Dual Intrauterine Device Placement for Refractory Endometriosis Pain in a Bicornuate Uterus: A Case Report

A 27-year-old nulliparous woman presented with chronic pelvic pain (CPP) (8/10 on the Numerical Rating Scale (NRS)), dysmenorrhea, heavy menstrual bleeding (HMB), and a family history of endometriosis. She had failed treatment with an etonogestrel implant and dienogest. Hysteroscopy confirmed a bicornuate uterus. Under direct hysteroscopic guidance, two levonorgestrel-releasing intrauterine systems (LNG-IUS) were inserted, with one device placed in each uterine horn. At the four-month follow-up, the patient reported a significant reduction in pain (2/10 on the NRS), dysmenorrhea, and bleeding, with ultrasound confirming correct device placement. At six months, her pain score had decreased to 1/10. Dual LNG-IUS insertion under hysteroscopic guidance represents a minimally invasive and effective strategy for managing endometriosis-related pain in patients with a bicornuate uterus when conventional therapies are inadequate. Long-term follow-up and regular monitoring are warranted to assess for potential side effects.