Endometrial morphology of women using a d-norgestrel-releasing intrauterine device.

Endometrial biopsies were obtained from 12 volunteers treated with d-norgestrel-releasing intrauterine devices (IUDs) with two different release rate. Four subjects scheduled for hysterectomy had d-norgestrel-releasing IUDs inserted approximately 1 month prior to surgery. The effect of d-norgestrel on the endometrium and fallopian tubes of the removed uteri was examined. A uniform suppression of the endometrium with glandular atrophy and decidualization of the stroma was found in all of the endometrial specimens. Moreover, changes similar to those observed during the luteal phase and early pregnancy could be seen in the tubal epithelium.

Postmenopausal oestrogen replacement therapy with subcutaneous oestradiol implants.

Ten postmenopausal patients were treated by means of subcutaneous oestradiol-releasing silastic implants. Half of the patients received 3 implants, each containing 12 mg oestradiol valerate (E2V), while the other half received 4 implants, each containing 27 mg oestradiol benzoate (E2B). Progestogen was added to the treatment for 14 days, 6 weeks after implant insertion and every fourth week thereafter. Serum levels of oestrone (E1), oestradiol (E2), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were followed up. The effects on endometrial thickness, uterine volume and breast tissue were evaluated by ultrasound, mammography also being used for breast examination. The follow-up period was 24 weeks, but the implants were not removed until the climacteric symptoms reappeared. E1 and E2 levels remained higher and gonadotrophin levels lower than the pretreatment values during the 24-week follow-up period. Oestrogen effects were seen in both the uterus and the breasts. Both types of implant were effective in relieving climacteric symptoms. The mean time for symptom return was 10 months (range 6-18 months) in the E2V group and 8 months (range 4-12 months) in the E2B group. Our results indicate that nonbiodegradable controlled-release oestrogen implants offer a safe, effective, convenient and well-accepted alternative means of administering oestrogen replacement therapy.

Endometrial morphology during long-term use of levonorgestrel-releasing intrauterine devices.

Levonorgestrel-releasing intrauterine devices (IUD) were inserted in 92 women. Endometrial biopsies were taken between 3 months and 7 years after these insertions. Intrauterine release of levonorgestrel resulted in endometrial glandular atrophy and decidualized stroma. Inflammation and necrosis were also seen as local signs of IUD use. The biopsies were similar regardless of the duration of IUD use. Endometrial morphology returned to normal in biopsy specimens taken 1-3 months after IUD removal.