Why do iuds fall out

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Last updated: April 8, 2026

Quick Answer: IUDs fall out in about 2-5% of users, most commonly within the first few months after insertion. The expulsion rate is higher for postpartum insertions (up to 10-25%) compared to interval insertions (2-5%). Risk factors include young age, heavy menstrual bleeding, and improper insertion technique. Most expulsions occur within the first 3 months, with 80% happening in the first year of use.

Key Facts

IUD expulsion occurs in 2-5% of users overall
Postpartum insertion has higher expulsion rates of 10-25%
80% of expulsions occur within the first year of use
Most expulsions (60-70%) happen within the first 3 months
Risk is highest for women under 20 years old

Overview

Intrauterine devices (IUDs) are small, T-shaped contraceptive devices inserted into the uterus to prevent pregnancy. First developed in the early 1900s, modern IUDs emerged in the 1960s with the Lippes Loop and gained FDA approval in the United States in 1968. Today, two main types exist: copper IUDs (like ParaGard, approved 1984) and hormonal IUDs (like Mirena, approved 2000). IUDs are among the most effective reversible contraceptives, with failure rates below 1% per year. Despite their effectiveness, expulsion (when the IUD partially or completely comes out of the uterus) remains a concern, affecting thousands of users annually. The World Health Organization estimates over 150 million women worldwide use IUDs, making understanding expulsion crucial for public health.

How It Works

IUD expulsion occurs when uterine contractions push the device through the cervix. Several mechanisms contribute: uterine contractions during menstruation can dislodge the device, particularly in women with heavy bleeding. The uterus may also contract in response to the foreign body, especially if the IUD is too large for the uterine cavity. Improper insertion technique—such as placing the IUD too low in the uterus or failing to release it correctly from the inserter—increases expulsion risk. Postpartum insertion carries higher risk because the uterus is still enlarged and contracting to return to its normal size. Additionally, certain uterine shapes (like a septate or bicornuate uterus) or conditions like fibroids can prevent proper IUD positioning. Users typically notice expulsion through symptoms like abnormal cramping, unusual vaginal discharge, or feeling the IUD strings protruding from the cervix.

Why It Matters

IUD expulsion matters because it compromises contraceptive effectiveness, potentially leading to unintended pregnancies. When an IUD falls out, users may not realize it immediately, leaving them unprotected. This is particularly significant in regions where IUDs are a primary contraceptive method due to their long-term, cost-effective nature. Understanding expulsion helps healthcare providers improve insertion techniques and patient counseling. For instance, checking IUD placement via ultrasound after insertion and teaching users to regularly feel for strings can reduce risks. Research into expulsion also drives device innovation, like smaller IUD designs for nulliparous women. Ultimately, addressing expulsion improves reproductive autonomy and reduces healthcare costs associated with unintended pregnancies.