The levonorgestrel-releasing intrauterine system (LNG-IUS) is used for contraception and treatment of heavy menstrual bleeding as well as endometrial hyperplasia and early endometrial carcinoma. A 48-year-old woman visited an Internal Medicine outpatient clinic due to significantly elevated CA-125 and CA-19-9 levels in a routine health examination. She had been using LNG-IUS for 3 years. Before LNG-IUS insertion, she suffered from heavy menstrual bleeding and severe dysmenorrhea. Her endometrial sampling and ultrasonographic imaging showed no evidence of endometrial carcinoma at the time of LNS-IUS insertion. After insertion, she complained of neither abnormal uterine bleeding nor dysmenorrhea. She received a routine health check-up every year and showed results within normal range until last year. To rule out pancreatic cancer due to significantly elevated CA-19-9 levels, her physician performed positron emission tomography–computed tomography, which demonstrated increased FDG uptake in the endometrial cavity. We obtained endometrial biopsy and found endometrial carcinoma in her uterus and performed radical hysterectomy with bilteral pelvic lymphadectomy. Permanent pathology confirmed endometrial carcinoma with lymph node metastasis. She received concurrent chemoradiation therapy. We emphasize the necessity of regular follow-ups with ultrasonography and assessment of serum tumor markers for the early detection of endometrial carcinoma, although rare, in women using LNG-IUS, including those without abnormal uterine bleeding.

To investigate the association between maternal iron status at the third trimester and fetal birthweight, maternal serum iron, ferritin, total iron-binding capacity (TIBC), and complete blood count values were measured at 36-weeks gestation. Delivery database on mothers who delivered babies at Chungbuk National University Hospital between January 2008 and March 2013 was extracted. A total of 353 uncomplicated term babies were analyzed using hierarchical regression and ANCOVA. Maternal age (standardized regression coefficient β=0.115, P<0.05), height (β=0.108, P<0.05), BMI (β=0.210, P<0.001), and gestational age (β=0.298, P<0.001) were significantly associated with birthweight. However, birthweight was not associated with maternal iron parameters. After adjusting for maternal age, height, BMI, and gestational age, babies born to mothers with lower mean values of hemoglobin, hematocrit, and serum ferritin were heavier than those born to mothers with higher values. Babies born to lower hemoglobin (11 g/dL) mothers were heavier than those born to higher hemoglobin (12 g/dL) mothers. However, birthweight was not significantly different between mothers with 10 g/dL or 13 g/dL of hemoglobin. Comparing birthweight according to 30 ug/dL of serum iron, 360 ug/dL of TIBC, 15 ng/mL of serum ferritin, and 10% transferrin saturation, babies born to mothers of the lower group were heavier than those born to mothers of the higher group. Therefore, maternal serum iron status at the third trimester seems to not be associated with birthweight.