Know the Anatomy of Your Intrauterine Device: A Case of Hormonal Sleeve Displacement Resulting in Concerns Over Foreign Body Loss

TL;DR

A case is described where a woman's IUD appeared to have fragments left behind, but it was actually due to the device's hormonal sleeve shifting during removal.

Contribution

This case highlights a previously unreported phenomenon of hormonal sleeve displacement during IUD removal.

Findings

The hormonal sleeve of the IUD slid over the arms during removal, creating a false appearance of an armless device.

This issue occurred in two separate removals for the same patient, leading to unnecessary diagnostic procedures.

The phenomenon is not widely documented in medical literature beyond a UK healthcare guideline.

Abstract

Intrauterine devices (IUDs) are one of the most commonly used forms of long-term reversible contraception and are also used for treating gynaecological conditions such as dysmenorrhea, endometrial hyperplasia, and abnormal uterine bleeding. While IUDs have a high safety profile, complications may occur during insertion, use, and removal. IUD fragmentation is a rare but potential complication, in which patients may be subjected to invasive management. We describe a 52-year-old female patient who, after having her levonorgestrel IUD removed, was mistakenly believed to have IUD remnants in her uterus. The removed device was found to be bilaterally armless, subjecting her to hysteroscopy. In her previous removal, the same phenomenon occurred, leading to a pelvic X-ray. It was discovered that the device’s hormonal sheath slid over both arms upon removal, most likely due to a narrowed cervical canal, giving the false appearance of an elongated armless device. To our knowledge, there has been no reported literature on this occurrence apart from being described in the United Kingdom's Faculty of Sexual and Reproductive Healthcare Guideline on Intrauterine Contraception.

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