Cervical cancer in 2 women with a Mirena ® -pitfalls in the assessment of irregular bleeding: a case series

Introduction The levonorgestrel-releasing intra-uterine device (Mirena ® ) is an effective, long term form of contraception that leads to a significant reduction of menstrual bleeding among majority of women. However, irregular bleeding is quite common in initial Mirena ® users and may thereby mask underlying cervical pathology. Case presentation Two women with cervical cancer and a Mirena ® initially presented with irregular bleeding, posing a diagnostic pitfall which resulted in doctor and patient delay. Conclusion Proper evaluation of irregular vaginal bleeding, including cervical cytology, should be a prerequisite among all women opting for a Mirena ® and must be repeated in case of persisting symptoms.