be in the right position in the uterus. There are several reasons why this may occur.
• The woman may be pregnant. As the uterus enlarges (even slightly) the strings are drawn up through the cervical canal.
• The IUD may have been expelled. If it’s still in place it can usually be felt with a uterine sound. Ultrasound examination will confirm whether the device is missing or still in place.
If the IUD is still in the right place, it may be easy to bring the threads back into the vagina. If not, you must decide with your doctor whether or not the IUD should be removed.
Perforation
The uterus may be perforated by the device (though the risk is very small) if the position and direction of the uterus were misjudged during the pre-insertion examination. It is also more likely to happen if the device is inserted soon after giving birth, especially if the woman is breastfeeding.
Perforation needs immediate action. If the IUD is not entirely inside the uterine cavity (that is, has gone partly through its wall), it won’t work properly. If the device has gone right through into the abdominal or pelvic cavities, it should be removed.
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