Abstract
IntroductionThe levonorgestrel-releasing intra-uterine device (Mirena®) is an effective, long term form of contraception that leads to a significant reduction of menstrual bleeding among majority of women. However, irregular bleeding is quite common in initial Mirena® users and may thereby mask underlying cervical pathology.Case presentationTwo women with cervical cancer and a Mirena® initially presented with irregular bleeding, posing a diagnostic pitfall which resulted in doctor and patient delay.ConclusionProper evaluation of irregular vaginal bleeding, including cervical cytology, should be a prerequisite among all women opting for a Mirena® and must be repeated in case of persisting symptoms.
Highlights
The levonorgestrel-releasing intra-uterine device (Mirena®) is an effective, long term form of contraception that leads to a significant reduction of menstrual bleeding among majority of women
A 40-year old nulligravida was referred to our outpatient clinic because of menorrhagia and irregular bleeding since 2 years, unresponsive to oral contraceptives
As our first case illustrates, a Pap smear should be repeated regardless of prior findings if new symptoms develop or irregular bleeding persists. It is questionable whether it was correct to attribute the ongoing irregular bleeding to the fibroid alone since no new cervical cytology was obtained at time of initial referral
Summary
The Mirena® (levonorgestrel-releasing intra-uterine device) has proven to be an effective, long term and reversible form of contraception that leads to a significant reduction (90%) of menstrual bleeding among the majority of women [1]. A 40-year old nulligravida was referred to our outpatient clinic because of menorrhagia and irregular bleeding since 2 years, unresponsive to oral contraceptives Her general practitioner obtained a Papanicolaou (Pap) smear at initial presentation of symptoms, which revealed no abnormalities. A 29-year-old woman was referred by her general practitioner 2 months after delivery of her first child for insertion of a Mirena® Her medical history revealed no prior gynaecological problems and she had no history of abnormal cervical cytology. As our first case illustrates, a Pap smear should be repeated regardless of prior findings if new symptoms develop or irregular bleeding persists It is questionable whether it was correct to attribute the ongoing irregular bleeding to the fibroid alone since no new cervical cytology was obtained at time of initial referral. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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