First, with a caveat -- If your pain is well and truly extreme, then disregard the rest of this comment and seek medical attention soon.
But when I expelled my IUDs, the way I could tell that I was expelling was that I felt the hard tip of the IUD poking out of my cervix. Because the cervix moves around during the menstrual cycle, it's normal for strings to feel different lengths at different points. By itself, feeling the strings wouldn't be an indication of expulsion, even if you haven't felt them before. Similarly, irregular bleeding is common with Mirena, even after the 6-month adjustment period.
If you're concerned, it's never a bad idea to see your health care provider, but I wouldn't necessarily assume you're expelling here.
no subject
But when I expelled my IUDs, the way I could tell that I was expelling was that I felt the hard tip of the IUD poking out of my cervix. Because the cervix moves around during the menstrual cycle, it's normal for strings to feel different lengths at different points. By itself, feeling the strings wouldn't be an indication of expulsion, even if you haven't felt them before. Similarly, irregular bleeding is common with Mirena, even after the 6-month adjustment period.
If you're concerned, it's never a bad idea to see your health care provider, but I wouldn't necessarily assume you're expelling here.