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Evaluation of the Levonorgestrel-Releasing Intrauterine System Following Difficult Insertion in Perimenopausal Women: A Case Report

Year: 2025

Type: article

Abstract: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-acting reversible contraceptive, offering high efficacy and therapeutic benefits. Although generally safe, mechanical complications such as malposition, perforation, or retained components can occur. We report a case of concealed LNG-IUS arms in a perimenopausal patient following a difficult insertion, illustrating a rare but clinically significant complication. Challenging insertions or removals, particularly in patients with a narrowed cervix or uterine anatomical changes, should raise suspicion for suboptimal device placement. When malposition is suspected, orthogonal two-dimensional (2D) transvaginal ultrasound views can improve visualization and guide management. Awareness of arm retraction within the hormonal sleeve is essential to avoid unnecessary imaging or surgical intervention. Thorough device inspection, including sleeve dissection when required, should be the first step when missing arms are suspected. This report emphasizes the importance of anticipating complications during difficult LNG-IUS insertions or removals and outlines practical diagnostic strategies for suspected malposition, maldeployment, or retained components.

Source: Cureus

DOI: 10.7759/cureus.90186

Authors: Kia Hui Lim, Jill C Lee

Institutions: National University Hospital, KK Women's and Children's Hospital

Language: English

Topic: Reproductive Health and Contraception

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4413379534