Levonorgestrel-releasing intrauterine system placement for severe uterine cervical stenosis after conization: two case reports

Abstract

BackgroundSeveral approaches for treating severe uterine cervical stenosis after conization for cervical intraepithelial neoplasia have been reported; yet, the condition can still be difficult to treat successfully.Case presentationWe performed uterine cervical dilation surgery in two patients with severe stenosis, followed by insertion of the levonorgestrel-releasing intrauterine system, which is used for dysmenorrhea or endometriosis-related pain because of its strong progesterone activity. Patient 1 was a 34-year-old Japanese woman who was diagnosed with dysmenorrhea caused by recurrent uterine cervical stenosis and hematometra after laser conization. Patient 2 was a 44-year-old Japanese woman who developed dysmenorrhea and prolonged menstruation caused by uterine cervical stenosis without hematometra. After providing informed consent, they underwent cervical dilation surgery followed by insertion of the levonorgestrel-releasing intrauterine system. After treatment, their symptoms immediately improved, and after removal of their devices, they remained asymptomatic.ConclusionsTo the best of our knowledge, this is the first report to confirm the usefulness and easy applicability of the levonorgestrel-releasing intrauterine system for uterine cervical stenosis. Although we had success with the method, this study of two patients is preliminary. Further study with larger numbers of patients is necessary to confirm the usefulness of our technique.

Hematometra and Hematocolpos, Secondary to Cervical Canal Occlusion, a Case Report and Review of Literature

“…Other case reports by Caceres et al [7] and Motegi et al [2] demonstrate success with the use of levonorgestrel-releasing intrauterine system at 5 months after placement. Additionally, there are reports of nylon threads tied to IUDs and protruding through the cervical canal, as well as the successful use of cooper IUDs [2]. Though preliminary, these results hold promise for yet another benefit to intrauterine devices.…”

“…Yang et al [16] presents a case report of severe, recurrent cervical stenosis and hematometra, refractory to both surgical and conservative management [16]. Other case reports by Caceres et al [7] and Motegi et al [2] demonstrate success with the use of levonorgestrel-releasing intrauterine system at 5 months after placement. Additionally, there are reports of nylon threads tied to IUDs and protruding through the cervical canal, as well as the successful use of cooper IUDs [2].…”

“…Uterine cervical stenosis is not a rare complication of LEEP or cervical conization; however, its severity varies from patient to patient [2]. Several studies have investigated the risk factors associated with uterine cervical stenosis after conization [2,[6][7][8][9][10].…”

“…There are also reports of cases of primary hematometra due to imperforate cervix in postmenarchal girls with didelphys uterus [3,5]. Hemometra can also be acquired by cervical stenosis secondary to surgical procedures of the cervix such as LEEP and conization [2,[6][7][8][9][10], previous cervical radiation therapy [11] or as a complication of endometrial ablation [12]. Ablating the cervico-uterine junction is possible in certain cases, likely owed to poor surgical technique [12].…”

“…It is most commonly caused by congenital abnormalities of the cervix or uterus [1,2]. Less commonly it can be acquired due to processes that cause obstruction of the cervical canal [1,2].…”