Hum. Reprod. Advance Access originally published online on May 13, 2004
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Human Reproduction, Vol. 19, No. 7, 1622-1628,
July 2004
© 2004 European Society of Human Reproduction and Embryology
Changes in gonadal steroid receptors in the cardinal ligaments of prolapsed uteri: immunohistomorphometric data
1 Leicester and Warwick Medical School, Leicester, UK
2 To whom correspondence should be addressed at: Gynaecology Research Unit, Department of Cancer Studies and Molecular Medicine, Clinical Sciences Building, Leicester and Warwick Medical School, Leicester LE2 7LX, UK. e-mail: fa2{at}le.ac.uk
BACKGROUND:The precise mechanism of uterine prolapse is poorly understood. This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate the differential expression of gonadal steroid receptors in human cardinal ligaments of prolapsed uteri compared with non-prolapsed controls. METHODS: Specimens from women with pelvic organ prolapse (POP) stage III (n = 33), together with the appropriate controls (n = 25), were stained for estrogen receptor 
(ER), ER
, progesterone receptor (PR), androgen receptor (AR) and Ki-67. The control materials were samples of the cardinal ligaments obtained from pre- and post-menopausal women with no prolapse, who were not using hormonal therapy. RESULTS The prolapsed ligaments expressed 1.5–2.5 times more ER-positive cells (statistically significant in post-menopausal women not taking HRT, P < 0.001), a 3–4 times greater percentage of AR-positive cells (P = 0.004 and P = 0.008 in pre-menopausal and post-menopausal women not taking HRT, respectively) and twice the percentage of PR-positive cells (statistically significant in the pre-menopausal group, P = 0.03) compared with the no prolapse group. Expression of ER was twice as high in the ligaments of pre-menopausal women with no prolapse compared with those with prolapse (P = 0.02), and no significant difference was found in the post-menopausal groups. The use of HRT was significantly associated with low AR and high PR expression. Ki-67 expression was not detected in these specimens. CONCLUSIONS: The clearly discernible levels of expression of ER, ER, AR and PR in the prolapsed cardinal ligaments may suggest a relationship to the process of tissue stretch ‘trauma’, rather than an effect of the menopausal status, HRT use or cell proliferation. The use of HRT in post-menopausal women appears to offset some of the changes observed with the prolapse.
Key words: androgen receptor/cardinal ligament/estrogen receptor/progesterone receptor/prolapse
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