Levonorgestrel-releasing intrauterine devices (LNG-IUDs) have high contraceptive efficacy and an excellent safety profile for medically complex patients.1 Additional benefits include treatment of dysmenorrhea, heavy menstrual bleeding, and anemia.2 Although the presence of a uterine anomaly is a contraindication for the placement of an IUD due to distortion of the uterine cavity,1 there are several case reports documenting the successful use of LNG-IUDs in persons with uterine anomalies.3., 4., 5., 6., 7., 8. The benefits described in these case studies include successful retention, effective contraception, amenorrhea, and treatment of heavy menstrual bleeding. No case reports of unsuccessful IUD placement in anomalous uteri or case series of IUD placement in anomalous uteri have been published (see Table 1).3., 4., 5., 6., 7., 8., 9.

Published in Obstetrics and Gynecology in 2006, Espey et al described the use of a CuT380A for a 17-year-old female with uterine didelphys and a complex medical history including seizure disorder. This patient strongly desired nonhormonal contraception. She was advised on the off-label use of placing 1 IUD in each uterus and elected to try it. This patient was parous with a previous vaginal delivery at 38 weeks in the left uterus. An unmodified T-arm CuT380A was placed in the parous left uterus. The uterine cavity in the never-parous right uterus was felt to be too small to accommodate the device. The medial arm of the second IUD was removed to create an L-shaped device, which was placed in the right uterus. Both IUDs remained in place with normal string length visualization 9 months after placement.4 As all of our patients were nulliparous, we utilized this IUD modification method for our dual IUD insertion attempts in patients with uterine anomalies. It is important to note that the T-arms do not contain any medication. Therefore, removal of a single arm should not affect the rate or amount of drug delivery.