My strings were tough to feel, they were up there and my fingers are fat and don't reach well. I could feel the very tips of the strings the day before my period and a few days after. Now, I can't find them at all. I can't get high enough to. It's possible I'm ovulating but I haven't gotten my period again since I got Mirena so I don't know my schedule for it. I've had some super light cramping, like some uncomfortable mild and dull cramps for short time spans the past few days. Haven't happened very often really, might just be normal cramping after insertion. Anyway, I'm just wondering, should I have reason to be concerned that my IUD is out of place, or might this just be really normal since its probably around time for me to start ovulating (my period would be 16 days away now if my cycle is 28 days)? I'm not sexually active at this moment. Just curious if I should be prepared to hear it expelled at my follow up in a month.
If you cannot locate your strings, the next step is to call your doctor and have him/her perform an exam to locate your IUD strings.
Two of the most straightforward reasons for missing IUD strings: The IUD has come out of the uterus, or the IUD has become perforated during insertion. This means that the IUD has been pushed through the uterus wall. Generally, this is quickly discovered and can be corrected right away. If either of these situations happens to you, make sure to use a backup method to protect against pregnancy because the IUD will not be of much help.
Another scenario that can cause the IUD strings to be pulled back up into the uterine cavity is if you are experiencing some type of enlargement/swelling in your uterus. This may be due to fibroids or pregnancy. If this has occurred, the IUD is still in the uterus, but further investigation would be needed. So, most doctors would try to locate the IUD and/or rule out pregnancy by using an ultrasound.
The good news is if the ultrasound reveals that the IUD is in its proper position (within the uterus), you can continue to use it for contraception even though you cannot locate the IUD strings. If you are in this situation, doctors recommend that you have an ultrasound once a year for the first few years (when you are more at risk for expulsion), just to make sure your IUD is still there.
There's also the chance that the IUD is still in the correct position, yet for whatever reason, the IUD strings have coiled and bent back into the passageway between your cervix and your uterus (known as the endocervical canal). The strings could have also broken off.
It's also possible that the IUD may have rotated either during or after insertion. This turning around could cause the IUD strings to retract up higher in your body. If this is the case, the good news is that the IUD is still working and is in place; the issue is just with the IUD strings.
How IUD May Be Located and Recovered
As long as it is determined that you are not pregnant, doctors have several ways to try to recover your IUD strings.
Doctors are going to use a special brush called a cytobrush (that looks like a long mascara brush) to try to maneuver out the IUD strings. This usually works, but if attempts are unsuccessful, doctors may use various tools to dilate (open) the cervix, measure your uterus, and obtain a precise view of the endocervical canal. Doctors can then determine if the IUD may be in the process of expulsion. If this is the case, the IUD strings tend to become more visible. But, to complicate matters, the strings can also become twisted and out of view. If it has been determined that the IUD has been partially expelled into the cervix, the doctors will typically remove the IUD and can replace it with a new one on the spot, if you’d like.
At last, if all of these attempts fail to locate the IUD, (from untwisting the IUD strings to ultrasound), doctors may conduct X-rays of your abdomen and pelvis. If your IUD does not show up on the x-ray film, expulsion can be confirmed. At this time, you can also get a new IUD inserted if you wish. If your x-ray reveals that the IUD is located outside the uterus, perforation has happened. This would need to be corrected as soon as possible before possible damage occurs to adjoining areas.
The only other way to definitively detect IUD expulsion is if you actually experienced your IUD coming out. This will typically happen during the first few months of IUD use. Your IUD is most likely to slip out of place during your period, so check your pads and tampons to confirm that your IUD has not been expelled.
Sources
Pocius KD, Bartz DA. Intrauterine contraception: Management of side effects and complications. Eckler K (Ed.) In:UpToDate. 2017.
Prabhakaran, S. and Chuang, A. In office retrieval of Intrauterine contraceptive devices with missing strings." NIH/Contraception/ University of North Carolina 2011.