Symptomatic and Asymptomatic Dislocation of a Levonorgestrel-Releasing Intrauterine Device in Breastfeeding Women: Two Case Reports and a Brief Literature Review
This paper presents two case reports of levonorgestrel-releasing intrauterine device migration in breastfeeding women—one symptomatic and one asymptomatic—to demonstrate that when transvaginal ultrasonography fails to visualize the device, an abdominopelvic radiograph is essential to confirm extrauterine migration and guide timely laparoscopic removal.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Contraception is a cornerstone of modern reproductive health, offering reliable ways to prevent pregnancy without daily effort. Among the most effective tools are intrauterine devices, small T-shaped objects placed inside the uterus that release hormones or copper to stop fertilization. These devices are generally safe and long-lasting, but like any medical procedure involving the body, they carry a small risk of complications. One such complication is uterine perforation, a rare event where the device pushes through the muscular wall of the uterus and enters the abdominal cavity. This can happen immediately during insertion or develop slowly over time as the uterus contracts. While often silent, a displaced device can cause pain or migrate to other organs, making it crucial for doctors to know how to find and remove it when it goes missing.
Two researchers from Vilnius University in Lithuania recently shared the stories of two women who experienced this exact problem while breastfeeding. Both women had received a hormone-releasing intrauterine device shortly after giving birth, a time when the uterus is still recovering and the body is producing milk. In the first case, a thirty-five-year-old woman felt persistent pain in her lower abdomen right after the device was placed. Although an initial ultrasound scan showed the device was inside the uterus, her pain did not go away. A follow-up scan later showed the device was gone from the uterus, leading doctors to believe it had been expelled naturally. However, because her pain continued, she sought a second opinion. A simple X-ray of her abdomen revealed the truth: the device had not fallen out of her body at all. It had pushed through the uterine wall and was sitting in her pelvic cavity. Surgeons removed it through a small incision using a camera, and she recovered without further issues.
The second story offers a stark contrast. A twenty-nine-year-old woman had the same type of device inserted three months after her delivery. A year later, during a routine check-up, a doctor could not see the strings of the device and an ultrasound could not find it inside the uterus. Unlike the first patient, this woman felt perfectly fine and had no pain or discomfort. Because the device was missing from the expected location, an X-ray was performed. The image showed the device had migrated outside the uterus and was resting against the fatty tissue that covers the intestines. Just like the first patient, the device was successfully removed through minimally invasive surgery, and the woman remained asymptomatic throughout the entire process.
These two cases highlight a critical lesson for medical practice: the absence of pain does not guarantee safety, and the presence of pain does not always mean the device has been expelled. When a device cannot be seen inside the uterus on an ultrasound, doctors must not assume it has simply fallen out. The authors explain that a plain X-ray is an essential next step to determine if the device is still inside the body but in the wrong place, or if it has truly been lost. This distinction is vital because a device left inside the abdomen can cause serious long-term problems, such as infections, blockages, or damage to nearby organs like the intestines or bladder.
The paper also reviews why this risk is higher for women who are breastfeeding. During lactation, the body produces high levels of a hormone called prolactin, which suppresses estrogen and keeps the uterine lining thin. At the same time, the hormone oxytocin, which helps release milk, causes the uterine muscles to contract more frequently. This combination of a thinner wall and stronger contractions may make it easier for a device to slowly work its way through the uterine muscle and into the abdominal cavity. The authors note that while the overall risk of this happening remains low, it is significantly higher in the months following childbirth, particularly for women who are nursing.
Ultimately, the report serves as a reminder that medical tools are not infallible and that the body can react in unexpected ways. The researchers conclude that when a device is missing from its usual spot, a quick X-ray is the only way to be sure it has not migrated into the abdomen. By catching these silent or confusing cases early, doctors can remove the device before it causes harm, ensuring that a highly effective form of contraception does not become a source of hidden danger.
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