Cervical cancer in 2 women with a Mirena®-pitfalls in the assessment of irregular bleeding: a case series

INTRODUCTION The levonorgestrel-releasing intra-uterine device (Mirena(R)) 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(R) users and may thereby mask underlying cervical pathology. CASE PRESENTATION Two women with cervical cancer and a Mirena(R) initially presented with irregular bleeding, posing a diagnostic pitfall which resulted in doctor and patient delay. CONCLUSION Proper evaluation of irregular vaginal bleeding, including cervical cytology, should be a prerequisite among all women opting for a Mirena(R) and must be repeated in case of persisting symptoms.