A 43 year old woman came to me with irregular bleeding despite being on birth control pills. Her OB/GYN had inserted a Mirena® IUD 7 months ago, which failed to stop her irregular bleeding.
A 43 year old woman came to me with irregular bleeding despite being on birth control pills. Her OB/GYN had inserted a Mirena® IUD 7 months ago, which failed to stop her irregular bleeding. During her first visit with me I did a vaginal ultrasound, which showed an almond size fibroid in the uterine cavity. We did an office hysteroscopy, and saw the IUD resting on the fibroid.
The IUD was removed. Since she was not planning any more children, we removed the fibroid by hysteroscopic myomectomy, and did an endometrial ablation at the same time as an outpatient procedure.
Comment: The Mirena® IUD (LNG-IUS) is often effective in treating heavy periods, but a fibroid inside the cavity can interfere. I always recommend doing a simple ultrasound exam in women with abnormal bleeding before deciding on a treatment. Other studies such as diagnostic hysteroscopy may also be done, as only with proper diagnosis can appropriate treatment be planned. In her situation a simple outpatient procedure was able to solve her bleeding problem. - Paul Indman, M.D.
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