Inadvertent use of a levonorgestrel-releasing intrauterine device as postcoital contraception.

The intrauterine device (IUD) is an effective means of contraception,1,2 and insertion is a procedure that is commonly performed in a family physician’s office. Standard practice requires that a current pregnancy be excluded before insertion; on-site urine testing is the most obvious way to do this. This case describes an instance of inadvertent insertion of an IUD in a woman who was already pregnant, resulting in an interruption of pregnancy that was not intended but was nonetheless welcomed by the patient. Although IUDs have been used for some time as a means of postcoital contraception,3-6 the levonorgestrel-releasing intrauterine system (LNRIUS) is specifically excluded from use for this purpose (presumably because of the ethical difficulties of conducting prospective trials of such use; moreover, the device has not been in existence long enough to accumulate case reports attesting to its efficacy and safety in this context).7 A search of MEDLINE and EMBASE, using the terms intrauterine devices; contraception, postcoital; contraceptives, postcoital; inadvertent; accidental; un intentional; and case report, failed to uncover any cases of inadvertent or emergency use of an IUD, particularly an LNR-IUS, as a postcoital contraceptive, in any context.