As Intrauterine Device (IUD) use increases, clinicians will confront the problem of missing IUD strings more often. What’s the best way to manage missing IUD strings? Sweeping the endocervix with a cervical cytology brush can release strings that are curled inside the endocervical canal. This straightforward procedure succeeds in most cases. However, if the clinician is unable to locate the strings with a cytobrush, an ultrasound should be used to locate the IUD. If the IUD is located in normal uterine position on ultrasound examination and the patient wants to keep the IUD, the patient needs no follow-up until she wishes to have the IUD removed. If the patient wants to have the IUD removed, the clinician can try grasping the strings with thin Alligator or Kelly forceps. Alternatively, an IUD string retriever (which looks like a small crochet hook) may succeed in bringing the strings down. A #5 cannula can also be inserted and suction placed on it to draw the strings down. A paracervical block can help with the discomfort of the probing associated with these procedures. A small number of women need hysteroscopy or surgery to remove the IUD. We appreciate your feedback! Please write to us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.   Sources Prabhakaran S, Chuang A. In-office retrieval of intrauterine contraceptive devices with missing strings.Contraception. Feb 2011. 83(2); 102-106.    Pharma-free The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.