A positive test when you have an IUD can feel like a bolt from nowhere. Many parents immediately ask: “Is this even possible?” “Is it dangerous?” “Should I remove it myself?” In India, there can be extra pressure too: privacy in a joint family, distance to a gynaecologist, and finding a centre that can do an urgent ultrasound.
Pregnancy with IUD is uncommon, but it needs timely evaluation. The first medical priority is always the same: confirm where the pregnancy is (inside the uterus or ectopic, usually in the fallopian tube) and confirm where the IUD is sitting. Step by step: confirm, date, locate, decide.
Pregnancy with an IUD: what it means and why evaluation matters
What “pregnancy with IUD” means
Pregnancy with IUD means a pregnancy has started while an intrauterine device may still be in the uterus (or may have shifted or been expelled without being noticed). Even when an IUD is inserted correctly, no method is 100%.
Clinicians usually focus on four questions:
- Is the pregnancy confirmed?
- How many weeks is it?
- Is it in the uterus?
- Where is the IUD right now?
How an IUD prevents pregnancy (and how pregnancy can still happen)
A copper IUD releases copper ions that affect sperm function and fertilisation, and creates local uterine changes that make implantation less likely.
A hormonal IUD releases levonorgestrel, which thickens cervical mucus (blocking sperm), thins the uterine lining, and may partly suppress ovulation in some cycles.
So why does pregnancy with IUD happen?
- malposition (IUD shifted or sitting low)
- partial or complete expulsion (sometimes silent)
- device used beyond recommended duration
- rarely, pregnancy starts despite correct positioning
Copper vs hormonal IUD: why your bleeding pattern matters
- Copper IUD (nonhormonal): periods usually continue and may be heavier or more crampy.
- Hormonal IUD (levonorgestrel): periods often become lighter, amenorrhea can occur over time.
With copper IUDs, a missed period is often a clearer signal. With hormonal IUDs, the first clue may be new nausea, breast tenderness, unusual fatigue, or unexpected spotting.
How common pregnancy with IUD is
IUDs are among the most effective contraception methods.
- Copper IUD: roughly 0.6-0.8% pregnancy rate in the first year.
- Hormonal IUDs: roughly 0.1-0.4% pregnancy rate in the first year.
With IUDs, typical use and perfect use are very similar because there is little daily action required.
Why early medical evaluation can help protect your health
A positive test with an IUD needs timely assessment to:
- confirm pregnancy location and rule out ectopic pregnancy
- check whether the IUD is still in the uterus and where it sits
- decide whether removal is possible and safer than leaving it in place
Early evaluation commonly includes pregnancy test confirmation, a pelvic exam, and an ultrasound (often transvaginal ultrasound early on). Acting quickly is not about fear, it is about preventing the small number of situations that can become urgent.
Why pregnancy with an IUD can happen
Malposition: a low-lying or tilted IUD
For full effectiveness, the IUD should sit correctly in the uterine cavity. If it is low, tilted, or partly embedded into the uterine wall, protection may decrease.
Possible clues (not always present): new pelvic pain, unusual bleeding, discomfort during sex, or a noticeable change in string length.
Partial or complete expulsion (sometimes silent)
An IUD can be partly or fully expelled, sometimes during a period, sometimes with minimal pain.
Possible clues:
- strings suddenly feel longer, or you cannot feel them at all
- pain or bleeding that changes abruptly
- a sensation of something at the vaginal opening
Duration of use: when an IUD is past its recommended timeframe
Each IUD has a recommended duration (often 3 to 10 years depending on the model). Beyond that, protection may decrease, increasing the chance of pregnancy with IUD.
Strings not visible: what it can mean
Strings not felt can happen because:
- strings have curled into the cervix
- the IUD has shifted
- the IUD has been expelled
- rarely, uterine perforation at insertion with migration
You cannot know which without examination and imaging. A pelvic ultrasound is commonly used to locate the device.
Higher-risk times: postpartum, soon after insertion, uterine anatomy
Shifting or expulsion can be more likely:
- in the weeks after insertion
- in the postpartum period while the uterus is changing
- when the uterine cavity has anatomical variations
Pregnancy with an IUD: quick next steps if you think you are pregnant
Take a home pregnancy test and note key details
If pregnancy with IUD is possible, do a home test as soon as you can. Note:
- first day of last period (or last bleeding like a period)
- IUD type (copper or hormonal, if you know)
- symptoms (bleeding, pain, nausea, fatigue)
- whether you can feel the strings (do not pull)
The IUD does not affect pregnancy test accuracy.
When to contact a clinician the same day
Contact a clinician the same day if:
- the test is positive
- you have missed a period (especially with a copper IUD)
- strings are not felt or have clearly changed length
- you have new pelvic pain or abnormal bleeding
What to avoid while waiting
Do not pull strings or attempt self-removal. Also avoid inserting anything into the vagina (tampons, douching) until you are assessed, especially if there is bleeding or pain.
When urgent care is the safer choice
Go to urgent care/emergency if you have:
- severe abdominal pain or worsening pelvic pain (especially one-sided)
- heavy vaginal bleeding with weakness, paleness, or feeling faint
- dizziness, fainting, or shoulder-tip pain
- fever with pelvic pain or foul-smelling discharge
Pregnancy with an IUD: symptoms that should not be ignored
Early pregnancy symptoms can be similar with or without an IUD: nausea, breast tenderness, fatigue, frequent urination, and sensitivity to smells. These symptoms do not confirm pregnancy location.
Bleeding becomes more concerning when it is heavy or persistent, linked with faintness/weakness, paired with one-sided pain, or associated with fever or foul discharge.
Pelvic pain should be taken seriously if it is severe, increasing, clearly one-sided, or linked with bleeding, dizziness, vomiting, fever, or shoulder-tip pain.
Pregnancy with an IUD and ectopic pregnancy risk
IUDs reduce the overall chance of pregnancy. But if pregnancy with IUD occurs, the chance that it is ectopic is higher compared with pregnancies in people not using contraception.
Seek urgent evaluation for:
- one-sided lower abdominal or pelvic pain
- pain with light bleeding
- dizziness, fainting, or unusual weakness
- shoulder-tip pain
Clinicians typically use transvaginal ultrasound and serial beta-hCG blood tests (often repeated after about 48 hours) to confirm location.
Confirming pregnancy with an IUD: tests and ultrasound
Urine pregnancy test
Urine tests detect hCG and remain reliable even with an IUD. If negative but concern remains, repeating in 3-7 days or doing a blood test can help.
Blood beta-hCG
Blood testing provides an exact hCG level and helps plan ultrasound timing. Early in pregnancy, hCG often rises significantly over 48 hours, though patterns vary.
Transvaginal ultrasound
Ultrasound checks for:
- a gestational sac in the uterus
- ectopic signs (adnexal mass, free fluid)
- the IUD position relative to the pregnancy
Sometimes the first scan cannot locate the pregnancy (a “pregnancy of unknown location”). Close follow-up is essential.
Finding and managing the IUD during pregnancy
If strings are visible, removal may be possible in clinic with sterile technique. If strings are not visible, removal should not be attempted blindly, ultrasound guides the decision.
If an intrauterine pregnancy is confirmed and the IUD can be safely removed, removal is often advised in the first trimester because leaving it in place increases risks like miscarriage, infection (including chorioamnionitis), rupture of membranes, and preterm birth. Early removal can reduce some risk but not remove it fully.
If the IUD cannot be removed, the care plan often involves closer monitoring for bleeding, infection symptoms, and fetal well-being.
Preventing another pregnancy with an IUD in the future
Most pregnancy with IUD situations relate to expulsion, malposition, or using the device beyond its recommended duration. Reviewing what likely happened can help you choose a future method with more confidence.
Fertility returns quickly after IUD removal.
Key takeaways
- Pregnancy with IUD is uncommon but needs prompt assessment.
- The priority is to locate the pregnancy and rule out ectopic pregnancy.
- Do not attempt self-removal.
- Urgent evaluation is needed for one-sided severe pain, fainting/vertigo, heavy bleeding, shoulder-tip pain, or fever.
- If intrauterine and strings are accessible, early clinician removal is often advised, if not visible, ultrasound-guided decision-making is essential.
- If the IUD cannot be removed, closer monitoring is usually planned.
- For personalised guidance and free child health questionnaires, you can download the Heloa app.
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