Re: Choosing the right menstrual products when you have an IUD
TL/DR: While it’s generally safe to use a menstrual cup or disc with an IUD, your risk for accidental IUD expulsion (a.k.a. removal) or displacement will depend on a variety of individual factors, including whether you are using a disc or cup, the type of IUD you have, the position of your strings, and your unique anatomy. The best way to know for sure? Talk to your doctor.
Here’s a question we get asked a lot: “I’m thinking about getting an IUD and I’m worried about whether I’d be able to accidentally pull it out with a menstrual cup or disc – is that a thing that can happen?”
It’s a super valid concern. Unfortunately, the answer is a little bit complicated and, thanks to the lack of scientific literature available on the subject, a little bit vague. That’s why we decided to dedicate a blog post to the topic: We figured our readers might appreciate some up-to-date, research-based, factual information on the safety of certain menstrual products for IUD users.
Keep in mind that this information is still changing. We’ll do our best to update content regularly as more studies are completed and more data is compiled. If you have a specific or urgent concern pertaining to your own IUD and menstrual product use, it’s always a good idea to speak with your doctor or OB-GYN. When in doubt, get it checked out!
Read on to learn more about accidental IUD expulsion and menstrual product/IUD safety.
What’s an IUD? And what’s it have to do With period products?
If you’ve heard of IUDs before but you’re aren’t totally sure what we’re talking about – no worries! The term “IUD” is short for “intrauterine device.” It’s a snazzy form of birth control that’s become more popular in recent years because it doesn’t require any sort of daily or weekly remembering (like with the pill, patch, or ring). It just does its thing, hanging out in the uterus and preventing pregnancy for up to 5 years at a time.
There are a couple of different types of IUDs available in the US; they fall into two categories. There’s the hormone-free copper IUD (a.k.a. ParaGard) and the hormonal IUD (Mirena, Kyleena, Liletta, Skyla). Which type you choose will depend on lots of individual factors – like whether you’re considering birth control as a means to control heavy, painful periods or whether you’d like to stop getting your period altogether.
Why does the type of period product you use with an IUD even matter? Well, IUDs are placed in your uterus: They’re little, T-shaped devices, about the size of a quarter, that are inserted through the cervix (by a trained healthcare provider), and they have strings attached to the bottom. These strings exist so that your healthcare provider has something to grasp onto when it’s time to remove the IUD.
IUD strings come down through the cervix and hang just slightly into the vaginal canal. Exactly how far down the strings hang depends on the IUD itself, whether or not your provider trimmed the strings after insertion, and your own, unique uterine, cervical, and vaginal anatomy. In most cases, you won’t notice or be able to feel the strings at all unless you’re putting a finger up there to check on them.
Here’s the thing: There’s a slight risk that your IUD could be accidentally dislodged should something get caught on those strings – or even if a certain amount of suction is applied to the vaginal canal. And, obviously, having something unexpectedly pulled out of your uterus through your cervix isn’t the most pleasant experience.
Is it likely? Thankfully, no! Accidental IUD displacement or expulsion are relatively uncommon.1 Read on to learn more.
IUD displacement & expulsion: The research
There aren’t a ton of studies out there on IUD expulsion (which is just a sciencey term for accidental removal) – and there appear to be even fewer on IUD displacement (which is when the IUD is shifted out of its proper position).
However, the research we do have shows that, on average, expulsion happens to roughly 6% of IUD users.1 Different factors appear to influence the likelihood of accidental expulsion – including menstrual cup use, as we’ll discuss in greater detail below – but the body of research is still too limited to make blanket statements about those factors.
In a 2012 study, for instance, “more expulsions were observed in females aged 14–19 compared to older women regardless of parity or IUD type.” However, the researchers note in that same study that “the higher incidence of expulsion observed among females aged 14–19 years should not discourage healthcare providers from recommending IUDs for this population.” They go on to mention that, in most situations, the advantages of IUDs outweigh the risks.1
How does IUD displacement or expulsion happen if it’s not due to something getting caught on the strings? According to another 2016 study, “Incompatibility between the IUD and the endometrial cavity will provoke uterine contraction in an attempt to expel the IUD. These forces can compress, distort, displace, and expel the IUD, particularly if the IUD is not capable of adaptive changes.”2
In plain English? Your uterus is powerful! If your IUD isn’t placed correctly, your uterus could be triggered to contract and dispel the device on its own. Don’t freak out, though – instances of this sort of displacement are rare.2
Menstrual cup & IUD: Safe to use together?
The short and simple answer here is yes, it is safe to use a menstrual cup if you also have an IUD. But that answer comes with a couple caveats: While uncommon, there is a risk of dislodging, displacing, or removing the IUD by pulling on the IUD string while removing your menstrual cup, including Flex™ Cup. IUDs have also, notably, been pulled out during tampon removal – so the experience isn’t unique to cups and discs.
As with the risk for IUD expulsion in general, the risk for menstrual cup-related expulsion depends on a number of factors:
- The position of your cervix
- How long it’s been since your IUD was inserted
- The length and position of the IUD strings
- The specific type or brand of menstrual cup you’re using
The only person who should really be telling you whether or not it’s safe to use a menstrual cup with your IUD is your provider.
If you have any concerns whatsoever about using a menstrual cup with an IUD, just grab your phone and call your doctor or OB-GYN (ideally, whoever placed your IUD). Alternatively, make an appointment with your local Planned Parenthood health center for a consultation or in-person visit.
If you’re looking for some facts and figures, though, we’ve got you covered. A recent 3-year study shed some light on the rate of IUD expulsion in menstrual cup users versus non-cup users:
All participants had a copper IUD placed at the beginning of the study. After one year had passed, the researchers found that IUD expulsion rates were 14.3% among menstrual cup users and 4.7% among non-cup users.3 By the end of the second year, these rates increased to 23.2% and 6.5%, respectively.
Keep in mind that this study only involved copper IUDs – so these rates do not necessarily apply to hormonal IUDs. And, authors suggest, that because hormonal IUDs often lessen the amount of bleeding and length of Another term for menstrual flow (commonly known as your period)., the rates might be lower in those using a hormonal IUD because they will use menstrual cups less often.
What about the suction that holds the cup in place?
Could it be that the suction that holds a menstrual cup in place, keeping it nice and cozy and leak-free, is both a blessing and a curse for IUD users? Could the cup’s vacuum-tight seal accidentally displace your IUD during a hasty removal?
Researchers have wondered the same thing – and they’ve asserted that it’s especially important for IUD users to break the seal before removing a menstrual cup to avoid suction. Here’s a closer look:
A 2019 case series followed seven unique IUD expulsions that took place in patients ages 16 – 26. In all seven cases, expulsions occurred when patients were removing a menstrual cup. The researchers concluded that “there are two plausible mechanisms for IUD expulsion with menstrual cup use: (1) patients may unintentionally pull the IUD strings when removing the cup, and (2) the suction and vacuum created during cup application may dislodge the IUD.”4
They go on to offer a few words of advice for menstrual cup users with IUDs, recommending that they “break the cup seal prior to removal and [discuss] the option of cutting the IUD strings flush with the cervix as a potential way to reduce risk of expulsion.”4
Whether or not you have an IUD, you should always break the seal on your menstrual cup before removing it (otherwise, you’re putting a lot of pressure on your vaginal canal, which your vag does not appreciate). With Flex™ Cup, the break-the-seal step is super easy: Just pull down on the patented pull-tab. The pull-tab draws the outer lip of the cup inward, keeping menstrual fluid neatly trapped inside.
With other brands of menstrual cups, use your fingers to pinch the base of the cup (as if you were trying to fold it for insertion) to break the seal before removal. Refer back to your particular brand of cup’s user guide for more information on removal.
Can I use a menstrual disc with an IUD?
We’ve covered menstrual cups with IUDs. But what about menstrual discs, like Flex™ Disc? For more information, we spoke with Dr. Jane van Dis, a board-certified OB-GYN with 13 years of experience. The verdict? “Flex Disc is very safe for IUD users,” she explains.
“Theoretically, I think some women are worried that, as they are removing Flex, they might accidentally dislodge the strings of the IUD and accidentally pull out the IUD. I haven’t ever heard of a client actually being able to dislodge their IUD while they’re using a Flex Disc, but potentially that could be a concern – however, in summary, Flex is safe when used as directed, and if you have questions, contact your provider.”
Pretty similar to our recommendation for using menstrual cups with an IUD: If you want to use menstrual discs, you should be in the clear. Talk to your provider if you have any concerns or want detailed information about your IUD’s placement, length of the strings, and its position in relation to your unique anatomy.
Other FAQs: Menstrual cup & disc with IUDs
1. How soon after my IUD is placed can I use a menstrual cup or disc?
Most physicians recommend that you wait at least two cycles after IUD placement before resuming the use of menstrual discs or a menstrual cup. That’s because your IUD is slightly more likely to be displaced during the first six weeks after insertion.4
A few months after your IUD is placed, you’ll typically be asked to return for a follow-up appointment to confirm that your device is in the right place. The easiest way to do this is via a pelvic ultrasound, but your provider will also likely do a physical exam. This appointment is a good time to discuss any concerns you may have about menstrual product use.
2. Should I get my IUD strings trimmed first?
Some individuals opt to have their IUD strings trimmed (by their provider) so that they are flush with the cervix. This may reduce the risk of accidental IUD displacement or expulsion when removing a menstrual cup or disc. However, it’s important to remember that trimming the strings may also result in a slightly more difficult or uncomfortable removal process when it comes time to take out your IUD.5
You don’t have to have your IUD strings trimmed in order to use a menstrual cup or disc – just be mindful to feel for the strings when removing your menstrual product (try running a clean finger all the way around the edge of the cup or disc) to make sure they are out of the way.
3. What if I have a low cervix?
Fun fact: Your cervix doesn’t stay in the same place all the time. It actually moves and shifts positions throughout your menstrual cycle (and after penetrative sex, too). Some individuals, however, are born with a “low cervix.” This is totally normal, it just means your cervix position is a little closer to the entrance of your vaginal canal.
If you have a low cervix, your menstrual cup may sit closer to your cervix than it would in others (typically, a cup sits low in the vaginal canal, away from the cervix). This doesn’t mean you can’t use a cup with an IUD! Just be extra careful during insertion and removal, checking that your IUD strings are out of the way.
What about a menstrual disc? IUD users with a low cervix can still use menstrual discs. You may even find them easier to insert and remove. Just make sure your disc stays tucked behind your pubic bone during use, and be gentle when pulling it out.
Disclaimer: The content of this blog post is based on information and research currently available as of the time of publication. As new information becomes available, we’ll update our content accordingly. However, if you have any specific questions or concerns pertaining to your use of Flex Cup or Disc, please feel free to reach out to our team directly at (800) 931-0882 or via our online contact form. We also recommend speaking to your healthcare provider for additional clarity.