Scanning electron microscopy of the human endometrium in pill users.

PIP: 20 premenstrual endometrial biopsies were examined in 20 fertile women using combined conventional oral contraceptive pills (Anoviar-1) for periods from 1-15 years using both SEM and light microscopy. 3 types of endometria were detected. These were irregular secretory, suppressed, and atrophic endometria. Using scanning electron microscopy, the 1st type showed few ciliated cells with weak cilia as well as collapsed nonciliated cells. The 2nd type showed nonciliated cells with few signs of secretion. The 3rd showed rarely ciliated cells, flat secretory cells with no signs of secretion. The longer the duration of pill use, the more atrophic changes there were. Focal glandular proliferation was also detected.^ieng

Ovarian morphology and histopathology in post pill amenorrhea.

PIP: There have been a large number of reports of amenorrhea after oral contraception termination. It may be due to oversuppression of the hypothalamic-pituitary axis or to direct atrophic effects on the endometrium. Comparative studies were done by means of a laparoscopic examination of the ovaries of 20 women with postpill amenorrhea as compared with normal ovaries. In the women with postpill amenorrhea the ovaries were free from the fimbrial ends of the tubes. They were almond-shaped and were close to the size of the resting ovaries in the control group. The amenorrhea patients' ovaries were of a porcelain white color with no superficial blood vessels. There were no corpora lutea or growing follicles. Ovarian biopsies showed diffuse fibrous stroma, primordial primary follicles, and atrophic follicular cysts. Endometrial biopsy showed characteristic atrophic or resting endometria. None of the findings were pathological, which may explain why most cases of postpill amenorrhea are reversible.^ieng

The effect of injectable contraceptive on lipid metabolism in women.

The effect of long acting progestational contraceptive injection, norethisterone-oenanthate was studied in twenty six women. The post injection results showed a significant decrease in total lipids, free cholesterol, total cholesterol, triglycerides, phospholipids and free fatty acids.

PIP: 26 healthy Egyptian women, aged 20-35 years, were studied to determine the effects of norethindrone-enanthate in injectable form on lipid metabolism. The dose was 200 mg, with the 1st injection being given on Day 5 of the menstrual cycle. Blood samples were taken before injection, while the subjects were in a fasting state, and 2 months after the last injection, a total of 6 months later. Injections were repeated every 2 months in the interim. Levels of total lipids, free cholesterol, total cholesterol, triglycerides, phospholipids, and free fatty acids were compared. Total serum lipids decreased significantly after 2, 4, and 6 months of injection (significantly different from pretreatment values at the level of 1%). Total and free serum cholesterol both decreased significantly after 2, 4, and 6 months of injection. Serum triglycerides and serum phospholipids were likewise significantly decreased after 2, 4, and 6 months of injection. however, plasma free fatty acids were significantly lower after 2 months but not after 4 and 6 months of injection. The decrease in free fatty acids may be attributed to suppression of lipolysis due to decreased cyclic adenosine monophosphate or to epinephrine suppression; triglyceride suppression may have resulted from a possible effect on estrogen receptors decreased transport of lowered fatty acids to adipose tissues or increased lipoprotein lipase; phospholipid reduction may be related to the lessening of fatty acids being transported to the adipose tissues or to impaired liver function; and total lipid suppresson was thought to be the result of the significant decrease in blodd lipid fractions observd. it is concluded that this injectable preparation is more satisfactory, in terms of lipid metabolic effects, than combined contraceptive preparatios.

Immunoglobulin pattern in women using Lippes loop.

PIP: Immunoglobin A, M, and G were studied among 80 women divided into 4 groups according to the time interval between insertion of a Lippes Loop and collection of sera for assay: 1) control group, sera collected before insertion; 2) group A, 3 days after insertion; 3) group B, 6 months after insertion; and 4) group C, 12 months after insertion. Results were: 1) for immunoglobin A the pattern in control group ranged from 90-395 mg/dl, group A 115-355 mg/dl, group B 145-395 mg/dl, and group C 110-355 mg/dl; 2) for immunoglobin M, control group was 30-250 mg/dl, group A 25-260 mg/dl, group B 20-285 mg/dl, and group C 200-385 mg/dl; and 3) for immunoglobin G, control group was 450-2550 mg/dl, group A 50-2500 mg/dl, group B 1000-2500 mg/dl, and group C 600-2550 mg/dl. The results show that there is elevation in all immunoglobin 12 months after IUD insertion, and immunoglobins were elevated not only in the serum but also in the interstitial area and basement membrane of the endometrium. There was an increased incidence of cytotoxic antibodies against lymphocytes in parous women which may explain the greater rate of expulsion of IUDs in nonparous women and which supports the immunologic involvement in IUD function.^ieng

The effect of intra-uterine device on the endometrial pattern.

PIP: Although there is general agreement that asynchrony of the endometrial mucosa is the mechanism by which implantation is inhibited among IUD users, there is a lack of consensus as to whether the type of asynchronism is a delayed or accelerated maturation. To detect the effect of IUDs on dating of the endometrial mucosa, endometrial biopsies were taken from 50 asymptomatic Lippes loop users on days 16, 20, and 24 of the menstrual cycle. The cases, who ranged in age from 20-40, all had regular cycles. A discrepancy of 2 or more days was categorized as representing endometrial asynchrony. On day 16, 29 cases (58%) showed a delayed maturation ranging from 2-12 days. By day 20, delayed maturation was noted in 40 cases (80%), with a range in delay from 2-10 days. On day 24, 44 cases (88%) showed endometrial asynchrony from 2-8 days. The incidence of endometrial asynchrony observed in this series is considerably higher than that obtained in previous studies. This may reflect differences in definition and in dating time and methods. Some studies have considered 3 or more days of delay to be significant. Another study took specimens during the proliferative phase of the menstrual cycle, at which time accurate dating is not possible. The results from the present series suggest that endometrial asynchrony in for form of delayed maturation may be a contraceptive factor. However, further research involving larger numbers of cases is needed.^ieng

Culdoscopic tubal ligation.

PIP: The indications for, techniques, and results of 100 culdoscopic tubal ligations performed at the Shatby Maternity Hospital, Alexandria University, are presented. The procedures took place between July 1976 and September 1978. Sterilization indications were simple multiparity (91 cases), compensated rheumatic heart (4), diabetes mellitus (2), status asthmaticus (1), pulmonary tuberculosis (1), and leukemia (1). The procedure used the knee-chest position. Each patient was premedicated. A fulcrum perineal retractor with attached fiberoptic light was introduced through the vagina and local anesthesia was infused. The Douglas pouch was punctured by a trocar, the trocar was removed, and the culdoscope introduced. The fallopian tube was grasped either from the mesosalpinx or from a point proximal to the tube's fimbrial end. A Pomeroy-type sterilization was done after the tubes were grasped. Operative time ranged from 6-40 minutes with a mean of 8.4 minutes. The only postoperative complications were 1 case of pneumoperitoneum pain, 1 pelvic abscess, and 1 small broad ligament hematoma. Hospital stay ranged from 0-5 days, with .7 days the mean. 60 patients followed up by hysterosalpingography showed perfect tubal patency. No pregnancy has been recorded. The procedure was virtually bloodless.^ieng

Comparative study of the effect of oral contraceptives containing 50 microgram of estrogen and those containing 20 microgram of estrogen on adrenal cortical function.

Because the adrenal cortex is an endocrine gland essential to life, its function was studied in women who were taking an oral contraceptive that contained either 50 microgram or 20 microgram of estrogen. Of 32 healthy women studied, 18 used an oral contraoceptive that contained 50 microgram of estrogen, and 14 used an oral contraceptive that contained 20 microgram of estrogen. With 50 microgram of estrogen, the total plasma cortisol level rose significantly, the level of urinary cortisol excretion did not change significantly, and the levels of 17-ketosteroids and 17-ketogenic steroids were significantly reduced. With 20 microgram of estrogen, there were no significant changes in the levels of total plasma cortisol, urinary cortisol excretion, and the excretion of 17-ketosteroids and 17-ketogenic steroids. Thus, adrenal cortical function was altered in women who used an oral contraceptive that contained 50 microgram of estrogen, but there was no significant effect with the use of an oral contraoceptive that contained only 20 microgram of estrogen. Our findings confirm previous ones in regard to the effects of 50 microgram of estrogen on adrenal cortical function, although no studies had been carried out previously on the effects of 20 microgram of estrogen.

PIP: The effect of oral contraceptives (OCs) containing 50 mcg vs those containing 20 mcg of ethinyl estradiol (EE) on adrenal cortex function was assessed. From a total of 32 women studied, 18 used the 50-mcg EE OC and 14 used the 20-mcg preparation. Blood and urine specimens were obtained at the start of the trial and in 3-month intervals for 9 months thereafter, and total plasma cortisol, urinary cortisol excretion, urinary 17-ketosteroids excretion, and urinary ketogenic steroids excretion were assayed. In women using the 50-mcg OC, the total plasma cortisol level rose significantly after 3, 6, and 9 months of OC use with no significant difference between the mean values of these periods. Urinary cortisol excretion level did not change significantly after 3, 6, and 9 months of use. Urinary levels of 17-ketosteroids and 17-ketogenic steroids were significantly reduced after 3, 6, and 9 months of OC use; however again means were not statistically significantly different. In the 20-mcg OC group, the measured substances did not change significantly after 3, 6, and 9 months, confirming the previously reported findings that adrenal cortical function was affected during use of high-dose EE OCs.