Removal of Mirena® with fibrous tissue around the arms
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* Amy Elizabeth Davies

*   intrauterine systems

I would like to share a photograph with journal readers. I removed a nulliparous woman’s Mirena® intrauterine system (IUS) recently which had been *in situ* for 2.5 years. The woman had been unhappy with her IUS for a year or so, as she blamed it for some intermittent pelvic pains that she was experiencing. She was in a long-term relationship and experienced intermittent light bleeds with a white discharge that could be heavy at times. An ultrasound scan showed her IUS *in situ* plus an ovarian cyst. Her swabs were normal apart from heavy growth of *Candida*, and she felt much better for a while after this infection was treated. Despite this I removed the IUS at her request and was surprised by its appearance. The arms appeared to be bound by fibrous tissue in a vertical position (figure 1).

![Figure 1](http://jfprhc.bmj.com/https://srh.bmj.com/content/familyplanning/43/4/347/F1.medium.gif)

[Figure 1](http://jfprhc.bmj.com/content/43/4/347/F1)

Figure 1 
Mirena with fibrous tissue around the arms.

I have never seen an IUS with this appearance before and wondered if any other journal readers had encountered this situation. There was some resistance when the IUS was removed, but not to an unusual degree. The woman’s IUS had been fitted by her previous general practitioner and while she recalled the procedure being uncomfortable, at the time she did not experience any adverse symptoms. She was happy for me to share this photograph with journal readers to garner professional opinion about the IUS’ unusual appearance.

## Footnotes

*   Competing interests None declared.

*   Provenance and peer review Not commissioned; internally peer reviewed.