Understanding the position of your IUD is key to ensuring it works safely and effectively. Hartford Nurse Practitioner Meghan Killilea Galli, APRN, FNP-BC, explains how an IUD should sit in your uterus, what “embedded” or “malpositioned” means, and how an ultrasound confirms correct placement.
What Are the Parts of an IUD?
An intrauterine device (IUD) is a small, T-shaped contraceptive device inserted into the uterus to prevent pregnancy. It’s one of the most effective reversible birth control methods, lasting anywhere from 3 to 10 years depending on the type.
The main parts of an IUD include:
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T-shaped frame: The body of the device that fits inside the uterus.
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Arms: Two flexible horizontal arms that open once inserted, holding the IUD in place.
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Stem: The vertical section of the T that carries the active ingredient.
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Strings: Thin nylon threads that extend into the vaginal canal for removal and position checks.
Two main types exist:
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Hormonal IUDs (e.g., Mirena, Kyleena, Liletta, Skyla) – release levonorgestrel.
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Copper IUD (Paragard) – releases copper ions that create a sperm-repelling environment.
Normal IUD Placement in the Uterus
A correctly positioned IUD sits inside the uterine cavity, with:
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The T-arms extended at the top of the uterus (near the fundus).
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The stem running down the middle of the uterine cavity.
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The strings extending through the cervix into the vagina — typically 1–2 inches long.
Your provider will usually confirm correct placement with a pelvic exam or ultrasound shortly after insertion.
On ultrasound, a normally placed IUD appears as:
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A bright white (echogenic) line or T-shape within the endometrial canal.
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Both arms symmetrically extended across the uterine fundus.
How Is IUD Placement Checked?
After insertion, you may be advised to come back for a follow-up exam in 4–6 weeks to ensure correct positioning.
Methods used to confirm IUD placement include:
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Pelvic exam: Checking for visible strings in the cervical canal.
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Ultrasound imaging: The gold standard to confirm IUD location and detect malposition.
Normal IUD Placement on Ultrasound
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Seen in the endometrial canal
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T-arms extended horizontally near the uterine fundus
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Stem centered in the uterus
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Strings visible through the cervix
If the IUD is not in this position, your provider may diagnose a malpositioned IUD.
What Does “IUD in Lower Uterine Segment” Mean?
An IUD in the lower uterine segment means the device has slipped slightly downward from its ideal location near the fundus.
This can happen due to:
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Uterine contractions (especially during menstruation)
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Incorrect initial placement
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Individual uterine shape or size
While not always dangerous, a lower IUD may reduce contraceptive effectiveness or cause irregular bleeding and cramps. Your provider may recommend an ultrasound or removal if it’s too low.
IUD Embedded in the Uterus: What It Means
An embedded IUD occurs when part of the device (usually one of the arms) becomes lodged in the uterine wall (myometrium) instead of staying in the cavity.
Symptoms of an embedded IUD:
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Persistent pelvic pain or cramping
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Abnormal bleeding
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Pain during sex
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Strings that feel shorter or longer than usual
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Missing or hard-to-find strings
Diagnosis:
Ultrasound or, in some cases, hysteroscopy (a small camera inside the uterus) confirms the diagnosis.
Treatment:
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Minor cases may resolve with careful removal in the office.
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Deeply embedded IUDs may require removal under anesthesia or by a specialist.
IUD Stuck in the Uterus Wall
When an IUD becomes stuck in the uterus wall, it’s considered a complication called partial perforation.
This can happen during insertion if the uterus is soft or angled, or if insertion resistance was felt but not recognized.
Key signs of a stuck IUD:
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Sharp or prolonged pain during insertion
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Ongoing cramping or bleeding
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Missing strings
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IUD not visible in the uterine cavity on ultrasound
If the IUD is partially perforated, removal by an experienced gynecologist is necessary — sometimes under sedation or local anesthesia.
IUD in the Myometrium or Embedded in Uterus Wall
When imaging shows an IUD embedded in the myometrium, it means the device has pushed into the muscular layer of the uterus.
Risks of an embedded IUD include:
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Uterine irritation or inflammation
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Reduced contraceptive effectiveness
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Pain or bleeding
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Risk of further perforation
Treatment involves:
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Ultrasound-guided removal in a clinic or outpatient setting.
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In some cases, hysteroscopic removal if embedded deeper.
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Follow-up imaging to ensure complete removal and no retained fragments.
Your healthcare provider will also advise when it’s safe to insert a new IUD afterward.
Malpositioned IUD: Causes and Management
A malpositioned IUD refers to any IUD that’s not in the optimal location within the uterus. This includes:
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Low-lying IUDs (in the lower uterine segment)
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Rotated IUDs (arms not properly spread)
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Embedded IUDs (partially in the wall)
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Perforated IUDs (migrated outside the uterus)
Causes:
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Difficult insertion or uterine contractions
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Small or irregularly shaped uterus
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Recent pregnancy or postpartum changes
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Uterine fibroids or scarring
What to do:
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Schedule an ultrasound to assess placement.
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If malpositioned, your provider may remove and replace it during the same visit.
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Avoid self-attempted removal, as it can cause injury or bleeding.
How to Know If Your IUD Is Out of Place
While many women feel fine after insertion, pay attention to these warning signs:
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New or worsening cramping
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Heavy or prolonged bleeding
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Strings feel unusually short, long, or missing
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Sharp pain during sex
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Feeling unwell or dizzy
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Positive pregnancy test
If you notice any of these, contact your Hartford women’s health provider immediately.
Diagnostic Tools for IUD Location
When placement issues are suspected, your provider may use:
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Transvaginal ultrasound: Provides a clear image of IUD location.
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X-ray or CT scan: Used if the IUD is not visible on ultrasound (possible perforation).
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Hysteroscopy: Direct visualization using a thin scope to locate or remove the device.
These tests ensure safe management and protect uterine health.
What to Expect After IUD Placement
Some discomfort is normal after insertion. Here’s what you may feel:
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Mild cramping for 1–3 days
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Light spotting
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Occasional mild backache
Tips for comfort:
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Use a heating pad on your lower abdomen.
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Take over-the-counter pain relief (ibuprofen).
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Avoid inserting anything vaginally (tampons, intercourse) for 24 hours.
If you experience severe pain, heavy bleeding, or signs of infection, contact your provider.
Local Care for IUD Placement in Hartford
Women in Hartford seeking IUD services can visit trusted local centers such as:
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Hartford Hospital Women’s Ambulatory Services
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UConn Health OB/GYN Associates
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Planned Parenthood of Southern New England (Hartford Center)
Each offers IUD placement, ultrasound evaluation, and removal services for hormonal and copper devices.
Key Takeaways
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A normally placed IUD sits in the uterine fundus with visible strings.
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Ultrasound is the best way to confirm placement.
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Malpositioned or embedded IUDs can cause pain, bleeding, or reduced effectiveness.
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Seek prompt evaluation if symptoms appear or strings change in length.
Disclaimer: This is informational content, not a substitute for professional medical advice.
Author:
Meghan Killilea Galli, APRN, FNP-BC
Family Nurse Practitioner | Hartford, Connecticut
Specializing in Women’s Pelvic Health & Urology
Meghan Killilea Galli, APRN, FNP-BC, is a Connecticut-based board-certified Family Nurse Practitioner with over 5 years of experience in urology, women’s pelvic health, and primary care. She practices with Hartford HealthCare and Griffin Faculty Practice Plan and founded Health Gardeners to share reliable, evidence-based health information.
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