Ibrahim Sozen1, Kelly Morgan, John S Shannon. 1. Department of Obstetrics and Family Medicine, Penobscot Valley Hospital, Lincoln, Maine 04457, USA. isozen@hanfqhc.org
Abstract
BACKGROUND: Although the Dalkon Shield intrauterine device (IUD) was removed from the market in the early 1970s, some women currently in their late 50s and early 60s may still have the Shield in their uteri. An IUD retained for a long time is very rare but can be a cause of postmenopausal bleeding. CASE: A 58-year-old, postmenopausal woman presented with vaginal bleeding and spotting of 8 months' duration. Careful investigation of her history revealed that she had undergone IUD placement 33 years earlier. She was not sure about the type and whether the IUD was removed or expelled subsequently. There was no string visualized in the vagina. An office endometrial biopsy revealed Actinomyces and an associated polymorphonuclear cell exudate. A retained Dalkon Shield was diagnosed and removed hysteroscopically. CONCLUSION: Providers should include "retained IUD" in the differential diagnosis of postmenopausal bleeding. In addition to endometrial biopsy, hysteroscopic evaluation of the uterine cavity is a valuable tool in the diagnosis and treatment of such bleeding. A retained IUD may cause postmenopausal bleeding secondary to chronic endometritis or migration into the uterine wall. Hysteroscopic dislodgement and removal may be challenging due to chronic embedding within the uterine wall.
BACKGROUND: Although the Dalkon Shield intrauterine device (IUD) was removed from the market in the early 1970s, some women currently in their late 50s and early 60s may still have the Shield in their uteri. An IUD retained for a long time is very rare but can be a cause of postmenopausal bleeding. CASE: A 58-year-old, postmenopausal woman presented with vaginal bleeding and spotting of 8 months' duration. Careful investigation of her history revealed that she had undergone IUD placement 33 years earlier. She was not sure about the type and whether the IUD was removed or expelled subsequently. There was no string visualized in the vagina. An office endometrial biopsy revealed Actinomyces and an associated polymorphonuclear cell exudate. A retained Dalkon Shield was diagnosed and removed hysteroscopically. CONCLUSION: Providers should include "retained IUD" in the differential diagnosis of postmenopausal bleeding. In addition to endometrial biopsy, hysteroscopic evaluation of the uterine cavity is a valuable tool in the diagnosis and treatment of such bleeding. A retained IUD may cause postmenopausal bleeding secondary to chronic endometritis or migration into the uterine wall. Hysteroscopic dislodgement and removal may be challenging due to chronic embedding within the uterine wall.