title: Hysteroscopic management of displaced levonorgestrel-releasing intrauterine system.
abstract: OBJECTIVE
  This study was designed to evaluate feasibility and effectiveness of hysteroscopic intervention in the management of symptoms related to the displaced levonorgestrel-releasing intrauterine system (LNG-IUS).
  
  
  METHODS
  One hundred and thirteen patients with displaced LNG-IUS presenting with irregular uterine bleeding, pelvic pain or asymptomatic displacement were recruited for hysteroscopic examination. Displaced LNG-IUS was relocated by hysteroscopic intervention and the effect on symptoms and LNG-IUS position was followed.
  
  
  RESULTS
  The displaced LNG-IUS was successfully relocated by hysteroscope in 112 (99.1%) of 113 cases. Following LNG-IUS relocation, 71 (79.8%) patients of 89 with preoperative irregular uterine bleeding had amenorrhea or vaginal spotting, and 14 of 15 (93.3%) patients with preoperative pelvic pain became asymptomatic. LNG-IUS expulsion was recorded in two patients 7 and 21 days after hysteroscopy.
  
  
  CONCLUSIONS
  Displaced LNG-IUS can cause clinical symptoms (e.g. irregular bleeding, pain). Hysteroscopic relocation of displaced LNG-IUS is a feasible method in the management of these symptoms. Risk of spontaneous expulsion associated with hysteroscopy is low.
authors.affiliation: Department of Obstetrics and Gynaecology, Charles University, First Faculty of Medicine and General Faculty Hospital in Prague, Prague, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Kuzel
authors.forename: Lucie
authors.initials: L
authors.lastname: Hrazdirova
authors.forename: Kristyna
authors.initials: K
authors.lastname: Kubinova
authors.forename: Pavel
authors.initials: P
authors.lastname: Dundr
authors.forename: David
authors.initials: D
authors.lastname: Cibula
authors.forename: Michal
authors.initials: M
authors.lastname: Mara
mesh_terms: D000328:Adult; D015331:Cohort Studies; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy; D058736:Intrauterine Device Migration / Q000009:adverse effects*; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage*; D008796:Metrorrhagia / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D016912:Levonorgestrel