One successful intrauterine device into a uterus, didelphys: a case report and literature review

Abstract

Uterus didelphys represents a uterus malformation where the uterus is present as a double organ due to embryonic fusion failure of the mullerian ducts. As a result, there is a double uterus with separated cervices. This congenital malformation used to be a controversial contraindication of an intrauterine device (IUD) insertion. It is a category 4 WHO medical eligibility criteria: not being used because of its association with a high risk of IUD expulsion, malposition into the uterus, uterine perforation and its migration into the abdominal cavity and viscera. We present and discuss the case of a 35-year-old woman, P4+6, known with uterus didelphys who came to our outpatient clinic for family planning. She was counselled about all available methods and opted for a levonorgestrel IUD (LNG-IUD). We inserted the device into one of her double uterus and she is fully satisfied with the method now one year and three months ago. Levonorgestrel IUD is a long acting, highly effective and reversible form of contraception that works mainly by thickening of the cervical mucus and also by thinning the endometrial lining. Considering its effect on the endometrium and the cervical mucus; and its high level of progesterone pelvic release, we think one LNG-IUD contraception into one of the double uterus is enough and effective in individualized and known women with such condition instead of two IUDs, one being into each uterus, such published in all articles we read through. The purpose of this case report is to demonstrate that only one LNG-IUD contraception can be sufficient and effective method in known and selective women with uterus didelphys. However a case-series study is needed for more evidence.