Endometrial histology following 1 year of a continuous daily regimen of levonorgestrel 90 μg/ethinyl estradiol 20 μg

University of Vermont, Burlington, Vermont, United States
Contraception (Impact Factor: 2.34). 02/2007; 75(1):23-6. DOI: 10.1016/j.contraception.2006.07.009
Source: PubMed


The objective of this study was to evaluate the effect of a continuous daily regimen of levonorgestrel (LNG) 90 micro g/ethinyl estradiol (EE) 20 micro g on endometrial histology.
This was a substudy of a large phase 3 trial conducted in six sites in North America. Healthy and sexually active women aged between 18 and 49 years took LNG 90 micro g/EE 20 micro g daily for 1 year. Results from endometrial biopsies performed at pretreatment baseline and those after at least 6 months of treatment were compared.
Of the 146 participants, 93 had a baseline biopsy and completed at least six pill packs. Before treatment, 56 subjects (60%) had an endometrial biopsy with findings classified as "weakly proliferative or proliferative." During the last on-therapy visit, 48 subjects (52%) had an endometrium categorized as "other," which included primarily an inactive or benign endometrium (n=42). No hyperplasia or malignancy was observed during the study.
The results of a 1-year continuous regimen of LNG 90 micro g/EE 20 micro g were shown to have a good endometrial safety profile.

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    • "Page 6 of 34 epithelial cells initiated through local growth factors, and later by endogenous estradiol [16]. The glands and vessels become sinuous in the proliferative phase as their growth " outstrips " that of the stroma [17]. "
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    ABSTRACT: This review compares the histologic changes that occur in the endometrium following ovulation and progesterone secretion with contraceptive progestins and progesterone receptor modulators (PRMs) that may be used as contraceptive agents in women. The morphologic endometrial changes vary by the progestin type, dosage and duration; are often subtle and difficult to interpret; and may also vary depending on whether or not estrogen is used. The prolonged use of ethinyl estradiol and a progestin as a combined oral contraceptive results in common endometrial histologic findings that include glandular and stromal atrophy and spiral arteriole underdevelopment. Intrauterine systems releasing levonorgestrel have similar changes that are related to the proximity of the device to the endometrium, while progestin-only implants result in atrophy with marked vascular changes characterized by underdevelopment of spiral arterioles and dilated, thin-walled vessels near the surface epithelium. Lower doses of levonorgestrel delivered by a vaginal ring allow ovulation, and the endometrial changes appear to reflect the impact of the endogenous hormones. PRMs have been investigated as potential female contraceptives. PRM-associated endometrial changes include an inactive endometrium with cystically dilated glands, lined by epithelium with increased apoptosis in a background of compact nondecidualized stroma. Histologic differences between PRMs appear to depend on the degree of progesterone receptor agonistic activity.
    Contraception 01/2015; 91(5). DOI:10.1016/j.contraception.2015.01.008 · 2.34 Impact Factor
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    • "It has been reported that beside the suppression of ovulation, other peripheral manifestations in contraceptive users are thickening of cervical mucus, change in muscle tone and cervical endometrium [11,18]. Although these parameters were not investigated in the present study, the findings indicate that these factors may have been the cause of colonization of vagina with altered, higher percentages of vaginal microbiota found in our study and that these effects may become more enhanced in the age above 30 years. "
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    ABSTRACT: Background Previous studies report association of contraceptives with moderate increase in urinary tract infection among sexually active premenopausal women. The aim of our study was to find out whether the use of hormonal contraceptives has any effect on microbiota of the vagina in the contraceptives users in Khairpur Sindh Pakistan. Methods A prospective study in woman population of Khairpur Sindh Pakistan aged 20–30 years and 31–40 years, using Hormonal contraceptives was carried out. High vaginal swab samples (n = 100) were collected from the test populations as well as control group (n = 100) and investigated for vaginal microbial flora using standard microbiological and biochemical techniques. Results Vaginal swabs culturing from hormonal contraceptives users in the age group 20–30 years showed statistically insignificant Candida sp (10% samples), and statistically significant (p < 0.05) Staphylococcus saprophyticus. (18% samples), Streptococcus agalactiae (23% samples), Escherichia coli (28% samples) and Lactobacillus fermentum (32% samples). In the age group 31–40 years, statistically significant percentage of samples (p < 0.05) showed Lactobacillus fermentum (28%), Candida sp (24%), and E. coli, (24%) where statistically insignificant samples showed Staphylococcus saprophyticus (13%) and Streptococcus agalactiae (11%). Conclusions The use of hormonal contraceptives alters the normal microbiota of vagina in women according to the age. Lactobacillus fermentum appeared as the predominant species followed by E. coli among the age group of 20–30 years and, Lactobacillus fermentum, Candida sp and E. coli as predominant among women of age group 31–40 years when compared to corresponding control groups. An inverse relationship between E. coli and Lactobacillus fermentum was observed in the women aged 20–30 years.
    BMC Urology 08/2012; 12(1):22. DOI:10.1186/1471-2490-12-22 · 1.41 Impact Factor
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    • "At the last visit, 52% of the subjects had an endometrium categorized as “other,” which included primarily an “inactive” or “benign” endometrium. No hyperplasia or malignancy was observed during the study.86 This study indicates a good endometrial safety profile. "
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