Mirena® removal from a nulliparous woman.

I recently removed a Mirena® intrauterine system (IUS) from a lady who had a tight nulliparous cervix. I had to pull on the threads fairly fi rmly to get the IUS to come out from the cervix. When the IUS came out I noticed that the levonorgestrel-containing cylinder had become displaced and was near the top of the ‘arms’ of the IUS (Figure 1). I have never dilated a cervix for an IUS/ intrauterine device removal but perhaps, in retrospect, in this case it might have been a good idea. I was concerned that if the cylinder had become further displaced, it might have remained inside the uterine cavity after the main body of the IUS had been removed.