Migration of levonorgestrel IUS in a patient with complex medical problems: what should be done?

Patients with complex medical problems should be counselled about the need for highly effective contraception. As failure resulting in pregnancy, could cause significant morbidity and mortality. The LNG-IUS has gained great popularity and generally has a low side effect profile; however, perforation of the uterus and migration of the device is a potentially serious complication known to be associated with its use. The current accepted management is removal of the device from the abdominal cavity in order to prevent further morbidity. However this is not always a simple matter in patients who have complex medical problems and who are deemed unfit for surgery. Each time the patient comes for renewal of the contraceptive method, clinicians need to reassess the risks and benefits. This is particularly relevant in patients who have complex medical problems where special attention needs to be given, not only to immediate risks but also to long-term ones. Careful individualised counselling and consideration are paramount and perhaps it would have been prudent to discuss vasectomy with this patient and her husband (as the first line of contraception), as this may have avoided the ensuing complications arising from the chosen method.