Why strings matter
An IUD’s strings are how the device is checked and how it comes out. Under normal standards of care, an IUD is placed and removed in the office, and removal is done with instruments that never enter the cervix.
A complicated removal is any removal that needs more than that: additional instrumentation into the cervix or uterus, ultrasound-guided removal, or hysteroscopic removal in the operating room. By far the most common reason is strings that are barely visible or not visible at all at the external cervical os — nothing to grasp, so removal escalates.
The consequences are real: unnecessary pain from invasive instrumentation, repeated removal attempts, imaging costs, the risks of surgery and anesthesia, and damage to trust in a highly effective contraceptive. The burden lands hardest where ultrasound and gynecology specialists are scarce.
Nearly all complicated IUD removals due to nonvisible strings are preventable.
The Safestring concept
The concept proposed in the project’s clinical materials: mark IUD strings in 1-centimeter increments, giving string length an objective, visual, and enduring measure.
The deck’s working sketch goes further — marked zones that tell a clinician at a glance when strings are safe to trim and when they are already too short to cut.
Marking turns “about 3 centimeters” from a visual approximation into something a patient and a clinician can both verify — at placement, at follow-up, and at removal.
How this could help
Marked strings would let clinicians follow string-length guidance objectively instead of by eye, document real lengths instead of estimates, and notice change over time.
They would also make better evidence possible: studies could finally compare string length at removal between complicated and uncomplicated cases — the study the project is asking manufacturers and the FDA to run.
These are proposals to be tested, not proven claims. The campaign asks the people who can test them to do so and publish what they find.
A systems problem, not a blame problem
This project is deliberately not about changing individual provider behavior one clinician at a time. The contributing factors are systemic.
Manufacturer instructions differ by brand — one product says cut the threads to “about 3 cm,” another says “3 to 4 cm.” Professional resources differ again. And because no strings are marked, every cut is a visual approximation no one can verify afterward.
The project also asks for transparency at the system level: honest discussion of complicated-removal risk as part of informed consent before every placement, and truthful disclosure of those risks in manufacturer advertising — not minimization or omission.
Sources and review
This page is adapted from the project’s internal clinical summary and deck, written by the project’s physician founder. Statistics and clinical statements are being verified against the primary literature and reviewed before launch; nothing here is final medical language.
Source citations pending medical review