An unusual shaped IUS.

A 45-year-old nulliparous woman attended for removal and replacement of a levonorgestrel-releasing intrauterine system (IUS) for continued management of dysmenorrhoea. I had placed the IUS some 6 years previously under a cervical block, needing to dilate the tight cervical canal for insertion. The patient’s periods had been well controlled. The IUS was easily removed but, as pictured, the arms of the device were sheathed in the everted hormone cylinder (Figure 1). A new device was inserted under local anaesthesia, without need for dilation. Have any Journal readers seen something similar, I wonder?