Successful management of intractable menorrhagia with a levonorgestrel-releasing intrauterine device, in a woman with a bicornuate uterus

CT imaging of intrauterine devices (IUD): expected findings, unexpected findings, and complications

Intrauterine devices (IUDs) are a commonly used form of long-acting reversible contraception, which either contain copper or levonorgestrel to prevent pregnancy. Although symptomatic patients with indwelling IUDs may first undergo ultrasound to assess for device malposition and complications, IUDs are commonly encountered on CT in patients undergoing evaluation for unrelated indications. Frequently, IUD malposition and complications may be asymptomatic or clinically unsuspected. For these reasons, it is important for the radiologist to carefully scrutinize the IUD on any study in which it is encountered. To do so, the radiologist must recognize that normally positioned IUDs are located centrally within the uterine cavity. IUDs are extremely effective in preventing pregnancy, though inadvertent pregnancy risk is higher with malpositioned IUDs. Presence of fibroids or Mullerian abnormalities may preclude proper IUD placement. Radiologists play an important role in identifying complications when they arise and special considerations when planning for an IUD placement. There is a wide range of IUD malposition, affecting IUDs differently depending on the type of IUD and its mechanism of action. IUD malposition is the most common complication, but embedment and/or partial perforation can and can lead to difficulty when removed. Retained IUD fragments can result in continued contraceptive effect. Perforated IUDs do not typically cause intraperitoneal imaging findings.

Levonorgestrel intrauterine system (IUS) in a patient with uterine didelphys: A case report

This case demonstrates the use of a single levonorgestrel 13.5 mg intrauterine system (IUS) for contraception in a patient with uterine didelphys. IUS are contraindicated for use with Congenital Müllerian uterine anomalies, but there is very limited evidence to support this restriction.

Management of menorrhagia with hydrothermal endometrial ablation in 2 women with bicornuate uteri

The majority of second generation endometrial ablation techniques are contraindicated in abnormal shaped uteri. We present two cases of bicornuate uteri with menorrhagia that have been successfully treated with Hydrothermal Ablation (HTA). To our knowledge this is the first report that describes the application of HTA in bicornuate uteri. One treatment was adequate to treat one of the patients, but in the other patient each cavity had to be treated separately. Both women were amenorrheic six months after the operation. We consider HTA as a safe alternative to hysterectomy in women with menorrhagia and congenital uterine abnormalities since simultaneous hysteroscopic view of the endometrial cavity allows proper adjustment of the procedure according to the shape of the uterus.