Subakir S B, Abdul Madjid O, Sabariah S, Affandi B
Department of Physiology, Faculty of Medicine, University of Indonesia, Jakarta.
Hum Reprod. 2000 Aug;15 Suppl 3:18-23. doi: 10.1093/humrep/15.suppl_3.18.
Endometrial bleeding problems can be the major reason for discontinuing progestin-only contraception. In this study the endometrial angiogenic response in Norplant users was found to be lower than in women with normal menstrual cycles. These disturbances in angiogenic response may be caused by oxidant-antioxidant imbalance in the endometrium. The aims of this study were to investigate the effect of progestin only contraceptives on blood concentrations of lipid peroxide and vitamin E, and the effect of vitamin E supplementation on endometrial angiogenic response in vitro. The subjects for this study were Norplant users, depo-medroxyprogesterone acetate (DMPA) users, and controls. Circulating lipid peroxide and vitamin E concentration was measured by routine methodology. Endometrial angiogenic response was assayed using an endothelial cell migration assay. The results showed that the blood concentrations of lipid peroxide from Norplant users with bleeding problems were significantly higher than normal menstrual controls (P < 0.05) and supplementation of vitamin E (in vitro) increased the endometrial angiogenic score. Blood concentrations of lipid peroxide were significantly increased (P < 0.05), and the blood concentrations of vitamin E were significantly decreased (P < 0.05) after 3 months exposure to Norplant or DMPA. The endometrial angiogenic scores in Norplant and DMPA users were significantly lower than in controls (P < 0.02). It is concluded that in progestin-only contraceptive users, higher lipid peroxide and lower vitamin E concentration may cause endometrial cell damage and decrease the endometrial angiogenic response. It is suggested that vitamin E supplementation may counteract these unwanted side-effects.
子宫内膜出血问题可能是停用仅含孕激素避孕方法的主要原因。在本研究中，发现使用诺普兰（Norplant）的女性子宫内膜血管生成反应低于月经周期正常的女性。血管生成反应的这些紊乱可能是由子宫内膜中氧化 - 抗氧化失衡引起的。本研究的目的是调查仅含孕激素避孕药对脂质过氧化物和维生素E血浓度的影响，以及维生素E补充剂对体外子宫内膜血管生成反应的影响。本研究的受试者为使用诺普兰的女性、使用醋酸甲羟孕酮长效避孕针（DMPA）的女性和对照组。采用常规方法测量循环脂质过氧化物和维生素E浓度。使用内皮细胞迁移试验测定子宫内膜血管生成反应。结果显示，有出血问题的诺普兰使用者的脂质过氧化物血浓度显著高于正常月经对照组（P < 0.05），并且（体外）补充维生素E可提高子宫内膜血管生成评分。在使用诺普兰或DMPA 3个月后，脂质过氧化物血浓度显著升高（P < 0.05），而维生素E血浓度显著降低（P < 0.05）。诺普兰和DMPA使用者的子宫内膜血管生成评分显著低于对照组（P < 0.02）。结论是，在仅含孕激素避孕方法的使用者中，较高的脂质过氧化物和较低的维生素E浓度可能导致子宫内膜细胞损伤并降低子宫内膜血管生成反应。建议补充维生素E可能抵消这些不良副作用。
