Soon after Melinda Nichols delivered her youngest son in 2007, she decided to get an intrauterine device (IUD) to prevent future pregnancies. But when Nichols returned to the doctor for a checkup just a few weeks after having the device implanted, the Ohio mom was told her IUD was nowhere to be found.
Nichols’ doctors told her the device must have been expelled from her body without her knowledge, according to an article in the New York Post. So imagine her surprise when, more than a decade later, the tiny T-shaped device reappeared in a completely unrelated X-ray of her midsection—all the way in her upper abdomen.
“It’s been in me 11 years,” Nichols wrote in a Facebook post that’s now been shared more than 50,000 times. “The doctors told me it fell out.” The post includes a photo of the X-ray with the outline of her IUD circled in red. A lower yellow circle indicates where the IUD should have been.
Nichols told the Post that the IUD was spotted on an X-ray while she was receiving treatment for a strained muscle in her back. (A doctor told Nichols she needed to call her ob-gyn because her IUD was “in a weird spot,” according to the newspaper.) Had she not had an X-ray at that time, “there’s no telling how long she may have kept going with the IUD missing inside her body,” the article states.
Well, that’s certainly disturbing. But before you start worrying about your own IUD—or swear off the idea of ever getting one—it’s important to know that this type of thing is extremely rare. To learn more, Health spoke with Christine Greves, MD, an ob-gyn with Orlando Health System in Florida. Dr. Greves did not treat Nichols, but she does see lots of patients with IUDs—including a few that have dislodged or migrated. Here’s what she wants everyone to know.
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IUD migration is rare, but it can happen
The failure rate of IUDs is very low. For every 1,000 women who receive one, only about four women on average will have a problem with their IUD not staying put and working the way it’s supposed to, according to the CDC.
Very rarely, an IUD can perforate the uterine wall and make its way out of the uterus and into the abdominal cavity—a phenomenon that was first described in the 1930s and has an incidence rate of about one in 1,000. This scenario has also been called the “wandering IUD” or the “ectopic IUD.”
It was originally thought that uterine contractions were responsible for IUDs migrating to other parts of the body. But according to a 2017 review in the Open Access Journal of Contraception, it’s now believed that it’s much more common for IUDs to be “forced into or through the uterine wall at the time of insertion,” sometimes by inexperienced physicians.
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Yes, IUDs can fall out
IUDs can also become dislodged and make their way out of the body—also known as expulsion. This is also rare, but it is most likely to happen during a woman’s period. If this happens, women might find their IUD when they remove their tampon or change their pad. It could also be flushed down the toilet without a woman noticing at all.
If an IUD becomes partially expelled, it may become lodged in the cervix or vaginal canal—which can cause pain, discomfort, or heavy bleeding. Instead of trying to move the device back into place yourself, call your doctor right away.
If your doctor can’t find your IUD, you need further testing
After an IUD is inserted, a woman should see her doctor the following month for a “string check,” says Dr. Greves. Her doctor will feel for the two strings that hang down from the bottom of the IUD to ensure that it’s still in its proper place in the uterus. (Women can check themselves by feeling for these strings every month, but they may not always be able to find them.)
“If a woman comes back and we can’t feel those strings, we perform an ultrasound,” Dr. Greves explains. “And if we still don’t see it on an ultrasound, and the patient doesn’t remember it falling out, an X-ray can usually find it if it’s made its way to the abdominal cavity.” As for Nichols, it’s not clear why her doctors didn’t see her IUD on her X-ray back in 2007, and she told the Post that she never went back to that office to ask about what happened.
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A misplaced IUD may cause health complications
It’s possible for an IUD that migrates to the abdominal cavity to stay there for years without being noticed or causing any harm, says Dr. Greves. (In one case in the scientific literature, a woman’s missing IUD wasn’t found for 43 years!) “But other times, if it’s entangled in the bowel or it’s near a vital organ, for example, that can be a concern,” she adds.
It’s also possible that an out-of-place IUD could cause scar tissue to form around it or trigger an infection. It could also continue to release chemicals into the body for longer than intended, says Dr. Greves—although the level of hormones released by these devices decreases every year, so that may not be too big of a concern. (That’s why the Mirena IUD, for example, must be replaced after five years.)
Nichols, by the way, is fine: She underwent laparoscopic surgery—involving a tiny incision and a small camera to guide doctors—to locate and remove her left-behind IUD. She says she occasionally had strange stomach pains over the last decade (which may or may not have been related to her IUD), but otherwise had no symptoms that something was amiss.
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Consider the risks and the benefits
Even though she knows IUD migration is a (very slim) possibility, Dr. Greves is still a huge proponent of this method of birth control. “Everything in medicine is risks versus benefits versus alternatives, and it’s important people know that the benefits of IUDs far exceed the risks for most women,” she says.
IUDs are highly effective at preventing pregnancy and, unlike oral contraceptives, you don’t have to remember to take a pill every day or pick up your prescription from the pharmacy every month. IUDs may also come with other perks, like fewer cramps and lighter periods.
Plus, says Dr. Greves, IUD usage has gone up in recent years—which means that doctors have become more experienced with insertion and more familiar with their usage. “We have more strategies in place to deal with complications,” she says, “and to make sure that women are having a good experience and making the best choice for them.”
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