# Ectopic Pregnancy with a Normally Located Levonorgestrel-Releasing Intrauterine System in a Woman with Adenomyosis: Case Report and Literature Review

## TL;DR

A woman with adenomyosis and a contraceptive device had an ectopic pregnancy, highlighting the need for early diagnosis and tailored surgical management.

## Contribution

This case report adds to the limited literature on ectopic pregnancy in users of levonorgestrel-releasing intrauterine systems.

## Key findings

- A 39-year-old woman with adenomyosis and a LNG-IUS developed a right tubal ectopic pregnancy.
- Laparoscopic bilateral salpingectomy was performed, aligning with the patient's desire for sterilization.
- A literature review identified eight case reports of ectopic pregnancy in LNG-IUS users between 2015 and 2025.

## Abstract

Background: Ectopic pregnancy (EP) is a potentially life-threatening condition, often associated with acute abdominal pain and hemoperitoneum. Certain conditions, such as adenomyosis and the use of long-acting reversible contraceptives (LARC), may represent risk factors for the development of ectopic pregnancy. Management is tailored according to hemodynamic stability, reproductive desires, and associated comorbidities. Case Presentation: We report the case of a 39-year-old Caucasian woman with a history of adenomyosis and heavy menstrual bleeding (HMB) treated with a levonorgestrel-releasing intrauterine system (LNG-IUS). She presented to the emergency department with acute abdominal pain, vaginal bleeding, and a rising serum β-human Chorionic Gonadotrophin (β-hCG > 4000 mIU/mL). Transvaginal ultrasound revealed an adnexal mass (24 mm × 19 mm) consistent with a right tubal ectopic pregnancy, associated with hemoperitoneum. The patient, who expressed a desire for definitive sterilization, underwent laparoscopic bilateral salpingectomy. The procedure was uneventful with minimal intraoperative blood loss. Histopathological examination confirmed the diagnosis of right tubal ectopic pregnancy. Literature Review: A case report prompted a focused search of MEDLINE and Scopus (2015–2025) on ectopic pregnancy in users of levonorgestrel-releasing intrauterine systems. Eight eligible case-report studies assessing ectopic pregnancy type and device positioning were ultimately included. Conclusions: This case highlights the importance of early diagnosis of ectopic pregnancy, paying attention to any comorbidities, particularly adenomyosis, the role of minimally invasive surgery, and the possibility of adapting surgical management to the patient’s reproductive wishes.