Partial or unnoticed expulsion may
irregular bleeding and/or pregnancy
Factors contributing to expulsion:
- Provider's skill at placement of IUD at the top
of the uterine cavity
- Age and parity of woman
- Time since insertion
- Timing of insertion
The expulsion of an IUD is not in itself a medical complication.
However, a partially expelled device could result in irregular
bleeding. Further, an expelled or partially expelled IUD that
goes unnoticed leaves the client believing she is protected
from pregnancy when she is not. Providers should understand
the factors that can contribute to the risk of an IUD being
Several factors influence expulsion rates, including the skill
of the provider, the womans age and parity, the length
of time since insertion and the timing of insertion.
Many studies indicate that the providers ability to place
the IUD correctly at the top of the uterine cavity, or fundus,
may be the most important factor in determining the risk for
expulsion. In some studies, higher expulsion rates were associated
with providers whose skills were inadequate.
Studies also show that younger women who have never given birth
are more likely to expel an IUD than older women with children.
In general, the risk of IUD expulsion is greatest during the
first few months after the IUD is inserted, while the womans
body is adjusting to the device. Thereafter, the risk decreases.
However, contractions of the uterus during the first few months
after the insertion or during later menstrual periods can push
the IUD downward, expelling it either partially or totally.
It is recommended that users check after each menses for the
presence of IUD marker strings to ensure that the IUD is still
in place. Next we will discuss expulsion rates as they relate
to timing of insertion.