The likelihood of your intrauterine device (IUD) becoming displaced is low, about 5 percent (and that feels worth the risk, for a birth control method 99 percent effective when it’s in place). So why do I know dozens of women who have suddenly been able to feel their IUD when they sit cross-legged, whose IUDs have fallen into the toilet, whose IUD rejected during sex and cut their partner’s penis, who have taken an IUD out thinking it was a tampon, and who have become pregnant with an IUD inserted? I thought I’d found my “perfect” birth control method with a Paraguard; I realized there’s no such thing.

The warning signs of a displaced IUD

Alden decided to go on birth control for the first time in her junior year of college, just before a summer spent interning across the country. She wasn’t sure she would remember to take a pill every day and had heard “weird things” about the implant. A five-year Mirena IUD seemed like the right move and her doctor agreed. She had no issues with insertion and while health professionals recommend a check-up after six weeks, she would already be in San Francisco. That’s no biggie, they said. Just check for the strings.

“I was spotting for a month and using panty liners all the time. They were getting really annoying and chafing,” Alden said. “I thought a DivaCup would be great for light spotting and not going to dry things out like a tampon would. No one told me that would be a problem. But that’s where things got kind of weird.”

Over the next months, Alden experienced cramping and a heavier flow. Signs of her period, right? Maybe not. Massachusetts OB-GYN, Dr. Nina M. Carroll identifies displacement warning signs as unusual bleeding, cramping or persistent pelvic pain, and touching something firm at the cervix while conducting a self-exam. Alden tried to check the strings but wasn’t exactly sure what she was feeling for. Back at school in the fall, she followed up. Oh no, the doctor said. We can’t find it.

How to treat a displaced IUD

In this case, an ultrasound and x-ray were necessary to ensure the IUD hasn’t migrated elsewhere in the body. Dr. Michael Tahery, L.A.-based OB-GYN, has been placing IUDs for 25 years and only seen two fall out. One patient had a distorted uterine cavity with larger than normal fibroids, and a hemorrhagic episode (heavy bleeding, essentially) expelled the device. The second patient came in with an IUD placed in another country that, like Alden’s, was missing. An x-ray showed the device inside the patient’s abdomen, meaning it had perforated the uterus. Tahery had to go in through her belly button to extract it.

“The real issue with migration is that she now requires a surgical procedure, which requires anesthesia and so on. And she could be thinking that she’s protected but she’s not,” Dr. Tahery said. Pregnancy with an IUD happens and it’s scary.

Alden’s x-ray, on the other hand, found nothing. Everyone thinks the IUD fell out when she removed her DivaCup, but how can you be sure if you never saw it happen? It’s a surreal feeling to not know where this thing inside your body went. Studies show that there is in fact little correlation between IUD expulsion and the use of menstrual cups. As Dr. Alice Byram explains, if both devices are placed and used properly, the menstrual cup should not be touching the strings (but you can always ask your doctor to trim the strings if you’re worried). “Since menstrual cups rely on suction to prevent leaks when removing the cup, it is important to release the suction-created seal on the cup before removing it,” she says. This is true whether or not you have an IUD.

“My body probably just didn’t want that in me. It tried to get rid of it and it did,” Alden said. She never got a new IUD inserted. “The prohibitive cost of devices means you can’t try them out like you can try different pill options. Like, ‘Oh, this birth control pill is making me really moody. Let me try a different formulation of it. I wish it didn’t feel like you have to make a commitment and if it doesn’t work out it’ll be $500 down the drain.”

How to prevent displacement

Dr. Tahery emphasizes that placement is the single most important factor for an IUD that does its job. “The ideal scenario is to get a check-up beforehand and do an ultrasound to make sure the cavity of the uterus is healthy. Then have the IUD placed with local anesthetic so there’s not much pain and more control for the physician. Try to reduce any high-impact activities for a couple weeks so the cervix contracts down and holds the IUD in. After a couple of weeks, come back for another ultrasound. Then, if the IUD is verified to be where it’s supposed to be, the chances of that IUD falling out are almost zero.”

Tell your physician as much as you can about your gynecological history. Placement is more difficult if you’ve frozen precancerous cervical cells, if you’ve recently given birth or experienced a second trimester abortion, if you have large fibroids or if you have a small uterus. I used to rave about IUDs to anyone who would listen, in large part because they seemed maintenance-free. One quick doctor’s visit and you’re good for up to 10 years? Science is magic! Turns out that not only do IUDs need a little more planning and a few more office visits, they aren’t for every woman’s body. That’s more than okay.

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