Learn How to Check Your IUD Strings and Why That’s Important

An intrauterine device (IUD) is a convenient and highly effective form of long-acting, reversible contraception. IUDs are more than 99 percent effective at preventing pregnancy; they work by intercepting fertilization.

An IUD is a small, T-shaped piece of plastic inserted into the vagina, past the cervix, and placed in the uterus. IUD strings sit high in the vagina.

A copper IUD can last up to 10 years, while hormonal IUDs last three to six years, depending on the brand. IUD strings are not visible to you, but you can check them and ensure proper placement every so often. While the IUD is highly effective, one of its uncommon risks is expulsion from the uterus, or when it comes out slightly.

An out-of-place IUD can mean pregnancy is possible. Expulsion occurs in only 2 percent to 10 percent of IUD users within the first year of placement. Displacement is also more common within the first few months of insertion, so doctors may advise self-checking during this time.

A small 2017 study published in the International Journal of Gynecology & Obstetrics found that while a majority of clinicians counseled patients on checking IUD strings, some participants were uncomfortable self-checking or did not know what to feel for when checking. Each FDA-approved IUD brand recommends checking IUD strings, although complications from IUD insertion are rare.

Why do I need to check for IUD strings?

The device is likely in place when you can feel your IUD strings.

"IUD strings can be felt on a self-exam or visualized on a gynecologic exam. If they cannot be seen or felt, then that is considered out of place, so the IUD itself needs to have its position confirmed on pelvic ultrasound," explained Aldene Zeno, M.D., a fellowship-trained surgeon in urogynecology at the OB-Gyn & Incontinence Center in Arcadia and Glendale, California.

If you can't feel your IUD strings, it doesn't necessarily mean the IUD is out of place, but it is worth calling your doctor. A 2011 study published in the journal Contraception cited research indicating that up to 18 percent of users could not feel their IUD strings.&

Unlike tampon strings, IUD strings do not hang out of your vagina but are located higher in the vaginal canal, toward the cervix.

Steps for checking your IUD strings

"I recommend that people check their own IUD strings about once per month," Zeno said.

Checking after your period can be helpful. During your period, the cervix is located lower to help with blood flow.

"You could check once a month at the end of your period or if you feel strange cramps during your period," explained Sophia Yen, M.D., the CEO and co-founder of Pandia Health, based in California.

Some doctors advise patients to check every month for the first three months, Yen said.

"After washing hands with soap and water, place one or two fingers inside the vagina until you seem to reach the end or top," Zeno explained. "The cervix can be identified by feeling for something with a firmer texture, like the tip of the nose. The IUD strings exit from the cervical canal, which is in the middle of the cervix."

IUD strings may vary in length.

"They are about the consistency of fishing wire," Zeno said. "If they're short, you may feel the tips of them poking straight outward. If they're longer, they may be tucked around the cervix. If they can't be felt initially, try sweeping a finger around the cervix to see if they may be tucked away."

Tips for self-checking IUD strings

It can be helpful to find a comfortable position, such as squatting or standing on one leg and placing the opposite leg on the toilet, just as you might when inserting a tampon.

"It can also be helpful to use a hand mirror to help see where you are," said Emerson Karsh, a sex and kink educator and lecturer at Centre College in Danville, Kentucky.

The best advice to keep in mind when self-checking is that it's a preventive action, Karsh explained.

"Checking your IUD strings does not mean anything is wrong or that anything will go wrong. IUD checks allow you to be aware and in charge of your reproductive health," Karsh said. "Additionally, a good tip is to check your IUD after your period, as that is when your cervix is closer, so it may be closer."

If the IUD strings are hard to find during a self-check, it doesn't necessarily indicate a problem.

"For some, the strings dangling from the IUD can curl up on themselves," Karsh said. "The strings curl up just like any other flexible string. These curled strings may be resting against the cervix, which could make them more difficult to feel. The curled up strings can also be a bit harder to determine the length of the strings. Additionally, folds or vaginal tissue may also hide the strings."

To get a sense of what you might be looking for, you can ask to feel the IUD strings before the device is inserted or you can feel the leftover bits after the OB-GYN cuts the excess string, Yen added.

What should I do if I can't feel my IUD strings?

If someone with an IUD could feel their IUD strings before and now can't, it's a good time to call their healthcare provider, Zeno explained.

"Most commonly, the strings are in the right place and were missed for whatever reason. However, sometimes this can mean that the IUD is malpositioned or has fallen out. Typically, people experience sudden cramping and heavy bleeding if the IUD falls out," Zeno said.

Any new symptoms could warrant an appointment with your provider.

You should make an appointment if you have new, painful cramps after not having cramps with the IUD, Yen explained. Schedule an exam if you see the IUD fall out or you feel hard parts of the IUD instead of the strings, she added.

Self-checking IUD strings can help identify that your IUD is in the proper place. While expulsion is rare, self-checking can help ensure adequate placement between doctor's appointments.

If you experience new symptoms or have concerns about the placement of your IUD, it's worth scheduling an exam with your doctor.