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Contraception - Management
What should I do if the woman cannot feel the thread(s) of her levonorgestrel-releasing intrauterine system (IUS)?
- If no threads are seen and it cannot be confirmed clinically that the levonorgestrel-releasing intrauterine system is in the uterus, arrange for ultrasonography and recommend alternative contraception in the meantime.
- If ultrasonography cannot locate the device and there is no definite evidence of expulsion, arrange plain abdominal radiography.
- If the abdominal radiograph shows extrauterine placement, refer for surgical retrieval.
Basis for recommendation
- Guidelines published by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), recommend that suspected perforation, lost threads, pregnancy, presence of actinomyces-like organisms, and pelvic infection should be managed as for copper intrauterine device use [FFPRHC, 2004d].
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