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Hum. Reprod. Advance Access published online on June 10, 2004
Human Reproduction, doi:10.1093/humrep/deh348
© 2004 by European Society of Human Reproduction and Embryology
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Received September 17, 2003
Accepted May 7, 2004

Article

Correlation between endometrial histology, microvascular density and calibre, matrix metalloproteinase-3 and bleeding pattern in women using a levonorgestrel-releasing intrauterine system

Marilia Oliveira-Ribeiro 1, Carlos A. Petta 1*, Liliana A.L. De Angelo Andrade 2, Luis Bahamondes 1, Margarete M. Hidalgo 1

1 Human Reproduction Unit, Department of Obstetrics and Gynaecology, Campinas, Brazil
2 Department of Pathology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil

* To whom correspondence should be addressed. E-mail: cpetta{at}attglobal.net.


  Abstract

BACKGROUND: The main reason for discontinuation of the levonorgestrel-releasing intrauterine system (LNG-IUS) is unpredictable bleeding pattern. METHODS: The objective of the study was to evaluate the endometrial histology, microvascular density and calibre, and the quantification of matrix metalloproteinase (MMP-3) in long-term users of LNG-IUS, with and without bleeding. Endometrial biopsies were obtained from 58 healthy women, 29 who maintained some degree of endometrial bleeding and 29 who were amenorrhoeic. RESULTS: In the histological analysis, the majority of samples displayed a progestin-modified appearance. The major glandular diameter and the perimeter were significantly greater in the group of women with amenorrhoea. A significantly higher number of leukocytes was found in the group with bleeding (P=0.014). No significant correlation was observed between the microvascular density or calibre and the bleeding pattern. MMP-3 showed a significantly higher number of reactive cells (P=0.005) in the group who maintained some degree of bleeding. CONCLUSIONS: Women using LNG-IUS who maintained endometrial bleeding during its use presented a higher number of leukocytes and MMP-3 in the endometrium when compared to women using LNG-IUS who became amenorrhoeic. However, the results did not provide evidence for microvascular pattern changes.

Key words: endometrial bleeding, intrauterine levonorgestrel, leukocytes, MMP-3, microvessels


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