Effects of contraceptive hormone preparations on the fine structure of the endometrium.

Abstract

The present study was undertaken to ascertain the differences in the effects of combination and sequential tablets on the fine structure of the human endometrium the cause for the decrease in menstrual flow in some women after prolonged treatment with combination-type tablets and requirements for absence of withdrawal bleeding. This report compares morphologic changes in endometrial glands during treatment with Enovid-E and during estrogenic and progestational phases of a sequential oral contraceptive regimen. The rapid reversibility of these changes after discontinuation of therapy was documented with light and electron micrographs of endometrial biopsies taken with a Novak suction curet before during and after treatment. After treatment with Enovid-E (EE) daily for 20 days the proliferation of endometrial glands was suppressed from Day 5 through Day 24. Secretory activity was accelerated during the early phase but from midcycle on decreased. The secretory activity of the endometrium never develops to the extent of the late secretory phase of a menstrual cycle. Microscopic findings are described. In women using a sequential regimen C-Quens (CQ) 3 characteristic morphologic phases can be distinguished and the differences between active secretory endometrium under sequential therapy and the inactive state under the combination therapy become obvious. Characteristic postovulatory features showing complete recovery of the endometrium the ovary and the pituitary gland were shown in an endometrial biopsy taken on Day 27 after the last EE tablet. Under oral contraceptive treatment glandular development is advanced by 5-6 days when a steroid combination is taken and delayed by 5-6 days when in the sequential regimen the estrogenic compound alone is taken for 15 days and then for 5 days more in combination with a progestagen. Under sequential therapy menstruation can be expected to be more predictable than after continued use of combination pills. Only a normal menstrual period will reassure a patient who was experienced amenorrhea.