Mirena® removal from a nulliparous woman
=========================================

* Alex Manning

I recently removed a Mirena® intrauterine system (IUS) from a lady who had a tight nulliparous cervix. I had to pull on the threads fairly firmly to get the IUS to come out from the cervix. When the IUS came out I noticed that the levonorgestrel-containing cylinder had become displaced and was near the top of the ‘arms’ of the IUS (Figure 1). I have never dilated a cervix for an IUS/intrauterine device removal but perhaps, in retrospect, in this case it might have been a good idea. I was concerned that if the cylinder had become further displaced, it might have remained inside the uterine cavity after the main body of the IUS had been removed.

![Figure 1](http://jfprhc.bmj.com/https://srh.bmj.com/content/familyplanning/37/3/191.2/F1.medium.gif)

[Figure 1](http://jfprhc.bmj.com/content/37/3/191.2/F1)

Figure 1 
The displaced levonorgestrel-containing cylinder can be seen near the top of the ‘arms’ of the intrauterine system.

I was wondering if other readers had come across this situation?

## Footnotes

*   Competing interests None.