Ober W B
Hum Pathol. 1977 Sep;8(5):513-27. doi: 10.1016/s0046-8177(77)80112-3.
Combined regimen contraceptive steroids produce precocious endometrial secretion, followed by involution leading to a suppressed endometrium with small tubular glands and failure of spiral arterioles to develop; decidua-like stromal changes are dose related as is dilatation of venules. Thrombosis of the latter, perhaps estrogen mediated, leads to local tissue infarction and is the proximate cause of "breakthrough bleeding". Sequential regimen contraceptive steroids lead to retarded endometrial secretion, failure of spiral arterioles to develop, and a weak decidua-like stromal transformation. Contraceptive steroids occasionally produce polypoid lesions of the endocervix with atypical microglandular hyperplasia. There are conflicting reports about the effects of contraceptive steroids on the squamous epithelium of the exocervix, but they neither protect against cancer nor cause it in the usually accepted sense. Uterine leiomyomas may exhibit increased cellularity and bizarre, hyperchromatic nuclei or mutinucleation in women receiving contraceptive steroids. Both polyethylene and metal-containing intrauterine devices may initiate inflammatory responses in the endometrium varying from mild to severe, related to the time the device has been in contact with the mucosa. Salpingitis and ectopic pregnancy are increased in frequency in device users.
复方甾体避孕药会使子宫内膜过早分泌，随后退化，导致子宫内膜变薄，管状腺体变小，螺旋小动脉发育不全；蜕膜样间质变化与剂量有关，小静脉扩张也与剂量有关。后者的血栓形成可能由雌激素介导，导致局部组织梗死，是“突破性出血”的直接原因。序贯甾体避孕药会导致子宫内膜分泌延迟、螺旋小动脉发育不全以及微弱的蜕膜样间质转化。甾体避孕药偶尔会导致宫颈息肉样病变伴非典型微小腺体增生。关于甾体避孕药对外宫颈鳞状上皮的影响存在相互矛盾的报道，但它们既不能预防癌症，也不会在通常意义上引发癌症。接受甾体避孕药的女性，子宫平滑肌瘤可能会出现细胞增多、细胞核怪异、核深染或多核现象。聚乙烯和含金属的宫内节育器都可能引发子宫内膜从轻度到重度不等的炎症反应，这与节育器与黏膜接触的时间有关。使用节育器的女性患输卵管炎和异位妊娠的频率会增加。
