Endometrioid adenocarcinoma after insertion of a levonorgestrel-releasing intrauterine system.

The levonorgestrel-releasing intrauterine system (IUS) is now widely used and recommended as a reliable contraceptive and treatment for menorrhagia. It also potentially provides a simple alternative to treatment for women with stage-1, grade-1 endometrial cancers who are at high risk for surgery. This case describes a 39-year-old multiparous patient who visited the gynecology outpatient department at a district general hospital with a history of heavy, prolonged periods for 1 year. Hysteroscopy and biopsy specimen revealed benign nonsecretory endometrium and a levonorgestrel-releasing IUS was inserted. The patient visited again 4 years later with an 8-month history of prolonged bleeding. Endometrial biopsy specimen confirmed well-differentiated endometrioid adenocarcinoma. This is the first case report, to our knowledge, where hysteroscopy was performed before levonorgestrel-releasing IUS insertion with conclusive evidence of initial negative malignancy followed by development of endometrial cancer 4 years after insertion. This case raises the question of the safety of levonorgestrel-releasing IUS for the prevention and treatment of endometrial hyperplasia and carcinoma.

Microwave endometrial ablation: development and clinical application.

Heavy menstrual bleeding is a common problem. Hysterectomy has been the standard treatment for women with heavy menstrual bleeding who have not responded to medical treatment. Minimally invasive procedures to destroy the lining of the uterus (the endometrium) are alternatives to hysterectomy. They involve destroying the endometrium using lasers, radiofrequency waves, electrocautery, microwaves, heated saline, or a heated balloon. Microwave endometrial ablation (MEA) is one of these minimally invasive procedures. In this Chapter, use of microwave MEA in the management of heavy menstrual bleeding is described. MEA was developed in Bath, UK in the mid 1990s. MEA is a second-generation method of EA, which involves the use of microwaves at a fixed frequency of 9.2 GHz to destroy the endometrial lining. Initial results for MEA were encouraging, with active treatment times of less than three minutes and high satisfaction rates. Recent studies also showed an equivalent outcome with regards to patients' satisfaction and health-related quality-of-life issues. The procedure, indications, contraindications, principles of operation, potential risks, results, and patient-satisfaction is described herein.