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  • Title: A longitudinal study of changes in endometrial microvascular density in Norplant implant users.
    Author: Hickey M, Simbar M, Young L, Markham R, Russell P, Fraser IS.
    Journal: Contraception; 1999 Feb; 59(2):123-9. PubMed ID: 10361627.
    Abstract:
    This study aimed to investigate the effects of the subdermal levonorgestrel contraceptive implant Norplant on endometrial vascular density at different durations of exposure, and the relationship between endometrial histology, vascular density, and bleeding patterns. A prospective controlled trial of Norplant implant users compared endometrial vascular density in biopsies taken before and after Norplant implant insertion. A total of 34 women with regular menstrual cycles requesting long-term contraception were recruited at the Sydney Centre for Reproductive Health Research, Australia. A significant increase in mean endometrial microvascular density was observed from as early as 3 weeks after insertion of Norplant implants. Vascular density was increased from a control secretory phase value of 189.6 (7.0 vessels/mm2 (+/- SEM) to 253.80 +/- 7 vessels/mm2 at 2-13 weeks of Norplant implant exposure (t ratio = 2.08, p = 0.01) and 212.7 +/- 12.9 vessels/mm2 at 14-42 weeks of exposure (t ratio = 2.03, p = 0.02). In those with atrophic endometrium, or in whom myometrium and basalis only were found in biopsies (20 of 66, 30%), mean endometrial vascular density was increased at 273.1 +/- 16.1 vessels/mm2 compared with 210.9 +/- 11.7 vessels/mm2 in other histological groups (F ratio = 9.74, p = 0.0028). Bleeding and spotting in the previous 30 days were less common in those with this histological appearance at a mean of 4.95 days compared with 8.22 days. This is the first study to assess endometrial vascular density in the early months of Norplant implant use. The findings suggest that the endometrial vasculature is profoundly altered in the early months of Norplant implant exposure when bleeding problems are most common. This is a study on the effects of Norplant on endometrial microvascular density at different durations of implant exposure and on the relationship between endometrial histology, vascular density, and bleeding patterns. A total of 34 women aged 18-40 years who had regular menstrual cycles and wanted long-term contraception were recruited between May 1994 and September 1995. Results showed a marked increase in endometrial vascular density after exposure to Norplant implants. Mean endometrial vascular density in the control cycle was 189.0 + 7.0 vessels/mm, which was significantly less than that seen at 2-13 weeks of exposure (253.9 + 80.7 vessels/mm; t ratio = 2.08, p = 0.01) and at 14-42 weeks of exposure to Norplant implants (212.7 + 12.9 vessels/mm; t ratio = 2.03, p = 0.02). The increase in vascular density was observed from as early as 3 weeks after insertion of Norplant implants. Endometrial vascular density was related to histological appearance. Subjects with regressed endometrium biopsies had significantly higher mean endometrial vascular density (273.1 + 16.1 vessels/mm). This study has assessed changes in endometrial vascular density before and after Norplant-implant insertion. Bleeding and spotting were not frequently present in subjects with these histological appearances.
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