A 32-year-old woman wishes to insert a levonorgestrel IUS (Mirena). She has a uterine cavity length of 8 cm on hysteroscopy. Which contraindication is ABSOLUTE for IUS insertion?

• A Nulliparity
• B Age below 35 years
• C Previous caesarean section
• D Undiagnosed abnormal uterine bleeding ✓

Explanation

Undiagnosed abnormal uterine bleeding is an absolute contraindication (WHO MEC Category 4) to IUS insertion because malignant or premalignant pathology must be excluded before masking bleeding with progestogen. Nulliparity, young age, and prior caesarean are not contraindications; IUS use in nulliparous women is endorsed by WHO and FOGSI. Uterine cavity length of 6–9 cm is appropriate for standard Mirena insertion.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.