Recognizing malignancy in intrauterine contraceptive device users

Abstract

A 43 year old woman, gravida 2, with a Lippes Loop IUD for 4 years presented herself at the family planning clinic of the New York Medical College in New York City complaining of intermittent spotting for 4 months. In her 2 previous clinic visits, clinic staff assured her that this bleeding was a result of the IUD. Upon examination during her 3rd visit for the same complaint, however, the physician noted an enlarged uterus with an irregular contour. The loop was removed and sent for a pathologic examination which showed a grade 1 adenocarcinoma of the endometrium. After confirming the diagnosis with a fractional curettage, the patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. As of April 1980 there was no evidence of recurrence. Another woman, a 24 year old, gravida 4, had been followed by the same clinic for 3 months. On her 1st visit a health professional inserted a Copper 7 IUD, even though the health professional noted a cervical erosion. In addition, her Pap smear was not satisfactory. She missed her next appointment, but did attend the clinic 3 months later because of irregular bleeding. Staff removed the IUD and then reevaluated her. Due to the friability and abnormal appearance of her cervix, she had a colposcopy and the physician noted abnormal vessels in a large lesion, compatible with invasive cancer of the cervix. A biopsy and a laparotomy confirmed the physician's preliminary diagnosis. She was treated with radiotherapy, but her condition deteriorated quickly. Immunotherapy was unsuccessful, and she died 1 year after the initial diagnosis. Although abnormal bleeding in IUD users is common, health professionals must always consider the possibility of malignancy.