Forgotten Intrauterine Contraceptive Device as an Uncommon Cause of Postmenopausal Bleeding

Author Information

Shila Chakre*, N M Mayadeo**, Sachin Pardeshi*
(* Assistant Professor, ** Professor. Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Mumbai, India.)


Postmenopausal bleeding is a common presenting complaint of patients in the gynecology outpatient department. Its incidence is 5 to 10%.[1,2] The most common cause for postmenopausal bleeding  is atrophic vaginitis and uncommon cause is retained or forgotten intrauterine contraceptive device.[3] Our case report presents forgotten intrauterine contraceptive device, an uncommon but simple to manage cause of postmenopausal bleeding, in a 58 year old multiparous patient. Simple removal of this device resulted in resolution of symptoms.


Postmenopausal bleeding is genital tract bleeding occurring more than 1 year after the last menstrual period. It is only a presenting symptom of the underlying pathology and not specific for the site of bleeding. Causes of postmenopausal bleeding are endometrial polyp, endometrial hyperplasia, external use of estrogens, atrophic endometritis, endometrial cancer, genital prolapse, forgotten intrauterine device (IUD), cervical cancer, uterine sarcoma, granulosa cell tumor of the ovaries and urogenital schistosomiasis.[3] As endometrial pathology like endometrial hyperplasia or cancer is common in postmenopausal women, and hence its evaluation is essential.[4] Management of postmenopausal bleeding depends upon the cause. Postmenopausal bleeding due to forgotten or retained intrauterine contraceptive device is simple to manage, as its removal leads to resolution of the symptom.

Case Report

A 58 year woman, old para four, living four, postmenopausal for 10 years, presented to the gynecology outpatient department with two episodes of bleeding per vaginum. The first episode was one month back, which lasted for two days with soakage of one pad per day. The second episode was two days back, which was similar in nature. There was no medical or surgical illness. There was no bowel or bladder complaint. General and systemic examination was normal. On abdominal examination, no mass was felt. On per speculum examination, the cervix and vagina were atrophic. On per vaginum examination, the uterus was of less than normal size and bilateral fornices were clear. Pap smear was atrophic. Ultrasonography was suggestive of  anteverted uterus with dimension of 6×5×4 cm with endometrial thickness of 5 mm. There was an acoustic shadow in the uterine cavity which was suggestive of an endometrial polyp or a blood clot. A fractional curettage was performed. The endocervical sample was scanty. While curetting the endometrium, a grating sensation was felt. Surprisingly, a white round knob of an IUD was seen at external os. It was held with a hemostat and removed. It was calcified. The uterine cavity was regular. Endometrial sample was also scanty. Both endometrial and endocervical sample sent for histopathology. Retrospectively when asked, patient had given the history of a copper T insertion but she had no memory of removal or expulsion of the copper T. She was discharged on day 2. Histopathology report was normal. On follow up, patient complaint were resolved.


Postmenopausal bleeding may be due to a serious pathology. Among the causes, endometrial cancer is a serious cause. Its evaluation is done with clinical examination, along with endometrial aspiration, transvaginal ultrasonography (TV USG) and curettage. With endometrial aspiration, serious pathology can be missed. On TV USG, endometrial thickening and heterogeneity suggestive of endometrial cancer has false negative report.[2,5]
Hysteroscopy with dilatation and curettage is standard investigation for postmenopausal bleeding.[6] Vaginal bleeding is common after the insertion of IUD in younger patients, but is uncommon as a cause of postmenopausal bleeding. IUD can lead to abnormal uterine bleeding either by chronic inflammatory reaction or by embedding, displacing or migrating into uterine the cavity.[7]
In our patient, its presence was not considered preoperatively because she had not given any history of insertion or expulsion of an IUD. TV USG was only suggestive of a polyp or a blood clot with in the endometrial cavity, while the IUD was surprisingly not seen, though it contains barium sulfate forradiopacity. On fractional curettage the cause of postmenopausal bleeding was incidentally found to be forgotten IUD, and its removal lead to cure of symptoms. Thus retained or forgotten IUD is cause of postmenopausal bleeding. It should be included in differential diagnosis of postmenopausal bleeding. It is very simple to manage.


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5.      Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium, in women with postmenopausal bleeding: a Nordic multicenter study. Am J Obstet Gynecol 1995;172:1488-1494.
6.      MacKenzie IZ, Bibby JG. Critical assessment of dilatation and curettage in 1029 women. Lancet 1978; 2:566-568.
7.      Tadesse E, Wamsteker K. Evaluation of 24 patients with IUD-related problems: Hysteroscopic findings. Eur J Obstet Gynecol Reprod Biol 1985;19:37-41.


Chakre S, Mayadeo NM, Pardeshi S. Forgotten Intrauterine Contraceptive Device as an Uncommon Cause of Postmenopausal Bleeding. JPGO 2014 Volume 1 Number 7 Available from: