title: Endometrial expression of glycodelin in women with levonorgestrel-releasing subdermal implants.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Mandelin
authors.forename: H
authors.initials: H
authors.lastname: Koistinen
authors.forename: R
authors.initials: R
authors.lastname: Koistinen
authors.forename: J
authors.initials: J
authors.lastname: Arola
authors.forename: B
authors.initials: B
authors.lastname: Affandi
authors.forename: M
authors.initials: M
authors.lastname: Seppälä
mesh_terms: 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*
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; D000071816:Glycodelin; D006023:Glycoproteins; C045246:PAEP protein, human; D011257:Pregnancy Proteins; D012333:RNA, Messenger; D016912:Levonorgestrel