- Determine risk of pregnancy
- Perform pelvic exam; probe for strings in cervical
- Give choice of another contraceptive method
- Tell client to check for strings after next menses
Insert another IUD if expulsion is
- Woman is not pregnant
- There is no damage from perforation
Missing IUD strings may be a sign that the IUD has been expelled
or has perforated the uterus. If a client says her IUD strings
are missing, the health care provider should determine her risk
of pregnancy by asking the woman when she last felt the strings
and if she has had unprotected intercourse since that time.
Next, perform a pelvic exam to determine if the strings are
high in the cervix or hidden by a fold in the vagina. Often
the strings can be located by probing the cervical canal with
cotton swabs or narrow forceps. Gently rotate the instrument
to draw the strings down.
Although not absolutely necessary, an ultrasound or X-ray can
be used to locate the IUD if the strings cannot be found. If
there is a risk that the woman is pregnant however, an X-ray
should not be used. The client should be provided another contraceptive
method to use until her next menses. If the strings have retracted
into the uterus, they may fall back into place during menstruation.
Tell the client to check for strings after her next menses.
If the strings are still not present after the next menstrual
period, the client should see a physician for further examination.
If pregnancy and a perforated uterus are ruled out and the IUD
has been expelled, another IUD can be inserted immediately.
If the IUD has perforated the uterus, refer the client to a
hospital for treatment.