Endometrial expression of glycodelin in women with levonorgestrel-releasing subdermal implants.
OBJECTIVE
To determine whether subdermal levonorgestrel implants induce endometrial expression of glycodelin.


METHODS
Cross-sectional, blinded study.


METHODS
University clinic.


METHODS
One hundred and eight women with subdermal implants and 19 postmenopausal women.


METHODS
Endometrial biopsies, curettages, and hysterectomies.


METHODS
Endometrial glycodelin expression was examined through immunohistochemistry, in situ hybridization, and morphologic endometrial dating.


RESULTS
Overall, 80% of the endometrial specimens obtained from women with subdermal levonorgestrel implants stained positive for glycodelin. Endometrial morphology of these women showed proliferative (71%), inactive/weakly proliferative (19%), menstrual or regenerating (6.5%), and other patterns (2.8%). Of these, 79%, 71%, 100%, and 100% were glycodelin positive, respectively. Nineteen specimens were obtained during the midcycle when glycodelin is not normally expressed: of these, 89% stained positive for glycodelin. Implant-related amenorrhea was associated with endometrial glycodelin expression in 58% of the women, whereas the endometrium specimens obtained from women with postmenopausal hypoestrogenic amenorrhea contained no detectable glycodelin.


CONCLUSIONS
Subdermal levonorgestrel implant use is often associated with endometrial expression of glycodelin. Because glycodelin has been shown to inhibit sperm-egg binding, the induction of glycodelin may contribute to the contraceptive activity of the implant.
Mandelin
E
E
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Koistinen
H
H
Koistinen
R
R
Arola
J
J
Affandi
B
B
Seppälä
M
M
D000328:Adult; D000368:Aged; D000568:Amenorrhea / Q000473:pathology / Q000503:physiopathology; D001706:Biopsy; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D003475:Curettage; D004343:Drug Implants; D004717:Endometrium / Q000166:cytology / Q000473:pathology / Q000502:physiology*; D005260:Female; D005786:Gene Expression Regulation / Q000187:drug effects*; D000071816:Glycodelin; D006023:Glycoproteins / Q000032:analysis* / Q000235:genetics*; D006801:Humans; D007044:Hysterectomy; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D016912:Levonorgestrel / Q000008:administration & dosage / Q000494:pharmacology*; D008597:Menstrual Cycle; D008875:Middle Aged; D015588:Observer Variation; D017698:Postmenopause; D011257:Pregnancy Proteins / Q000032:analysis* / Q000235:genetics*; D012333:RNA, Messenger / Q000032:analysis / Q000235:genetics; D016037:Single-Blind Method; D014158:Transcription, Genetic / Q000187:drug effects*
D003271:Contraceptive Agents, Female; D004343:Drug Implants; D000071816:Glycodelin; D006023:Glycoproteins; C045246:PAEP protein, human; D011257:Pregnancy Proteins; D012333:RNA, Messenger; D016912:Levonorgestrel