Critchley H O, Wang H, Jones R L, Kelly R W, Drudy T A, Gebbie A E, Buckley C H, McNeilly A S, Glasier A F
Department of Obstetrics and Gynaecology, University of Edinburgh, Centre for Reproductive Biology, UK.
Hum Reprod. 1998 May;13(5):1218-24. doi: 10.1093/humrep/13.5.1218.
Irregular bleeding remains a common reason for the discontinuation of progestin-only contraception. The levonorgestrel releasing intrauterine system (LNG-IUS) has profound morphological effects upon the endometrium. Specific features are gland atrophy and extensive decidual transformation of the stroma. Morphological changes in the endometrium may be associated with perturbation of mechanisms regulating normal endometrial function. This study describes endometrial stromal and glandular features prior to and up to 12 months following insertion of the LNG-IUS. Comparison is made with first trimester decidua. In order to elucidate further mechanisms governing endometrial function with local intrauterine delivery of LNG, we here report histological features consistent with decidualization; a significant increase in granulocyte-macrophage colony stimulating factor (GM-CSF) immunoreactivity in decidualized stromal cells; glandular and stromal prolactin receptor expression and an infiltrate of CD56 + large granular lymphocytes and CD68 + macrophages. We are unaware of previous reports which have documented longitudinally both morphological and functional observations in endometrium exposed to local intrauterine levonorgestrel delivery. These studies demonstrate that long-term administration of intrauterine levonorgestrel results in features of altered morphology and function. No correlation was apparent between the end points in the study and the bleeding patterns described by the subjects. Further evaluation of these features in the context of menstrual bleeding experience may contribute to a better understanding of this troublesome side-effect which often leads to dissatisfaction and discontinuation of the intrauterine system.
不规则出血仍然是停用仅含孕激素避孕方法的常见原因。左炔诺孕酮宫内节育系统（LNG-IUS）对子宫内膜具有深远的形态学影响。其特征包括腺体萎缩和间质广泛蜕膜样变。子宫内膜的形态学变化可能与调节正常子宫内膜功能的机制紊乱有关。本研究描述了LNG-IUS置入前及置入后长达12个月的子宫内膜间质和腺体特征。并与孕早期蜕膜进行了比较。为了进一步阐明LNG宫内局部给药调控子宫内膜功能的机制，我们在此报告与蜕膜化一致的组织学特征；蜕膜化间质细胞中粒细胞-巨噬细胞集落刺激因子（GM-CSF）免疫反应性显著增加；腺体和间质催乳素受体表达以及CD56 + 大颗粒淋巴细胞和CD68 + 巨噬细胞浸润。我们未发现之前有报告纵向记录了暴露于宫内局部左炔诺孕酮的子宫内膜的形态学和功能观察结果。这些研究表明，长期宫内给予左炔诺孕酮会导致形态和功能改变。研究中的终点与受试者描述的出血模式之间无明显相关性。在月经出血经历的背景下对这些特征进行进一步评估，可能有助于更好地理解这种常常导致对宫内节育系统不满和停用的麻烦副作用。
