Forgotten Intrauterine Device Causing Postmenopausal Endometritis: A Case Report

Intrauterine devices (IUDs) are among the most widely used long-acting reversible contraceptives. Although generally safe, forgotten or retained IUDs, beyond their intended duration, can lead to complications, particularly in postmenopausal women. We describe an 85-year-old gravida 4, para 4 woman, postmenopausal for 40 years, who presented with yellowish vaginal discharge, groin pain, and vaginal bleeding. Transvaginal ultrasound demonstrated irregular echogenicities within the endometrial cavity, while transabdominal ultrasound showed an echogenic structure with posterior acoustic shadowing, suggestive of a retained IUD. A computed tomography (CT) scan performed six months earlier had also revealed the presence of the device, but no intervention was done at that time. The IUD was successfully removed with forceps, despite the absence of retrieval strings, with purulent discharge noted. Histopathology of endometrial curettage confirmed acute and chronic endometritis with abscess formation, but no evidence of malignancy. Symptoms resolved following removal and antibiotic therapy. Retained IUDs in elderly postmenopausal women may remain undetected for decades and present with bleeding, infection, or incidental imaging findings. Prolonged retention is associated with infectious complications and technical difficulties during retrieval. Guidelines recommend removal once contraceptive need has ceased. This case emphasizes the importance of identifying and removing forgotten IUDs in postmenopausal women to prevent infection, ensure accurate imaging interpretation, and allow safe retrieval.