Dallenbach-Hellweg G, Sievers S
Virchows Arch A Pathol Anat Histol. 1975 Nov 28;368(4):289-98. doi: 10.1007/BF00432307.
To study the histologic changes produced by a new type of progesterone-medicated intrauterine device we examined the endometria of six hysterectomy specimens and one complete curettage. After being in place for 1 month the device induced a mild perifocal "arrested secretion" of the upper layers of the endometrium; after 3 months the change was pronounced, with decidually transformed stromal cells and atrophic glands. After 12 months these changes had partially progressed to fibrous atrophy. The endometrium underlying the perifocal-arrested secretion showed either proliferative or secretory changes almost like those of the lower functionalis of a normal menstrual cycle. A generalized atrophy of glands developed only when the patient had used oral contraceptive agents before the device was inserted. The perifocal arrested secretion thus differs from the generalized arrested secretion of the endometrium that follows use of oral or injected gestagens and from the decidualization produced mechanically by the local effect of an intrauterine device. The contraceptive effectiveness of the medicated intrauterine device, as compared with that of a simple device, is increased by the glandular atrophy of the arrested secretion. It avoids the dangers of the generalized effects of progestational agents by limiting the changes to the upper layers of the endometrium which are so important for implantation.
为研究一种新型含孕酮宫内节育器所产生的组织学变化，我们检查了6例子宫切除标本及1例完整刮宫标本的子宫内膜。该节育器放置1个月后，可引起子宫内膜上层轻度灶周“分泌停滞”；3个月后，变化明显，出现蜕膜样化生的基质细胞及萎缩的腺体。12个月后，这些变化部分进展为纤维性萎缩。灶周分泌停滞下方的子宫内膜呈现出增殖期或分泌期变化，几乎类似于正常月经周期中功能层下部的变化。仅当患者在放置节育器前使用过口服避孕药时，才会出现腺体的广泛性萎缩。因此，灶周分泌停滞不同于使用口服或注射孕激素后子宫内膜出现的广泛性分泌停滞，也不同于宫内节育器局部作用所机械性产生的蜕膜化。与单纯节育器相比，含药宫内节育器的避孕效果因分泌停滞导致的腺体萎缩而增强。它通过将变化限制在对着床极为重要的子宫内膜上层，避免了孕激素类药物全身作用的风险。
