Hysteroscopic management of displaced levonorgestrel‐releasing intrauterine system

Kužel, D; Hrazdírová, L; Kubínová, Kristýna; Dundr, Pavel; Cibula, David; Mára, Michal

doi:10.1111/jog.12007

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Following application, the LNG-IUS may drop from the uterine cavity or some patients may request the removal of the system due to dissatisfaction for various reasons [46]. In the present study, the rate of continuation of LNG-IUS use was 90.2% at the end of 6 months and 84.6% at the end of 12 months.…”

Section: Discussionmentioning

confidence: 44%

Effect of Levonorgestrel-Releasing Intrauterine System on Sexual and Urinary Functions

Arlıer¹,

Uysal²,

Nazık³

et al. 2017

Journal of Gynecology Research

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Section: Discussionmentioning

confidence: 44%

Effect of Levonorgestrel-Releasing Intrauterine System on Sexual and Urinary Functions

Arlıer¹,

Uysal²,

Nazık³

et al. 2017

Journal of Gynecology Research

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“…The repositioning of displaced IUDs has been commonly performed using hysteroscopy 15,16 . The first study that described repositioning of displaced 52-mg LNG IUDs in 113 cases reported a success rate of 99.1% (112/113), with only two cases of expulsion within 6 months after the procedure 15 . Despite the high success rate of the hysteroscopic IUD repositioning, this procedure requires a specialized team and involves high costs, which can be less cost-effective than the removal and replacement of the displaced IUD with a new one.…”

Section: Discussionmentioning

confidence: 99%

“…Data on IUD expulsion beyond 6 months of the procedure were not available. Nevertheless, no other IUD repositioning studies have presented expulsion data after 6 months of the procedure 9,15 . Our expulsion rate within 6 months was 17.6% (9/51), similar to that reported in the study of Ber and Seidman 9 , in which IUD repositioning was performed without ultrasound guidance (3/17; 17.6%).…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Yamaguti

Reis

Martins³

et al. 2023

Ultrasound in Obstet & Gyne

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Objective To describe the feasibility of an ultrasound‐guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. Methods This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6‐month follow‐up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. Results We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound‐guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow‐up. No uterine perforation or infection‐related complications occurred within 6 months of the procedure. Conclusion The ultrasound‐guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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“…Of these, the device moved downward again within 2 months in three cases, with 14 remaining in their normal position 6 months after restoration; the success rate of restoration was 78.0%. Kuzel et al 10 evaluated the effectiveness of symptom relief with hysteroscopic restoration of symptoms associated with downward displacement of the LNG‐IUS position; they found that 110 of 113 patients had a correct IUS position 6 months after restoration. In these studies, high success rates were only indicative of short‐term performance (up to 6 months after repositioning), whereas device retention rates 1, 2, 3, and 5 years after repositioning were not reported.…”

Section: Discussionmentioning

confidence: 99%

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Hong¹,

Wang²,

Fu³

et al. 2021

J of Obstet and Gynaecol

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Aim: The levonorgestrel-releasing intrauterine (LNG-IUS) system is an effective primary treatment for adenomyosis; however, it has high expulsion rates. We aimed to modify the system-allowing affixion to the myometrium-and evaluate the expulsion rate, effectiveness, and side effects in patients with adenomyosis and heavy menstrual bleeding. Methods: This study included patients with adenomyosis and heavy menstrual bleeding who underwent implantation of: a modified LNG-IUS (experimental group, n = 47); and the original system after gonadotropin-releasing hormone agonist treatment (control group, n = 47), between January 2014 and April 2016. Results: In the experimental group, two device expulsions occurred 12-18 months postimplantation. In the remaining 45 patients, the system was safely removed after the 60-month validity period, and no extrauterine device movement or infection occurred. In the control group, downward displacement and expulsion of the device occurred in eight (17%) patients within 60 months. The 5-year total expulsion rates were 4.3% and 17.0% in the experimental and control groups, respectively (p = 0.045). There were significant changes in the pretreatment severity of dysmenorrhea, menstrual volume, uterine volume (cm 3 ), and hemoglobin level in each group compared with after 1 year (p < 0.01 in all groups). The severity of dysmenorrhea, menstrual volume, uterine volume, and hemoglobin level after 1 year were similar between the two groups (p > 0.05 in all groups). Conclusions: Use of the modified LNG-IUS is a safe, cost-effective, and simple method for reducing the downward movement and expulsion rate in patients with adenomyosis and heavy menstrual bleeding.

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Hysteroscopic management of displaced levonorgestrel‐releasing intrauterine system

Abstract: Displaced LNG-IUS can cause clinical symptoms (e.g. irregular bleeding, pain). Hysteroscopic relocation of displaced LNG-IUS is a feasible method in the management of these symptoms. Risk of spontaneous expulsion associated with hysteroscopy is low.

Cited by 5 publications

References 12 publications

Effect of Levonorgestrel-Releasing Intrauterine System on Sexual and Urinary Functions

Effect of Levonorgestrel-Releasing Intrauterine System on Sexual and Urinary Functions

Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

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