Mirena in Ultrasound. Confidence that lasts

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1 Mirena in Ultrasound Confidence that lasts

2 Modern gynecological practice cannot be visualized without ultrasound diagnosis. Sonographic images provide many uses, including a reliable and non-invasive means of exploring the individual anatomical conditions of the uterus and a safe way to identify possible pathological changes. Both transabdominal (TAS) and transvaginal (TVS) sonographic images of Mirena can be produced, allowing the positioning of Mirena to be controlled. We thank Dr Armin Soder, MD (gynecologist), Ettlingen, Germany, for the scientific consultation in compiling the texts of this ultrasound brochure as well as for the provisioning of the ultrasound images (device: GE Logic 400 Pro). 2

3 The characteristics of Mirena may be clearly presented arms knobs at the end of the arms hormone cylinder The cranial end loop The caudal end (loop) of the vertical stem of Mirena present hyper-reflexible (rich echoic) points. The hormone cylinder does not show a clear auditory reflex. It is mainly to be localized indirectly via its dorsal acoustical shadow. 3

4 Presentation of the uterus Prior to the insertion of Mirena, cervix uteri, uterus and cavum uteri may be examined sonographically. Thus, malformations or uterine pathology (e.g. submucose myoma) that may potentially complicate insertion can be recognized early. Furthermore, the current state of the uterus may be outlined allowing the insertion direction to be determined. In some cases this can facilitate Mirena insertion. Figure 1 shows the longitudinal section of the uterus (sagittal sectional plane) prior to Mirena insertion. The sonographic image displays the line-shaped endometrium during menstruation. 4

5 Figure 1: Uterus in the absence of Mirena (longitudinal section/tvs). 5

6 line-shaped endometrium Figure 1: Uterus in the absence of Mirena (longitudinal section/tvs). 6

7 Sonographic comparison Figure 2 shows a sonographic image of a copper iud (intrauterine device). Figure 3 shows a sonographic image of Mirena. A high-resolution ultrasound scanner clearly displays the dorsal acoustical shadow of the hormone cylinder. 7

8 Figure 2: Sonographic image of the copper IUD (longitudinal section/tvs). Figure 3: Sonographic image of Mirena (longitudinal section/tvs). 8

9 Figure 2: Sonographic image of the copper IUD (longitudinal section/tvs). cranial end caudal end dorsal acoustical shadow Figure 3: Sonographic image of Mirena (longitudinal section/tvs). caudal end cranial end Mirena removal thread 9

10 Image of Mirena (sagittal) Figure 4 shows the longitudinal section of the uterus (sagittal sectional plane) after insertion of Mirena. The hormone cylinder shows the typical trapeze-shaped dorsal acoustical shadow in the sonographic longitudinal section. Caudal end and cranial end of the vertical stem of Mirena can be clearly seen as rich echoic points in the cavum uteri. Caudal to the loop, the removal threads are discernible in the cervical channel. 10

11 Figure 4: Sonographic image of Mirena in the cavum uteri (longitudinal section/tvs). 11

12 dorsal acoustical shadow cranial end caudal end (loop) Mirena removal thread Figure 4: Sonographic image of Mirena in the cavum uteri (longitudinal section/tvs). 12

13 Image of Mirena (horizontal) Figure 5 shows a cross-section of the uterus (horizontal sectional plane) with Mirena in situ. The hormone cylinder shows the typical strap-shaped dorsal singular shadow in the sonographic cross-section image. These results arise from the ultrasound sectional plane (cross-section) being shifted along the hormone cylinder. The central dorsal acoustic shadow starts right below the arms and can be followed distally to the loop. 13

14 Figure 5: Strap-shaped singular shadow/central dorsal acoustic shadow (cross-section/tvs). 14

15 dorsal acoustical shadow Figure 5: Strap-shaped singular shadow/central dorsal acoustic shadow (cross-section/tvs). 15

16 Image of Mirena (horizontal) Figure 6 shows a cross-section of the uterus (horizontal section plane). The sonographic reflections of the released arms of Mirena can be discerned in the cranial section of the cavum uteri. Figure 7 shows a cross-section image of the uterus (fundus level). The knobs at the end of the horizontal arms as well as the hormone cylinder of Mirena both show a strap-shaped dorsal acoustic shadow. 16

17 Figure 6: Sonographic image of the horizontal arms (cross-section/tvs). Figure 7: Sonographic image of the knobs at the end of the arms and of the hormone cylinder with the typical strap-shaped singular shadows (cross-section/tvs). 17

18 horizontal arms Figure 6: Sonographic image of the horizontal arms (cross-section/tvs). three dorsal acoustical shadows Figure 7: Sonographic image of the knobs at the end of the arms and of the hormone cylinder with the typical strap-shaped singular shadows (cross-section/tvs). 18

19 Further images of Mirena Figure 8: Multi-strap image of the hormone cylinder of Mirena in case of an anteflected uterus. 19

20 Figure 9: Image improved by coloration. Released arms of Mirena in the crosssection image. Figure 10: Image improved by coloration. Strapshaped dorsal singular shadow in the cross-section image (horizontal sectional plane). 20

21 Mirena : Confidence that lasts Locally acting, estrogen-free contraception Lighter, shorter, less painful menstruation Fit and forget contraception Mirena product description: Mirena is a levonorgestrel-releasing intrauterine system (IUS) with an initial release rate of 20 microgram/24 h. Mirena is effective for five years. Indications: Contraception, idiopathic menorrhagia, and protection from endometrial hyperplasia during estrogen replacement therapy. Contraindications: Known or suspected pregnancy, current or recurrent pelvic inflammatory disease, lower genital tract infection, postpartum endometritis, infected abortion during the past three month, cervicitis, cervical dysplasia, uterine or cervical malignancy, progesterone-dependent tumors, undiagnosed abnormal uterine bleeding, congenital or acquired uterine anomaly including fibroids if they distort the uterine cavity, conditions associated with increased susceptibility to infections, acute liver disease or liver tumor, hypersensitivity to the constituents of the preparation. For full product information see package insert. For further information please contact the Manufacturer Bayer Schering Pharma AG, D Berlin, Germany, or on the Internet: or your local country office. This information is based on the CCDS/Version14/March 22, G.WH.FC

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