You’re probably aware that IUDs, like all forms of birth control, come with a risk of complications. In the case of an IUD, that can be as minor as it falling out or as severe as it puncturing your uterus.

Unfortunately for one woman, her IUD managed to puncture through her uterus and migrate into her abdominal cavity… where it stayed undetected for nearly 11 years, the New York Post reports.

Melinda Nichols got a Mirena IUD in 2007 and saw her doctor for a follow-up visit a few weeks later, where she was given a routine X-ray to make sure it was in place. But her IUD wasn’t seen on the X-ray. Nichols told the New York Post that her doctor simply said it must have fallen out and recommended that she get a new IUD. She refused and decided to have a tubal ligation instead.

Nearly 11 years later, Nichols, who is now 40, thought she had strained a muscle in her back at work. She had an abdominal X-ray to try to see what was going on. It showed that her IUD had punctured her uterus and migrated to her abdominal cavity.

“I had no clue,” she said. “It was in me for almost 11 years.” Nichols also shared a photo of the X-ray of her misplaced IUD on Facebook:

Is it normal for an IUD to move from its original location?

While your IUD can move, it’s rare. “The rate we usually quote is about four per 1,000 IUDs inserted could either fall out or migrate elsewhere in the body,” says Christine Greves, MD, a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies. However, she adds, she’s seen some statistics that say it’s even less than that, at around one per 1,000 IUDs inserted.

Still, this isn’t so rare that doctors never see it. “I’ve seen it happen,” Dr. Greves says. “I’ve had to find an IUD by X-ray and retrieve it.”

Signs your IUD is out of place

Unfortunately, there is a small—but real—risk that your IUD could move out of place or even puncture your uterus. In general, it’s most likely that this will happen when your IUD is inserted or soon after, Dr. Greves says. Worth noting: Women who have a tilted uterus are at a greater risk of this because of the force needed during an IUD insertion and the direction that doctors generally go to insert the device, she says.

If the IUD actually falls out, it’s pretty likely that you’ll see it, Dr. Greves says. If it punctures your uterus, you may have symptoms like pain in the area that the IUD migrated to, severe cramping, and spotting, says women’s health expert Jennifer Wider, MD. But it’s also possible that you’ll have no symptoms at all, she says.

Keep in mind that if you get a hormonal IUD, you should notice lighter periods or no periods at all, Dr. Greves says—and not having those could also be a sign that your IUD is out of place.

What should you do if you suspect your IUD has moved?

Your doctor should take certain steps if they or you suspect your IUD isn’t in place. A follow-up appointment should be scheduled for a few weeks after your IUD is inserted to make sure it’s in the right spot and that may involve an X-ray, Dr. Wider says. If your provider doesn’t schedule this, it’s perfectly acceptable to ask for a follow-up after you have your IUD inserted.

If they can’t find the IUD strings and the device doesn’t show up on an X-ray of your uterus, they should expand the X-ray to check the rest of your pelvic cavity, Dr. Greves says. “You need to search for it,” she says. “If the patient didn’t see it fall out, you need to look elsewhere.”

And, if your doctor is dismissive of your concerns that your IUD may have migrated, Dr. Greves says it’s worth getting a second opinion.

While losing an IUD in your body is a scary risk, this isn’t something you should stay up at night worrying about, says Dr. Wider. “Most users will never experience it, and IUDs causing perforations are rare,” she says.

This article originally appeared on Prevention US. 

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