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Adenomyosis and the use of long-acting reversible contraceptives (LARC), including levonorgestrel-releasing intrauterine systems (LNG-IUS), may increase EP risk. The case involves a 39-year-old woman with adenomyosis and heavy menstrual bleeding using LNG-IUS who presented with symptoms, rising β-hCG, and a right tubal ectopic pregnancy. Laparoscopic bilateral salpingectomy was performed with uncomplicated recovery. A literature search (2015–2025) reviewed EP type and device positioning in LNG-IUS users.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ectopic-pregnancy-with-a-normally-located-levonorgestrel-releasing-intrauterine-system-in-a-woman-with-adenomyosis-case-report-and-literature-review/462550/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ectopic-pregnancy-with-a-normally-located-levonorgestrel-releasing-intrauterine-system-in-a-woman-with-adenomyosis-case-report-and-literature-review/462550.png","ImageObject",300,407,{"name":92,"@type":93},"Chumphorn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What risk factors are discussed for ectopic pregnancy in LNG-IUS users?","Question",{"text":112,"@type":113},"The text highlights adenomyosis and long-acting reversible contraceptives (LARC), including LNG-IUS, as potential risk factors for ectopic pregnancy development.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What symptoms and diagnostic findings were reported in the case?",{"text":117,"@type":113},"The patient presented with acute abdominal pain and vaginal bleeding, had rising serum β-hCG (>4000 mIU/mL), and transvaginal ultrasound showed a right tubal ectopic pregnancy with hemoperitoneum.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment was provided and what did pathology confirm?",{"text":121,"@type":113},"The patient underwent laparoscopic bilateral salpingectomy, and histopathological examination confirmed a right tubal ectopic pregnancy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},462550,1790815011,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","Review  \nEctopic Pregnancy with a Normally Located LevonorgestrelReleasing Intrauterine System in a Woman with Adenomyosis:  \nCase Report and Literature Review  \nFrancesco Giuseppe Martire , Eugenia Costantini *, Errico Zupi and Lucia Lazzeri   \nAcademic Editor: Apostolos Mamopoulos  \nReceived: 25 November 2025  \nRevised: 22 December 2025  \nAccepted: 28 December 2025  \nPublished: 29 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; [francescogmartire@libero.it](francescogmartire@libero.it) (F.G.M.); [zupi@unisi.it](zupi@unisi.it) (E.Z.); [lucialazzeri79@gmail.com](lucialazzeri79@gmail.com) (L.L.)  \n* Correspondence: [eugenia.costantini22@gmail.com](eugenia.costantini22@gmail.com); Tel.: +39-3271817802  \nAbstract  \nBackground: Ectopic pregnancy (EP) is a potentially life-threatening condition, often associated with acute abdominal pain and hemoperitoneum. Certain conditions, such asadenomyosis and the use of long-acting reversible contraceptives (LARC), may represent risk factors for the development of ectopic pregnancy. Management is tailored according tohemodynamic stability, reproductive desires, and associated comorbidities. Case Presentation: We report the case of a 39-year-old Caucasian woman with a history of adenomyosisand 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.  \nKeywords: ectopic pregnancy; adenomyosis; levonorgestrel-releasing intrauterine system; intrauterine system; case-report  \n1. Introduction  \nAdenomyosis is a benign uterine disorder characterized by the presence of endometrial glands and stroma within the myometrium, leading to uterine hypertrophy and hyperplasia. Once considered a condition of older women, it is increasingly recognized in younger, reproductive-aged patients due to advances in transvaginal ultrasound criteria and magnetic resonance imaging, which allow earlier and more precise diagnosis [1] . In young women, adenomyosis presents a clinical challenge: symptoms such as abnormal uterine bleeding and chronic pelvic pain can substantially impair quality of life [2–4] . At the  \nsame time, affected patients often require effective contraception without compromising future fertility, particularly in the context of rising maternal age; in Italy, for example, the mean age at first childbirth is now approximately 31.9 years, compared with a significantly lower age three decades ago [5] . Beyond its symptomatic burden, adenomyosis has relevant implications for reproductive health. Increasing evidence suggests that t","cbCaisDCiEmHI3dT","https://ap.wps.com/l/cbCaisDCiEmHI3dT","pdf",1552491,13,"English","# Abstract\n# Keywords\n# 1. Introduction","[{\"question\":\"What risk factors are discussed for ectopic pregnancy in LNG-IUS users?\",\"answer\":\"The text highlights adenomyosis and long-acting reversible contraceptives (LARC), including LNG-IUS, as potential risk factors for ectopic pregnancy development.\"},{\"question\":\"What symptoms and diagnostic findings were reported in the case?\",\"answer\":\"The patient presented with acute abdominal pain and vaginal bleeding, had rising serum β-hCG (\\u003e4000 mIU/mL), and transvaginal ultrasound showed a right tubal ectopic pregnancy with hemoperitoneum.\"},{\"question\":\"What treatment was provided and what did pathology confirm?\",\"answer\":\"The patient underwent laparoscopic bilateral salpingectomy, and histopathological examination confirmed a right tubal ectopic pregnancy.\"}]","Ectopic Pregnancy with a Normally Located Levonorgestrel-Releasing Intrauterine System in a Woman with Adenomyosis - Case Report and Literature Review | PDF",1790764464,33]