Clinical Relevance and Symptom Patterns for Malpositioned Intrauterine Devices

OBJECTIVES: To evaluate the relationship between intrauterine device (IUD) malposition and patient-reported symptoms, identify risk factors associated with malposition, and assess the reliability of string checks compared with ultrasound findings. METHODS: A retrospective chart review was conducted at West Virginia University between January 2021 and December 2023. Patients with malpositioned IUDs identified by pelvic ultrasound were included. Data collected included demographics, body mass index (BMI), IUD type, provider type, anatomical abnormalities, symptom profiles, and string check findings. Descriptive statistics were used to summarize the data, and associations with types of IUD malposition were assessed in the statistical analysis. RESULTS: A total of 175 patients with malpositioned IUDs were identified. Approximately half of the patients were symptomatic (53.1%), most commonly reporting pelvic pain or abnormal uterine bleeding, while 46.9% were asymptomatic. Low intrauterine placement was the most frequent malposition pattern. String visualization was common but did not reliably exclude malposition. No demographic, device, or provider characteristics were significantly associated with specific malposition types. CONCLUSIONS: Nearly half of patients with malpositioned IUDs were asymptomatic, and visible strings were frequently present, highlighting the limitations of symptom assessment and string checks. Ultrasound plays a central role in evaluating IUD position when clinical concern exists.