Re: Dueñas-Garcia OF, Young C. 2012. Unusual finding of a metallic intrauterine device in postmenopausal bleeding. Journal of Obstetrics and Gynaecology 32:401–402

Dear Sir,

We read with interest the article by Dueñas-Garcia and Young (2012), which reported an unusual metallic intrauterine contraceptive device (IUCD) found in a woman presenting with postmenopausal bleeding. This article reminded practising physicians that nowadays they may still encounter different types of unusual IUCD during their practice. Therefore, particularly with the popularity of worldwide travelling, physicians should be familiar with the different types of IUCD used not only currently, but also those used in the past, and those IUCDs being used in different parts of the world (Cheung 2010).

It is not only important, but also, in our opinion, challenging and interesting to try to determine the exact type when an unfamiliar IUCD is encountered. Unfortunately, in Drs Dueñas-Garcia and Young's (2012) report, the hysteroscopic picture is not clear enough to allow us to determine the full appearance of the device. We did an extensive search, and based on the metallic nature and the hysteroscopic appearance of the device, we determined that it could be a Yugoslavian M-211 device (Figure 1). It was possible that in this reported case, the two side arms were either deeply embedded in the myometrial wall or pulled up to the uterine cornua, thus leaving only a small middle part (arrow in Figure 1) that could be seen at hysteroscopy.

Figure 1. The M-211 intrauterine contraceptive device. (Courtesy of Museum of Contraception and Abortion (MUVS), Vienna.)

Before attempting hysteroscopic removal of a retained IUCD, it is always useful to have an ultrasound examination and/or an X-ray, not only to locate, but also to determine the presence or absence of the device. A simple X-ray performed on Drs Dueñas-Garcia and Young's patient should have helped significantly to delineate the exact appearance of this metallic IUCD.

It is also interesting to note Drs Dueñas-Garcia and Young's statement in the first paragraph of their report regarding ‘spreading the use of the ring in Canada’, while Dr Cheung, the senior author of this letter, who practiced gynaecology in Canada for over 20 years, was never aware of any rings being inserted in Canada.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.