Spontaneous breakage and expulsion of a stem fragment of levonorgestrel intrauterine system (Mirena) following duplicate insertion

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Removal and changing an intra-uterine device (IUD) involves good history taking, a proper examination and appropriate experience in fitting IUDs.


We present a case of a woman who had two insertions of the levonorgestrel intrauterine system (LNG-IUS) which was diagnosed only at hysteroscopy when she presented with the spontaneous expulsion of a vertical stem of one of the devices.


This is a unique case where two LNG-IUS were inserted in error and hence it teaches the clinicians the importance of good training and being aware of the possibility of the missing thread which deserves further investigations especially when such cases are encountered in a busy general practice.

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