Fibroids distorting cavity — DFSRH MCQ

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HardIntrauterine contraceptionFibroids distorting cavityDFSRH

A 40-year-old woman with heavy bleeding and ultrasound-confirmed submucous fibroids distorting the uterine cavity asks for an LNG-IUD. What is the UKMEC category for IUD use?

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Correct answer: B — UKMEC 3

Submucous fibroids that distort the uterine cavity are classified under UKMEC as uterine fibroids with known cavity distortion. For both copper IUDs and LNG-IUDs, this is UKMEC 3: the theoretical or proven risks usually outweigh the advantages. Although an LNG-IUD can reduce heavy menstrual bleeding in suitable patients, cavity distortion raises concerns about insertion, malposition, expulsion, failure, and safety; therefore the correct category is UKMEC 3, not UKMEC 1 or 2.

Reference: Faculty of Sexual & Reproductive Healthcare (FSRH). FSRH Guideline: Intrauterine Contraception. March 2023, amended January 2025. Table 9: uterine fibroids with distortion of the uterine cavity = UKMEC 3 for LNG-IUD. https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/