Retained Intrauterine Device as an Unusual Cause of Postmenopausal Bleeding

Postmenopausal bleeding (PMB) is a common problem in postmenopausal women, occurring in as many as 10% of women over than 55 years of age. A 66-year-old woman, gravida 3, para 3, presented with a complaint of PMB last for one week. Careful investigation of her history revealed that she had undergone intrauterine device (IUD) placement 30 years previously. She was not sure whether the IUD had been subsequently removed or expelled. There was no string noted in the vagina. Transvaginal sonography revealed a small uterine myoma with thin endometrium (4 mm). Faint acoustic shadow near the cervix was also noted. A retained IUD was highly suspected. Hysteroscopy was then performed and an IUD fragment in the lower segment of the uterus was found. After removal of this IUD fragment, her PMB resolved. Presence of a foreign body, such as an IUD, should be considered in the differential diagnosis of PMB. Hysteroscopy should be performed for PMB especially when IUD removal or expulsion cannot be confirmed.