IUDs are an effective form of birth control, but for a small percentage of women they can fall out. Photo/Getty
IUDs are safe and effective birth control, but for some, keeping them in can prove difficult. Katie Harris investigates why they get dislodged and whether anything can be done to prevent them falling out.
The first time it happened I was swimming at a small beach near Cass Bay.
I'd been lazing in the water for hours, on one of those gorgeous 26-degree, late summer Christchurch afternoons, when my IUD decided it wanted out.
If you've been to the main bay you'll know the swimming spot. It's a few coves to the left, sheltered from the wind, facing out at Diamond Harbour. Idyllic, but the only real option for getting changed after a dip is the old underwear switcharoo.
You know the move. You pull your undies on over your togs, then yank the togs out one leg at a time. Look, it also felt a lot easier when I was 21.
Halfway through said tog tango, what looked like a mini metal anchor fell from the lining of my swimsuit.
At first I was confused, next I laughed and then I thanked all my lucky stars – if my IUD had been lost in the deep blue, I would not have known I was no longer protected from pregnancy.
There are two types of IUDs (Intrauterine Devices), hormonal and non-hormonal, and both work by stopping sperm from reaching an egg and stopping the egg from attaching to the wall of the uterus.
I first heard of IUDs when I was in high school. At the time they were these big scary things that seemed far too invasive, painful and whacky to ever consider.
So, like many of my late teen peers, I started the merry-go-round of trialling one hormonal birth control pill only to change a few months later to the next, slightly varied, version due to the side effects.
Bloating, missing periods and weight gain were just the mild symptoms.
One pill I popped made me so emotional that even the hint of a car coming too close to me on the motorway would leave me in tears. The next made the skin on my chin and lower face erupt with pimples. If you've experienced bad acne, you'll know this impacts much more than your makeup routine.
Acne can be as painful physically as it is mentally.
Following three months of my skin getting progressively worse, I bit the bullet and started taking heavy duty acne medication Roaccutane.
The side effects were nasty: dry, brittle and sensitive skin; however they felt like nothing compared to my experience on the pill.
I swore off the pill, then I met someone.
As the months went on I started flirting with the idea of an IUD and researching whether the device could work for someone like me.
After consulting Dr Google, I booked an appointment with my GP to discuss the idea of getting a hormone-free copper IUD and despite the potential for heavier periods, I was sold.
Saying farewell to the daily reminders, emotional up and downs, and cystic acne setting up shop on my face felt like a dream. And for a long time, it was.
But about a year later it fell out and three years on my next IUD went MIA too.
The second time was far worse because I had no idea when it came out; all I knew was that, all of a sudden, everything down there was out of balance for no apparent reason.
My pH had been thrown off, and it was causing repetitive bacterial infections that numerous pills, potions and appointments were not sorting out.
Everything was feeling a bit hopeless when, in a last-ditch effort to see what was going on, my doctor referred me to get an ultrasound to see if the device may have moved.
Getting a vaginal ultrasound is no holiday, as I discovered. You're lying on a table exposed and at the mercy of a medical professional with a plastic wand and ice-cold lube.
At least I hoped it would give me an answer as to why my own body had so suddenly turned against me.
Well, that was what I thought until the little metal rod never appeared on screen and I was left bare bottomed dripping with goop wondering where the heck it could have gone to.
When my IUD wasn't spotted in the ultrasound my doctor scheduled me in for an x-ray, which returned the same result.
Naturally, I did what any 20-something would, and took to social media to see if anyone else had experienced the same thing. About a dozen women replied, saying they too had their IUD disappear.
Some had their IUDs "stuck"; others also had their one fall out and some even had to get theirs surgically removed.
Family Planning New Zealand's site says the risk of infection when having an IUD put in is about 1 per cent, and the risk of damage to the uterus is about one in every 1000.
As well as this, they say IUDs come out about 5 per cent of the time.
According to the organisation's 2020 Contraception Use Survey, the use of long-acting reversible contraceptives - including the copper IUD, hormonal intra-uterine systems (IUS) and implants – has increased internationally and in New Zealand over the past decade.
But compared to the pill, condoms, and the withdrawal method, the survey found that long-acting reversible contraceptives were still less likely to have been used by respondents with 19 per cent reporting having ever used IUS, 17 per cent the implant and 14 per cent the IUD.
I still felt in the dark around why my IUDs kept falling out without a peep when so many others stayed in place, and whether anything could be done to stop it.
Again, I went to Dr Google, which echoed these stats, but many sites stated people usually will experience symptoms when their IUDs fall out, so I finally turned to an expert for answers.
Obstetrician-gynecologist Dr Danielle Jones, who goes by mamadoctorjones online, also says expulsions are relatively uncommon, with only about 5 to 7 per cent of IUDs falling out.
However, she says this can be higher or lower depending on some individual factors like when it was placed, for example immediately postpartum, after six weeks postpartum and if the uterus has fibroids or is abnormally shaped.
"Most of the risk factors are not modifiable, meaning you can't really do anything to make this less likely. Menstrual cup use very slightly increases the risk of expulsion, but not enough to recommend against use - just important to be aware of."
She told me the biggest risk of an IUD falling out or moving is unintended pregnancy. Other problems can include abnormal or heavy bleeding, spotting between cycles, bleeding/spotting after sex and pain.
None of which I personally experienced.
However, she did say people who have previously had an IUD expulsion are at a much higher risk for it to occur again.
"Likely, this is related to individual uterus shapes and positions, among other things."
Migration to the abdomen she says, is incredibly rare, but not impossible.
Overall, she says IUDs are safe and reliable, but the insertion process can be painful for some.
"Most people do okay with it. If you're nervous, call your doctor ahead of time to discuss what can be done to ease anxiety and reduce pain with placement."
Hearing how uncommon my situation is, is both frustrating and comforting. I'm glad having an IUD fall out is very uncommon, I'm thankful the overwhelming majority of people who get the devices won't go through what I have. Yet in the same breath, I'm hacked off I had the poor luck of being in that 5 per cent more than once.
Luckily I have a great GP, supportive friends and family and live in a country where healthcare like this is accessible. Would I get an IUD again? Probably not. But do I wish I could have one again without it falling out? Hell yes.
WHAT HAPPENS WHEN YOUR IUD GETS LOST INSIDE YOU? Kim Knight shares her story.
A nurse held my hand and a gynaecologist held the speculum that, in turn, opened my vagina. I focused my attention on breathing-not-screaming.
Goopy gel was smeared on my belly and everybody frowned at the ultrasound monitor. My body had been reduced to a black-and-white problem.
What I remember most from the day my Mirena went missing was how bright the room was, and the sheer casualness of it all. My IUD was MIA and the people looking for it might as well have misplaced their car keys.
"I think," the gynaecologist said after about five years and one local anaesthetic injected into my cervix, "That we are going to have to do this under a general. I don't think you can take much more of this?" It was definitely the day's most accurate health assessment.
Earlier that day, I'd told my boyfriend I'd be fine to catch a taxi home. My IUD was being removed and it should have been as straightforward as an eyebrow tint or a spray tan. My Mirena - a hormone-releasing intrauterine device used as a long-term contraceptive - had been in place for its recommended five-year life. Now, in my early 40s, I was starting to wonder about the Mirena's role in mood swings and a general feeling of flatness and blah.
A Mirena is a T-shaped, flexible plastic device, measuring about 3cm across and 3cm down. It is usually inserted and removed by a primary health provider - your regular GP who, when the time comes to take it out, pulls gently on the pair of strings dangling from the tail-end of the "T". Mine had actually been placed while I was out cold on a surgical table having an ovarian cyst removed - the IUD was a useful contraceptive but, for me, its primary function was to reduce painful heavy periods caused by uterine fibroids.
Women are told to routinely check for the presence of Mirena strings. I had never, ever been able to find mine, but I had never, ever worried. My assumption was that because I was under general anaesthetic when it was inserted, the gynaecologist had simply been able to place it further in and higher up than wide-awake comfort levels might have otherwise allowed. Out of sight and, for the past five years, very much out of mind.
But now, on a cold and rainy Auckland night, my Mirena was lost and so was my dignity. How common was this? Why had it happened? I should have asked more questions. But when you're in the middle of a women's health issue - when you are lying on a hard, flat surface with your legs up in the air and a speculum up in your business - it's difficult to form a cohesive thought.
Recently, I fired off some emails to the Ministry of Health. How many IUDs are removed under general anaesthetic? How many women are actually using them? Data is limited. The Ministry holds no information on individual IUD use or uptake. There is no breakdown showing the prevalence of copper IUDs versus the likes of the Mirena or Jaydess. The Ministry could confirm, however, that there were 838 removals carried out in an inpatient hospital setting in 2021/2022 and 972 the year prior. Not all of these necessarily required a general anaesthetic but the hospital setting raises questions. It's a long way from the MOH online fact sheet that simply states: "Your doctor removes the IUD by pulling the threads. This may be painful for a few seconds."
According to Te Whatu Ora-Health New Zealand spokesperson, the main reason a general anaesthetic might be used in a removal scenario would be the retraction of the IUD strings into the uterus. Other possible, but rare, complications included an IUD becoming embedded in the uterine wall, or going right through the wall and into the abdominal cavity. In my case, the problem was the fibroids. The non-cancerous growths had become so big, they were distorting my uterus and shrouding the Mirena from view. A week after that first disastrous attempt to locate it, I counted back from 10 and woke up 20 minutes later with medical tape in my hair and a period-type ache deep in my belly. I had a glass of water and a wine biscuit and waited for my lift home. And I wondered, for the millionth time, why female healthcare feels so much like one step forward and two steps back.
IUD Facts
- The copper IUD is 99 per cent effective in preventing pregnancy. Mirena is 99.5 per cent effective in preventing pregnancy - Copper IUDs can be used as emergency contraception after unprotected sex - Some IUDs work for up to 10 years - If used properly IUDs are 45 times more effective than the pill and 90 times more effective than male condoms, according to the Guttmacher Institute
‘Mum had lived and died with this secret,’ says writer Mary Garden.