Ultrasound Obstet Gynecol 2014; 44: 121 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.13414

Picture of the Month Are two intrauterine contraceptive devices better than one? S. GRANBERG Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway

A 47-year-old woman consulted a private gynecologist in April 2013 due to heavy menstrual bleeding. Findings on clinical and ultrasound examination, laboratory testing, cervical cytology and endometrial biopsy were all normal. A Mirena® levonorgestrel-releasing (levonorgestrel 52 mg, 20 μg/24 h) intrauterine device (IUD) (Bayer Healthcare Pharmaceutical) was inserted, but 6 months later she was still suffering heavy menstrual flow. Repeat clinical and ultrasound examinations were performed and no Mirena IUD was located in the uterine cavity. A new Mirena IUD was inserted into the uterine cavity, but the bleeding pattern persisted, with only marginal improvement. In May 2014, the woman presented to our unit. Ultrasound examination revealed the presence of two Mirena IUDs and a submucosal myoma (Figure 1). Histological analysis following hysteroscopy confirmed that the mass was a myoma. This case illustrates that visualization of a Mirena IUD by ultrasound is not always straightforward. The findings of any ultrasound examination are dependent on the skill and experience of the operator, and definitive assessment of the absence of an IUD should be made with caution. Common causes of heavy menstrual bleeding, for example intracavitary focal changes such as polyps and myomas, should always be ruled out before a Mirena IUD is inserted1 .

Figure 1 Three-dimensional rendered image showing presence of two Mirena intrauterine devices and a submucosal myoma.

Reference 1. Hauge K1, Ekerhovd E, Granberg S. Abnormal uterine bleeding refractory to medical therapy assessed by saline infusion sonohysterography. Acta Obstet Gynecol Scand 2010; 89: 367–372.

Correspondence to: Dr S. Granberg, Department of Obstetrics and Gynecology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway (e-mail: [email protected])

Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

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Are two intrauterine contraceptive devices better than one?

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