Human Reproduction, Vol 13, 1218-1224, Copyright © 1998 by Oxford University Press
HO Critchley, H Wang, RL Jones, RW Kelly, TA Drudy, AE Gebbie, CH Buckley, AS McNeilly and AF Glasier
Irregular bleeding remains a common reason for the discontinuation of
progestin-only contraception. The levonorgestrel releasing intrauterine
system (LNG-IUS) has profound morphological effects upon the endometrium.
Specific features are gland atrophy and extensive decidual transformation
of the stroma. Morphological changes in the endometrium may be associated
with perturbation of mechanisms regulating normal endometrial function.
This study describes endometrial stromal and glandular features prior to
and up to 12 months following insertion of the LNG-IUS. Comparison is made
with first trimester decidua. In order to elucidate further mechanisms
governing endometrial function with local intrauterine delivery of LNG, we
here report histological features consistent with decidualization; a
significant increase in granulocyte-macrophage colony stimulating factor
(GM-CSF) immunoreactivity in decidualized stromal cells; glandular and
stromal prolactin receptor expression and an infiltrate of CD56 + large
granular lymphocytes and CD68 + macrophages. We are unaware of previous
reports which have documented longitudinally both morphological and
functional observations in endometrium exposed to local intrauterine
levonorgestrel delivery. These studies demonstrate that long-term
administration of intrauterine levonorgestrel results in features of
altered morphology and function. No correlation was apparent between the
end points in the study and the bleeding patterns described by the
subjects. Further evaluation of these features in the context of menstrual
bleeding experience may contribute to a better understanding of this
troublesome side-effect which often leads to dissatisfaction and
discontinuation of the intrauterine system.
ARTICLES
Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery
Department of Obstetrics and Gynaecology, University of Edinburgh, Centre for Reproductive Biology, UK.
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