Intrauterine release of progesterone. II. Modification of macromolecular synthesis of endometrium.
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Biomedical subjects
Publications and source records attributed to R Aznar.
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A randomized, crossover study comparing the acceptability of two presentations of the same oral contraceptive, a paper formulation and the conventional tablet, was carried out among two-hundred-and-seventy women attending two urban family planning clinics in Mexico City. During the first three cycles of use, the percentage of women discontinuing the medication for side effects was almost identical in the two groups. Although the paper formulation failed to demonstrate any major advantage in terms of continuation or acceptability, it was preferred by a majority of the women who began oral contraception with its use.
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Salivary activity of N-acetyl-beta-D-glucosaminidase showed a characteristic pattern of changes during the normal menstrual cycle with a distinct peak on Day 13, 14, or 15 before the next menstruation. This peak of enzyme activity occurred withing one day of the nadir of basal body temperature and was absent in women with spontaneous or iatrogenic anovulatory cycles. These results are stongly suggestive that the salivary determination of this activity may be convenient indicatior for determining the day of ovulation.
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A prospective study was carried out in normal women in order to investigate the effects of the following procedures on the electrocardiogram and blood pressure: (1) insertion of an intrauterine device (IUD)--the Lippes loop, Tcu-200, uterine progesterone system or Cu-7; (2) endometrial biopsy; and (3) uterine flushing. In groups in which a large IUD like the Lippes loop and/or a stiff IUD like the Cu-7 was inserted, the frequency of bradycardia was significantly higher than in any other groups. The severity of the bradycardia was similar in all of the groups and the frequency of this alteration was also similar among the nulliparous women or in those who complained of pain during the instrumentation, irrespective of the type of IUD inserted or the procedure carried out. No alarming modifications of blood pressure were observed and maintaining the patients in the recumbent position was sufficient to alleviate symptoms. In severe cases use of the Trendelenburg position should be enough to correct any alterations.
The modifications induced by the intrauterine release of copper in the macromolecular and glycoprotein composition of the proliferative and secretory human endometrium were studied. In addition, the endometrial changes produced in women users of copper-T intrauterine devices in the polysome pattern and in the content of ribonucleoprotein particles were determined during the secretory phase. A group of ten untreated normal women (control group) and 15 users of 200 mm.-2 copper-T intrauterine device were selected for this study from the outpatient clinic of the Hospital de Ginecologia y Obstetricia No. 2 del Instituto Mexicano del Seguro Social. The main changes observed in the copper-T users were: a significant decrease in the endometrial content of RNA in both phases of the menstrual cycle, a significant decrease in protein in the secretory phase, and drastic changes in the fucose-sialic acid ratios, which decreased during the proliferative and increased during the secretory phases. Normal human secretory endometrium contained 4.89 plus os minus 0.28 (mean plus or minus standard error (S. E.) mg. ribonucleoprotein particle per gram wet weight, while the endometrium of the Cu-T users showed a significant decrease to 2.52 plus or minus 0.17 (mean plus or minus S. E.). In addition, the Cu-T induced a decrease in the heavy components of the polysome pattern with a concomitant increase in the lighter components.
A blind study was done in 402 endometrial biopsies of women who had intrauterine devices releasing different daily amounts of progesterone or a placebo (empty device): 175 were obtained in what presumably was the proliferative phase and 227 in the secretory stage, as all these subjects were normal, healthy women with a history of previous fertility. With all dose levels of the progesterone-releasing devices there was variation of the endometrium general pattern and the over-all picture varied from normal secretory to suppressed endometrium. In addition to these changes of the endometrial pattern, in 231 specimens there was significant inflammatory infiltration and in six cases even plasma cells were seen. Predecidual reaction was frequently seen and in 45 cases it was diffuse and marked. The significance of these data is discussed on the grounds of the frequent similarities of the changes here reported with those in women using combined oral steroids for contraception.
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