title: Continuation of a Levonorgestrel Intrauterine Device During Hematopoietic Stem Cell Transplant: A Case Report.
abstract: During treatment of hematologic malignancies in premenopausal women, both menstrual suppression and contraception are crucial. Continuation of hormonal intrauterine devices (IUDs) - widely used and highly effective contraceptives that also decrease menstrual flow - is controversial during hematopoietic stem cell transplants (SCTs) due to infectious and vaginal bleeding concerns.
  
  
  
  A 23-year-old nulligravid female was diagnosed with acute myeloid leukemia (AML, positive for FLT3-ITD, DNMT3A and RUNX1, with normal cytogenetics). She elected to retain her existing levonorgestrel-containing IUD during chemotherapy and SCT. During and following treatment, she remained amenorrheic without infection, despite severe neutropenia and thrombocytopenia. Eight months later, she remains in remission without IUD-related complications.
  
  
  
  This is the first report of levonorgestrel IUD retention during hematopoietic SCT. Despite severe neutropenia and thrombocytopenia, the patient developed neither pelvic infection by retaining her IUD nor significant vaginal bleeding. Future studies are needed to confirm the safety of levonorgestrel IUDs in women undergoing SCT.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A. pbrady2@partners.org.
authors.forename: Paula C
authors.initials: PC
authors.lastname: Brady
authors.affiliation: Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Ginsburg
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D005260:Female; D020073:Gravidity; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D016912:Levonorgestrel / Q000008:administration & dosage*; D008598:Menstruation / Q000187:drug effects; D011247:Pregnancy; D011379:Prognosis; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Acute myeloid leukemia; IUD; chemotherapy; contraception; hematopoietic stem cell transplant; intrauterine device; levonorgestrel; menstrual suppression; oncofertility