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  • Title: Endometrial biopsy collection from women receiving Norplant.
    Author: Hadisaputra W, Affandi B, Witjaksono J, Rogers PA.
    Journal: Hum Reprod; 1996 Oct; 11 Suppl 2():31-4. PubMed ID: 8982743.
    Abstract:
    A series of 191 endometrial biopsy procedures were performed on Indonesian women who had received between 3 and 12 months exposure to Norplant. In all, 87 biopsy procedures were attempted with a microhysteroscope using biopsy forceps, and 104 procedures were attempted with either Pipelle or Karman suction curettes. Regardless of the biopsy method, diagnosable endometrium was obtained in only approximately 50% of procedures. Myometrium was often found in microhysteroscope but not in suction biopsies. An analysis of a number of clinical characteristics showed that women from whom diagnosable endometrial tissue was obtained had higher mean peripheral oestrogen concentrations in the 2 weeks prior to biopsy (439 +/- 35 versus 289 +/- 33 pmol/l; P = 0.0018) and significantly more days when endometrial bleeding occurred in the 90 days prior to biopsy (26.5 +/- 2.1 versus 16.2 +/- 1.8; P = 0.0003). These results suggest that after 3-12 months exposure to Norplant approximately 50% of women have an endometrium too thin to sample, and that this group is characterized by lower peripheral oestrogen concentrations and reduced menstrual bleeding. Research on the causes of progestogen-induced breakthrough bleeding in Norplant users depends on the availability of endometrial biopsy samples. In this study, 3 biopsy techniques were utilized in 191 Indonesian women with 3-12 months of exposure to Norplant: microhysteroscopy with biopsy forceps (n = 87), Pipelle suction curette (n = 52), and Karman cannula (n = 52). Diagnosable endometrium were obtained in 51%, 42%, and 58% of these procedures, respectively. Use of the microhysteroscope often resulted in the collection of full thickness endometrium, including a small amount of myometrial tissue, but the endometrium was always very thin or absent. In contrast, both the suction curette techniques collected endometrial tissue only. Women from whom successful endometrial biopsies were obtained tended to have significantly more days of endometrial bleeding in the 90 days preceding biopsy (26.5 +or- 2.1 versus 16.2 +or- 1.8) and higher mean peripheral estrogen concentrations in the 2 weeks preceding biopsy (439 +or- 35 versus 289 +or- 33 pmol/l). The fact that the group from which successful biopsies are obtained may not be representative of all Norplant users should be considered in the analysis of clinical research.
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