Endometrial histopathology, ovarian changes and bleeding patterns among users of long-acting progestin-only contraceptives in Egypt

ABSTRACT

Objective To evaluate endometrial and ovarian effects, and bleeding patterns, among users of Depo-Provera^®, Norplant^®, and Implanon^®.

Study design One-hundred and fifty women, who had been using one of these long-acting progestin-only contraceptives (LAPCs) for at least the previous six months, with fifty in each of the groups, were assessed.

Results All results are mentioned in the following sequence: (1) Depo-Provera^®, (2) Norplant^®, and (3) Implanon^®. Normal bleeding was reported by 0%, 52%, and 8%; amenorrhoea or infrequent bleeding by 68%, 24%, and 72%; and abnormal bleeding by 32%, 24%, and 20%, respectively (p < 0.001). Histological evaluation revealed an atrophic endometrium in 84%, 32%, and 28%, respectively (p < 0.0001); a progestin effect in 16%, 28%, and 62%, respectively (p < 0.0001), and a proliferative pattern in 0%, 40%, and 10%, respectively (p < 0.0001). Endometrial thickness was 3 ± 0.41 mm, 3.62 ± 0.65 mm, and 5.2 ± 0.84 mm, respectively (p < 0.0001). Follicular growth in the ovaries was observed at ultrasound in 12%, 40%, and 72%, respectively (p < 0.001).

Conclusion Bleeding patterns, endometrial thickness, ovarian activity, and endometrial histology among Egyptian users of LAPCs differed significantly depending on the nature of the contraceptive.

KEYWORDS:

• Implanon^®
• Norplant^®
• Depo-Provera^®
• Contraceptive implants
• Endometrium
• Ovary
• Ultrasound
• Bleeding irregularities

Declaration of interest: The authors received no financial support for their research, and they report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.