title: Cervical cancer in 2 women with a Mirena(R)-pitfalls in the assessment of irregular bleeding: a case series.
abstract: BACKGROUND
  The levonorgestrel-releasing intra-uterine device (Mirena(R)) is an effective, long term form of contraception that leads to a significant reduction of menstrual bleeding among majority of women. However, irregular bleeding is quite common in initial Mirena(R) users and may thereby mask underlying cervical pathology.
  
  
  METHODS
  Two women with cervical cancer and a Mirena(R) initially presented with irregular bleeding, posing a diagnostic pitfall which resulted in doctor and patient delay.
  
  
  CONCLUSIONS
  Proper evaluation of irregular vaginal bleeding, including cervical cytology, should be a prerequisite among all women opting for a Mirena(R) and must be repeated in case of persisting symptoms.
authors.affiliation: Department of Obstetrics & Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. s.deweerd@planet.nl.
authors.forename: Sabina
authors.initials: S
authors.lastname: de Weerd
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Westenend
authors.forename: Sjarlot Gs
authors.initials: SG
authors.lastname: Kooi