Human Reproduction, Vol. 15, No. 7, 1509-1514,
July 2000
© 2000 European Society of Human Reproduction and Embryology
Superficial endometrial vascular fragility in Norplant users and in women with ovulatory dysfunctional uterine bleeding
1 Department of Reproductive Science and Medicine, Imperial College School of Medicine at St Mary's, Norfolk Place W2 1PG, London, UK and 2 Electron Microscopy Unit and 3 Sydney Centre for Reproductive Health Research, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia
The aim of this study was to develop an objective test for superficial endometrial vascular fragility at hysteroscopy, and to apply this test to women using Norplant® for contraception and to women with ovulatory dysfunctional uterine bleeding (DUB). A prospective observational study was carried out in 34 Norplant users and 20 women with menorrhagia due to ovulatory DUB. Superficial endometrial vascular fragility was assessed at hysteroscopy by observing the source and extent of frank and subepithelial bleeding during controlled collapse and redistension of the uterine cavity. Superficial endometrial blood vessels were more fragile in Norplant users compared to women with DUB (
2 = 11.60, P = 0.02). Superficial endometrial petechiae (2 = 37.9, P < 0.0001) and ecchymoses (2 = 42.2, P = 0.0001) were more frequently observed in the Norplant users than in the menorrhagia group. In Norplant users, superficial endometrial vascular fragility was increased in those with frequent bleeding or spotting during the past 30 days (2 = 6.15, P = 0.01), and in those who were examined during a bleeding episode (2 = 5.3, P = 0.02). Fragility was increased in the menorrhagia group during the perimenstrual period (days 24 to 05; 2 = 12.83, P = 0.01). There was no obvious relationship between subepithelial bleeding and circulating concentrations of oestradiol and progesterone.
Key words: breakthrough bleeding/contraception/endometrium/progestogen/vascular fragility
4 To whom correspondence should be addressed at: Imperial College School of Medicine at St Mary's, Department of Obstetrics and Gynaecology, Norfolk Place, London W2 1PG, UK. E-mail: m.hickey{at}ic.ac.uk
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