27) “How Do I Check My IUD Strings? Do I Need to Check My IUD Stings?” (Viewer Question)

hi i'm dr. christina der baddest a gynecologist in Newmarket Ontario Canada welcome back to my channel talking iuc with dr. D in today's video we are going to continue with our series devoted to viewer questions thank you again to all of the viewers who have commented via the channel and have given suggestions for video topics today's video topic was suggested by viewer Luna who had questions about IUD strings so questions being how do I check my IUD strings do I need to check my IUD strings is this actually necessary so in today's video we are going to address that question now one thing that I want to emphasize is that the IUD strings are designed that on a day to day basis neither you nor your partner should be bothered by the strings or be able to feel the strings either sort of just walking around existing or during intercourse so just to give you an example of the strings it's difficult to even show them so that the camera picks it up they're very very fine and very flexible so designed not to be bothersome if inadvertently touched or poked during intercourse but by that same token because the the strings are quite thin sometimes it can be a little bit difficult to check so I'm going to walk through some of the steps first I'm going to talk about why would someone want to check the IUD position and why are we checking the strings as a measure of checking the IUD position so there is about a 2 to 10 percent chance of what's called IUD expulsion or the IUD actually falling out or shifting out of place and for a very very detailed video regarding IUD expulsion I'd refer you to my video number 20 or so that can happen that the IUD can shift out of position or may fall out and that's part of why we're we're doing checks on the IUD in the form of checking for strings now the calmness window for IUD expulsion is generally within the first three months so some physicians recommend that being the critical window for checking I you D strings and might recommend that I you D strings be checked monthly during that time interval however it's not impossible for an IUD to fall out even after that three-month period so other obstetrician gynecologists may actually suggest that on a monthly basis or on a somewhat regular basis that you determine that you do continue to periodically check the IUD strings for as long as you're using the IUD now the number one way that in my office IUD strings are checked are actually with a visit with me in the office a month after the IUD insertion process so or roughly a month afterwards and I actually myself in the office and doing an internal exam where I myself feel for the strings or may use a speculum to actually look for the strings so that's one way of checking IUD strings is obviously via your physician now in terms of checking IUD strings on your own at home I was struggling with trying to think of exactly how to show you to do this but it's really more of a it's not a visual procedure the procedures done by feel so I'm just going to describe it and I'll use the aid of my little model here which is a uterus with an IUD in and it's again very very hard to even see the very very small strings there but basically the idea is to make sure that your hands are clean so wash your hands some patients might elect to do this in the bathtub or in the shower as they're washing that make sure your hands are clean and using either your index finger or your middle finger you're basically reaching into the vagina you might have to go actually quite high to actually feel the tip of the cervix this represents the tip of the cervix now the tip of the cervix will be quite firm sort of almost the consistency like the tip of your nose so if you reach up and you feel something sort of hard and rubbery that's likely the cervix and so then you would just feel along the surface of the cervix either for just feeling the threads against the cervix or feeling the threads coming out of the cervix sometimes you might be actually able to touch the strings on their tips like that other times the strings may be sort of pushed to one side in the other and pull ume sorry this keeps shifting so you may only feel through to the edges of the strings against the cervix now what I want to emphasize is if you don't feel those strings initially on your first try of checking your strings don't panic it doesn't necessarily mean that the IUD has has shifted or that the strings are missing again sometimes because the strings just curl up and they can sort of tuck so that their edges are tucked way up high in the upper corner of the vagina they can be harder to actually palpate or feel in that position sometimes strings can actually the ends may sort of travel up within the cervical canal and I can't make this do this but basically they they sort of sneak up so that the the IUD is still in position and working but the strings themselves are sort of hidden within the cervical cavity if that happens it doesn't mean that the IUD isn't working it does mean that you would probably have to have a check with your doctor to make sure things are in good position if I have a patient where the strings aren't visible then usually as a double check we'll do an ultrasound to confirm that the IUD is still in position and as I go through in my IUD removal video having strings that are lost in this or hidden within the cervical canal does not necessarily mean that there's going to be huge problems in terms of removing the IUD so more on that issue in the IUD removal video that I've done previously a couple other points about checking strings note that when you check the strings they are not going to feel like tampon strings so it's different than that be very careful that you're not pulling on the strings the idea is that we don't want to inadvertently actually pull out the IUD so be very cautious of that in terms of positioning for being able to best reach the cervix and do all of this some literature suggest that actually doing this in a squatted position may actually help you get the positioning of being able to reach the cervix but again I will emphasize that if you've tried this and you aren't able to either reach the cervix or feel the strings don't panic it doesn't necessarily mean problems depending on a patient's anatomy it may actually be difficult to feel the cervix depending on the angle of the cervix and the angle of the uterus and again the thin threads or they're very very thin and sometimes can be hard to miss with your fingers so if you're not feeling the strings don't automatically panic now in terms of addressing the question do I have to have my strings checked is it absolutely necessary or for how long do I have to check the strings now what I tend to tell my patients is that of course they will have a one month follow-up visit with me to check the strings the vast majority of my patients are usually electing on levonorgestrel iud s so the hormonal IUDs like kaileena or Mirena and most of those patients are noticing menstrual side effects so usually a lessening of menstrual bleeding a lessening of menstrual cramp so usually they have the added benefit of these menstrual symptoms to be able to alert them if something was amiss with the IUD or had it shifted out of position so for example I mentioned a patient's thought if all of a sudden you go from having very very light or in some cases non-existent cycles on Mirena or kaileena and then all of a sudden sort of without explanation your cycles are much heavier or much crampy ER than they were previously then that might be a sign that the IUD has shifted out of position and that would be a reason to go ahead and check for the strings and if you weren't able to feel the strings or if there were ongoing problems with regards to bleeding then that would be a reason to see your doctor in terms of so the bottom line is for those using hormonal IUDs most often your menstrual cycle bleeding pattern is going to be telling you that the IUD is still in place and doing its job and that's added reassurance so it may be less necessary to actually check the strings in some clinics they may recommend seeing a physician on an annual basis for string checks that's sort of one option but is not necessarily mandatory one thing I wanted to mention as well that if you are reaching up into the cervix and are feeling for the strings and instead of feeling just strings you actually your finger is bumping up against this hard portion here the actual stem of the IUD if you feel something hard and plastic there that could be a sign of partial expulsion or the IUD on its way to leaving the uterus and being out of position in which case the IUD may not be functioning appropriately so the bottom line is you need to book an appointment to see your physician right away to have that assessed and definitely to use back-up contraception until that visit until you're reassured as to what's going on with your IUD and whether or not it's in the right position and actually as a general comment I would also emphasize that in any situation where something's going on and you're worried because of whatever symptoms you're having whether it be things that you're finding when you're feeling for the strings whether it be a dramatic change in your menstrual bleeding if it's new spotting or new pain with intercourse if something's going on and you're worried that the IUD might be out of position definitely use backup contraception in the form of condoms for example I definitely use backup contraception until you have the opportunity to get into the doctor to have things checked out one other comment that I wanted to add with regards to checking the strings and the length of the strings so every physician has their own sort of length of bill cut the strings to on average we usually do it about two or two and a half centimeters from the outer edge of the cervix so that's typically what the length of the strings are and in terms of checking the length perhaps knowing the exact length of your strings is less important or not really possible per se but if you notice a dramatic change from one check to the next so if all of a sudden the strings are feeling quite a bit longer than they had been previously then that would be significant so for a very first check you can't really say oh it's three centimeters and not two centimeters and it's too long it's not as precise to track that way but if you're noticing from one check to the other a dramatic change in the strings either not able to feel the strings anymore the strings being much shorter or if the strings are dramatically longer than they were previously then that might be reason to book an appointment with your physician to have things more formally checked so that was just a brief video talking about some general concept concepts about checking the IUD strings and whether or not that's necessary I hope this has been helpful if after watching the video you still have questions about this feel free to ask the questions in the comment section and again would welcome any suggestions from viewers out there in terms of other possible video topics regarding contraception and intrauterine contraception and thanks again to Luna for suggesting this video topic so that's all for today's video I will end as I always do by reminding you that in less than the time that it took to watch this video you could have had an IUD inserted the whole thing takes usually about five minutes and provides up to five years of worry free contraception thanks for watching we'll see you in the next video take care

Channel: Dr. Kristina Dervaitis

Views: 151,001

Keywords: IUD, IUC, intrauterine device, Intrauterine contraception, IUD strings, checking IUD strings, check, gynecologist, Mirena, Kyleena, IUD expulsion, IUD removal, strings

Id: 1QK6CjRdYwk

Length: 14min 8sec (848 seconds)

Published: Thu Sep 19 2019