RESUMO
Hormonal contraceptives are female sex steroids, synthetic estrogen and synthetic progesterone [pro gestin], or pro gestin only. They can be administered in the form of oral contraceptives "OC", implants, and injectables. A large part of the modem medical research has focused on studying the effect of different forms of the hormonal contraception on the human endometrium whether by the conventional dilatation and curettage or by outpatient pipelle to study the endometrial histopathological changes either by light microscope or scanning electron microscope; and to correlate the findings detected by both modalities, in order to develop an effective method for diagnosis and treatment of different forms of eridometrial pathology. The aim of the present study was to evaluate the effect of estrogen treatment on the endometrium of women using pogestational injectable contraceptive [Depo-provera] [R]and complaining of irregular uterine bleeding using: Clinical assessment, transvaginal ultrasound and studying endometrial samples by: The ordinary light microscope and the scanning electron microscope. In this study 30 women using depo provera as a contraceptive method and all of them complaining of irregular uterine bleeding were randomly categorized into 2 groups; group A included 15 cases who received estriolfor 3 months, and group B included 15 cases who received Diosmine for the same period. Both groups were subjected to endometrial sampling by an out patient pippelle before and after treatments then the endometrial tissues were examined by the ordinary light microscope and the scanning electron microscope, results were then tabulated and statistically analyzed using the standard statistical tests. Microscopic examination of-the endometrial biopsies from all women receiving depot inedroxyprogesterone acetate revealed variable degrees of endo, netrial atrophy. The glandular architecture was cystic in cases and budded in the others. The glands were lined by mitotically inactive bland-looking cuboidal or flattened cells with rare pseudostratfication. The glands were embedded' in a mitotically inactive spindled stroma that exhibited varying degrees of collagenation. The ratio of glands to stroma was near one with predominant stroma. in many foci. Microscopic examination of the endometrial biopsies of the 15 patients that received Diosmine for 3 months didn't reveal any proliferative change in 12 of them and only weak prohferative changes were noted in 3 of them. All atrophic endometria examined with the SEM revealed inconsistency in cell size and shape, cellular loss and separation, infrequency of ciliated cells and absence of uterodomes. Epithelial surface was usually flattened, with cells often displaying raised cell borders; Microvillous cells were thinly populated with very low, blebbed microvilli. Afew to moderate number of glands with large openings were observed. Pitted cells were observed in 2 of the specimens that were treated with Diosmine. Number of injections and time lapse since the last injection had a role in the endometrial changes but age, gravidity and parity had no role. Depotmedroxyprogesterone acetate [DMPA] is one of the most effective hormonal iontraceptive methods used by women in reproductive age to prevent pregnancy. Discontinuation of DMPA is mainly due to menstrual irregularities including unpredictable bleeding or spotting; this bleeding is mainly due to endometrial atrophy. Estriol is considered the friendly estrogen and can he used in treatment of vaginal bleeding during DMPA use by changing the endometrium front vrophic to prolfirative so it causes building up of a new endometrium without evident side effects Endometriutn either under effect of DMPA or estriol is easy to be studied by combined scanning electron microscopy and ordinary light microscopy cfter endometrial sampling by outpatient pipelle