Management of Non-Visible IUD Strings

Initial Assessment and Management

If IUD strings are not visible, perform or refer for ultrasound examination to determine the location of the IUD, as the device may still be in the uterus, may have been expelled, or may have perforated the uterine wall 1
If the IUD is properly positioned and the patient is asymptomatic, the device can remain in place 1
Advise the patient to return promptly if she develops heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 1

The CDC recommends removal of a malpositioned IUD without requiring updated ultrasound if previous imaging confirmed malposition and the patient has persistent symptoms 2
Remove a malpositioned IUD as soon as possible if it is low-lying, extending into the cervix, or embedded in the myometrium, especially when associated with pelvic pain 2
An IUD that has perforated the uterus must be removed as soon as possible 3
Counsel the patient about alternative contraceptive methods if the IUD is removed 2

Advise the patient to seek immediate care for heavy bleeding, severe cramping, pain, abnormal vaginal discharge, or fever 1, 2
Discuss alternative contraceptive options if the IUD is removed 2
Schedule follow-up to ensure symptom resolution and discuss future contraceptive plans 2