Management of a perforated levonorgestrel‐medicated intrauterine device—a pharmacokinetic study: Case report

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.