Human Reproduction, Vol. 18, No. 6, 1231-1233,
June 2003
© 2003 European Society of Human Reproduction and Embryology
Management of a perforated levonorgestrel-medicated intrauterine device—a pharmacokinetic study: Case report
1 Department of Obstetrics and Gynecology, Hadassah University Hospital and 2 Institute of Hormone Research, Shaare-Zedek Medical Center, Jerusalem, Israel
3 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Hadassah University Hospital, Mount Scopus, P.O.B 24035 Il-91240, Jerusalem, Israel. e-mail: rkochman{at}hotmail.com
Intrauterine contraception is a widely used, highly effective method of birth control. Uterine perforation is a serious albeit rare complication with the use of an intrauterine device (IUD). Although uterine perforation by the levonorgestrel-releasing intrauterine system (LNG-IUS) has already been described, no plasma LNG concentrations in this setting were reported. Neither has the management of LNG-IUS been commented on to date. Two months after insertion of an LNG-IUS into a 33-year-old woman, it was noted to be in the peritoneal cavity. Laparoscopy for IUD removal was conducted 5 months after insertion. LNG and sex hormone-binding globulin plasma concentrations were measured prior to and following the laparoscopic removal of the IUD. Intra-peritoneal dislocated LNG-IUS resulted in plasma LNG levels 10 times higher (4.7 nmol/l) than the plasma level of LNG observed with LNG-IUS placed in utero. This high plasma LNG level suppresses ovulation. Therefore a misplaced LNG-IUS should be removed when pregnancy is desired.
Key words: intrauterine device/levonorgestrel/perforation/pharmacokinetics/progestagen