title: Effect of copper intrauterine device on the cyclooxygenase and inducible nitric oxide synthase expression in the luteal phase endometrium.
abstract: BACKGROUND
  To evaluate the effect of copper intrauterine device (IUD) on the expression of cyclooxygenase (COX) and inducible nitric oxide synthase (iNOS) in the luteal phase endometrium.
  
  
  METHODS
  A prospective clinical study was conducted on 30 women who were willing to use a copper IUD contraception. Endometrial biopsies and blood samples were taken before and 3 months after the insertion of the IUD on Day 3 and Days 20-24 of the cycle. Main outcome measures were to evaluate the effect of copper IUD on uterine artery blood flow using pulsed color Doppler ultrasonography and the relationship of bleeding abnormalities and menstrual pain level with the uterine blood flow, COX-2 and iNOS expression.
  
  
  RESULTS
  Only the left uterine artery pulsatility and resistance indices decreased statistically significantly (p=.005 and p=.039, respectively). Other Doppler parameters showed no change. Cyclooxygenase-2 expression of both endometrial luminal epithelium (p=.03) and gland epithelium (p=.03) increased significantly. Inducible NOS expression of the endometrial surface epithelium decreased significantly after IUD insertion (p=.01).
  
  
  CONCLUSIONS
  Although COX-2 expression increased 3 months after copper IUD insertion, iNOS expression of the luminal epithelium decreased. Local hypoxia caused by copper and vasoconstrictor prostanoids may play a role in IUD-related menstrual abnormalities.
authors.affiliation: Kocaeli University Department of Obstetrics and Gynecology, 41000 Kocaeli, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Coskun
authors.forename: Yigit
authors.initials: Y
authors.lastname: Cakiroglu
authors.forename: Banu Kumbak
authors.initials: BK
authors.lastname: Aygun
authors.forename: Bahar
authors.initials: B
authors.lastname: Muezzinoglu
authors.forename: Eray
authors.initials: E
authors.lastname: Caliskan
mesh_terms: D000293:Adolescent; D000328:Adult; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D004412:Dysmenorrhea / Q000209:etiology / Q000503:physiopathology; D004717:Endometrium / Q000201:enzymology* / Q000378:metabolism; D004848:Epithelium / Q000201:enzymology / Q000378:metabolism; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects*; D008183:Luteal Phase / Q000378:metabolism*; D008595:Menorrhagia / Q000209:etiology / Q000503:physiopathology; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism*; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D055988:Uterine Artery / Q000000981:diagnostic imaging / Q000502:physiology / Q000503:physiopathology; D014655:Vascular Resistance; D055815:Young Adult
chemical_list: C496319:NOS2 protein, human; D052247:Nitric Oxide Synthase Type II; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human