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Hormonally mediated disturbance of angiogenesis in the human endometrium after exposure to intrauterine levonorgestrel.

Author(s): McGavigan CJ, Dockery P, Metaxa-Mariatou V, Campbell D, Stewart CJ, Cameron IT, Campbell S

Affiliation(s): Department of Obstetrics and Gynaecology, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.

Publication date & source: 2003-01, Hum Reprod., 18(1):77-84.

Publication type: Clinical Trial; Randomized Controlled Trial

BACKGROUND: The levonorgestrel intrauterine system (LNG-IUS) is a contraceptive device that is used for treatment of menorrhagia. The system induces inter-menstrual bleeding within the first few months after insertion. We hypothesized that this bleeding might be associated with a change in vascular development. METHODS: A randomized, controlled study was undertaken on 48 women. RESULTS: Hysterectomy specimens were obtained and immunocytochemistry was carried out with antibodies to CD31, alpha-smooth muscle actin and myosin. Stereological measurement of blood vessels was also undertaken. Most vessels appeared normal, including the arterioles. Large thin-walled vessels were present in the superficial endometrium of the treated group but were almost completely absent in the controls. The distribution of cytoskeletal markers revealed well-formed basal arterioles with more widespread expression in the superficial stroma than was found in untreated tissue. The volume fraction of blood vessels (P = 0.0001), the number of vessel cross-sections per unit area (P = 0.0003) and the cross-sectional diameters of the largest vascular lumens (P = 0.0001) were significantly increased following treatment with LNG-IUS. However, there was no difference in the median values of vessel diameter or the vascular surface density. CONCLUSION: These findings suggest that the LNG has a localized effect on some vessels within the superficial endometrium.

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