Here’s Everything You Need to Know About IUD Expulsion, According to a Gynecologist

After combing through research, asking your friends for recommendations and sitting down to have the convo with your doctor, you finally came to the (very responsible) decision that an IUD was the right form of birth control for you. It’s 99 percent effective and is basically the countertop rotisserie of contraceptives: you “set it and forget it” for up to 12 years. But there was one very alarming side effect you came across that you can’t get out of your head: IUD expulsion (which sounds pretty scary). Try not to freak out and read on to learn all about it instead.

To be clinical about it, “IUD expulsion is when the IUD comes out of the uterine cavity on its own,” says Raquel Dardik, M.D., a gynecologist and clinical associate professor of obstetrics and gynecology at NYU Langone Health. Dr. Dardik says that an IUD becomes “expulsed,” or driven out, when it moves on its own, instead of being purposefully removed by a doctor. The only way an IUD is supposed to budge from the spot in your uterus where it’s originally implanted is if your doc goes in and removes it herself.

Frustratingly, “the cause is unknown,” according to Dr. Dardik. It might be your body’s reaction to a foreign object, like that time you got your cartilage pierced and your ear got rid of that stud real quick. But it’s hard to tell for sure why this happens because so few women experience it—less than one percent, according to our doc.

Unlike the insertion process, which could come with a good amount of pain, some cramping and even a little bleeding, IUD expulsion usually isn’t a painful process and sometimes, you can’t even tell it’s happening. If you have an IUD, you’re supposed to periodically “check the strings,” Dr. Dardik says—referring to the strings attached to the bottom of the IUD that dangle outside your cervix—by inserting your fingers into your vagina. If they’re there, you’re good to go. Can’t find them? It’s time to make an appointment with your doctor so she can give you an ultrasound and tell you for sure that it’s on the move.

If your doctor confirms that your IUD is, unfortunately, expulsed, she will have to remove it completely because when it moves out of place, an IUD can’t do its job of keeping you baby-free. “If the IUD is completely out, or even partially expulsed, then its efficacy is decreased,” Dr. Dardik says, meaning it’s not reliable. “Then we take it out and can discuss other contraceptive options if you don’t want to try an IUD again.”

You might be able to get a new IUD implanted right after the first one is removed—if you want to give an IUD another chance—but that’s totally your and your doctor’s call and relies on a number of things, like if you’re experiencing heavy bleeding or pain.

While this whole process sounds like no picnic, don’t let it put you off of one of the most effective and dependable forms of birth control available to you—plus, you can’t mess it up, like forgetting to take your pill. There are no repeated trips to the pharmacy (or repeated payments) and when or if you decide to get pregnant, you can have it removed and start trying right away. Until then, just remember to check the strings.