IUD String Check Follow-Up: Timing and Recommendations
No routine follow-up visit is required after IUD placement for string checks, as patients should be advised to return only if they have concerns or problems. 1
Evidence-Based Recommendations for Post-IUD Placement Follow-Up
The CDC's Selected Practice Recommendations for Contraceptive Use provides clear guidance on follow-up after IUD insertion:
- No routine follow-up visit is specifically required for IUD string checks
- Patients should be advised to return at any time to discuss side effects, problems, or if they want to change methods 1
At Other Routine Healthcare Visits
When IUD users are seen for other healthcare visits, providers should:
- Assess satisfaction with the contraceptive method
- Evaluate any health status changes that might affect IUD appropriateness
- Consider performing an examination to check for the presence of IUD strings 1
String Visibility and Monitoring
String visibility varies based on insertion method:
- String visibility is significantly higher after vaginal insertions (98.1%) compared to post-cesarean insertions (72.4%) 2
- When strings are not visible, ultrasound can confirm proper IUD placement 2
Evidence Against Routine Follow-Up Visits
Research shows limited value in scheduled follow-up visits:
- A technology assessment study found that regular follow-up after IUD insertion is not effective for preventing complications 3
- Women with scheduled follow-up visits actually had more unscheduled visits (RR: 1.6; 95% CI: 1.03-2.4) 3
- Despite recommendations to forgo the 6-week follow-up visit, these visits remain common with no demonstrated value added 4
Patient Self-Checking of Strings
Research on patient self-checking of IUD strings shows:
- Only about 59% of women report attempting to check their own IUD strings 5
- Of those who try, approximately 66% successfully feel the strings 5
- Overall, only about 46% of IUD users are both willing and able to palpate their IUD strings 5
- Counseling women to check their strings is associated with greater willingness to attempt palpation (adjusted OR 9.64,95% CI 3.57-26.04) 5
Important Considerations for Providers
When to Evaluate for Complications
Patients should be advised to seek care if they experience:
- Severe pain after IUD insertion (unusual and warrants evaluation) 6
- Persistent abnormal bleeding that doesn't improve with NSAID treatment 6
- Signs of infection or pregnancy
Common Pitfalls to Avoid
Unnecessary follow-up visits: Scheduling routine visits without clinical indication increases healthcare costs without improving outcomes 3, 4
Failure to counsel on self-checking: Patients who receive instruction on string checking are more likely to attempt it 5
Overreliance on string visibility: Lack of visible strings doesn't necessarily indicate expulsion, especially after cesarean delivery 2, 7
Unnecessary ultrasounds: Reserve ultrasound for cases where complications are suspected, not as routine follow-up 1
In summary, while routine follow-up visits for IUD string checks are not necessary according to current guidelines, patients should be counseled on when to seek care and how to check their strings if they wish to do so.