Missing threads are a common complication at the time of removal of a Mirena® intrauterine system (IUS). In the office setting, various different instruments have been used to retrieve the threads, such as artery forceps to grasp the threads, or hooks to ensnare them. These procedures are usually performed blindly, and they have varying degrees of success. In cases where office procedures have failed, women are referred for hysteroscopic removal. Ultrasound guidance may improve the success rate of IUS removal without the need for more invasive procedures such as hysteroscopy.

Aim
To assess the effectiveness and safety of ultrasound‐guided Mirena® intrauterine system removal when the strings are not visible and conventional office procedures have failed.

Method
Information on women who were referred for ultrasound‐guided removal of a Mirena® device when office procedures had failed was collected prospectively.

Results
Of the 38 cases attempted, 33 devices were successfully removed without complication.

Conclusion
Ultrasound guidance is a useful adjunct for the removal of a Mirena® intrauterine system when the strings are not visible and outpatient procedures have failed.