title: Management of a perforated levonorgestrel-medicated intrauterine device--a pharmacokinetic study: case report.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel. rkochman@hotmail.com
authors.forename: Ronit
authors.initials: R
authors.lastname: Haimov-Kochman
authors.forename: Hagay
authors.initials: H
authors.lastname: Amsalem
authors.forename: Amiram
authors.initials: A
authors.lastname: Adoni
authors.forename: Yuval
authors.initials: Y
authors.lastname: Lavy
authors.forename: Irving M
authors.initials: IM
authors.lastname: Spitz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D007700:Kinetics; D010535:Laparoscopy; D016912:Levonorgestrel / Q000097:blood / Q000493:pharmacokinetics*; D010529:Peritoneal Cavity; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D014595:Uterine Perforation / Q000209:etiology*
chemical_list: D012738:Sex Hormone-Binding Globulin; D016912:Levonorgestrel