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Human Reproduction, Vol. 15, No. suppl_3, pp. 18-23, 2000
© 2000 European Society of Human Reproduction and Embryology

Oxidative stress, vitamin E and progestin breakthrough bleeding

S.B. Subakir1,3, O.Abdul Madjid2, S. Sabariah1 and B. Affandi2

1 Department of Physiology, University of Indonesia Jakarta, Indonesia 2 Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Indonesia Jakarta, Indonesia

Correspondence: 3To whom correspondence should be addressed at: Department of Physiology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. E-mail:faalui{at}makara.cso.ui.ac.id

Endometrial bleeding problems can be the major reason for discontinuing progestin-only contraception. In this study the endometrial angiogenic response in Norplant users was found to be lower than in women with normal menstrual cycles. These disturbances in angiogenic response may be caused by oxidant-antioxidant imbalance in the endometrium. The aims of this study were toinvestigate the effect of progestinonly contraceptives on blood concentrations of Iipid peroxide and vitamin E, and the effect of vitamin E supplementation on endometrial angiogenic response in vitro. The subjects for this study were Norplant users, depo-medroxyprogesterone acetate (DMPA) users, and controls. Circulating Iipid peroxide and vitamin E concentration was measured by routine methodology. Endometrial angiogenic response was assayed using an endothelial cell migration assay. The results showed that the blood concentrations of Iipid peroxide from Norplant users with bleeding problems were significantly higher than normal menstrual controls (P < 0.05) and supplementation of vitamin E (in vitro) increased the endometrial angiogenic score. Blood concentrations of Iipid peroxide were significantly increased (P < 0.05), and the blood concentrations of vitamin E were significantly decreased (P < 0.05) after 3 months exposure to Norplant or DMPA. The endometrial angiogenic scores in Norplant and DMPA users were significantly lower than in controls (P < 0.02). It is concluded that in progestin-only contraceptive users, higher Iipidperoxide and lower vitamin E concentration may cause endometrial cell damage and decrease the endometrial angiogenic response. It is suggested that vitamin E supplementation may counteract these unwanted side-effects.

Key words: angiogenesis/endometrial bleeding/Iipid peroxide/progestin/vitamin E


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