Management of the malpositioned levonorgestrel-releasing intrauterine system.
BACKGROUND
The management of a malpositioned levonorgestrel (LNG)-releasing intrauterine system (IUS) can present a clinical challenge, complicated by the high cost of replacing it with a new device. We tried to challenge the guidelines and common practice that usually suggest prompt removal of any malpositioned IUS and replacement with a new one.


METHODS
We present our experience with 18 patients in whom the LNG-releasing IUS was found during a routine sonographic evaluation to be displaced towards the cervical canal 2 to 36 months postinsertion. Using an alligator forceps, the device was repositioned in the uterine cavity.


RESULTS
The procedure was deemed successful in 17 (94.4%) of 18 cases. In 3 (17.6%) of the 17 successful procedures, the LNG-releasing IUS was found again to be malpositioned within 2 months. No complications were noted, and no postprocedural infection occurred.


CONCLUSIONS
Repositioning of a malpositioned LNG-releasing IUS should be considered, as it is an easy and simple manipulation that can be done in the office with a high success rate and minimal risk of complications.
Maccabi Health Care Services, 68125 Tel-Aviv, Israel.
Amos
A
Ber
Daniel S
DS
Seidman
D000328:Adult; D005260:Female; D006801:Humans; D058736:Intrauterine Device Migration; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies
D016912:Levonorgestrel