title: Histological characteristics and altered expression of interleukins (IL) IL-13 and IL-15 in endometria of levonorgestrel users with different uterine bleeding patterns.
abstract: OBJECTIVE
  To determine the relationship between uterine bleeding patterns in levonorgestrel users with endometrial histology and expression of interleukins (IL) IL-13 and IL-15.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Academic research center.
  
  
  METHODS
  Questionnaires were sent to patients (n = 578) who had levonorgestrel implants concerning bleeding patterns; 35 of these patients were identified to have regular cycle (n = 13), amenorrhea (n = 8), or metrorrhagia (n = 14).
  
  
  METHODS
  Endometrial biopsies, serum, histology, and immunostaining.
  
  
  METHODS
  Endometrial histological assessment and immunostaining for IL-13 and IL-15 and for blood levonorgestrel, E2, and progesterone levels by ELISA or RIA.
  
  
  RESULTS
  No correlation was found between circulating levonorgestrel, E2, or progesterone levels with the bleeding patterns, although a trend toward a lower E2 level was observed in patients with amenorrhea who had inactive endometrium. There was a direct correlation between bleeding patterns and endometrial histology, as well as IL-13 and IL-15 expression in patients with regular cycles and metrorrhagia, demonstrating secretory and proliferative endometrium, respectively. Some patients in each group were also identified as demonstrating endometritis.
  
  
  CONCLUSIONS
  Endometrial histology may assist directing therapy and subsequently increasing compliance in progestin-only contraceptive users with irregular bleeding who fail to respond to standard therapies. Altered endometrial expression of IL-13 and IL-15, key cytokines in inflammatory and immune cell trafficking, may influence events, leading to irregular bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida 32610-0294, USA. rhotona@obgyn.ufl.edus
authors.forename: Alice
authors.initials: A
authors.lastname: Rhoton-Vlasak
authors.forename: Nasser
authors.initials: N
authors.lastname: Chegini
authors.forename: Nancy
authors.initials: N
authors.lastname: Hardt
authors.forename: R Stan
authors.initials: RS
authors.lastname: Williams
mesh_terms: D000568:Amenorrhea / Q000378:metabolism* / Q000473:pathology; D015415:Biomarkers; D001706:Biopsy; D003280:Contraceptives, Oral, Synthetic / Q000097:blood / Q000627:therapeutic use*; D004717:Endometrium / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D018793:Interleukin-13 / Q000378:metabolism*; D019409:Interleukin-15 / Q000378:metabolism*; D016912:Levonorgestrel / Q000097:blood / Q000627:therapeutic use*; D008595:Menorrhagia / Q000378:metabolism* / Q000473:pathology; D008598:Menstruation / Q000502:physiology; D010349:Patient Compliance; D011374:Progesterone / Q000097:blood; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D003280:Contraceptives, Oral, Synthetic; D018793:Interleukin-13; D019409:Interleukin-15; D011374:Progesterone; D004958:Estradiol; D016912:Levonorgestrel