To evaluate the long term effects of an IUD on the human endometrium and find the possible contraceptive mechanism of IUD, histologic, histochemical and ultrastructural studies of human endometrial biopsies from 44 normal controls and 178 IUD wearers were made. Histologic findings included interstitial hemorrhage, inflammatory reaction, hyperplasia, atrophy, focal necrosis and squamous metaplasia. However, all of these findings were either infreqnent or insignificant except for inflammatory reaction. Histochemica1, enzymatic and ultrastructural findings were a1so unremarkable. The most significant finding, was asynchronism between cyclic dating and endometrial histologic dating, showing delayed endometrial maturation in the majority of IUD users. In summary, IUD insertion brings about mild and little histologic alteration in the human endometrium, but the inflammatory reaction and asynchronous endometrial matruation may play some role in the antifertility actifertility action of an IUD.
Adult ; Comparative Study ; Endometriosis/etiology ; Endometriosis/ultrastructure ; Endometrium/ultrastructure* ; Female ; Human ; Intrauterine Devices/adverse effects* ; Middle Age ; Time Factors ; Uterine Diseases/etiology* ; Uterine Diseases/pathology

OBJECTIVETo analyze the ultrastructural characteristics of ectopic endometrium in endometriosis.

METHODSEctopic endometria collected from patients with adenomyosis and ovarian endometriosis were examined under transmission electron microscope (TEM).

RESULTSIn comparison to normal human endometrium, the ectopic glandular epithelium of adenomyosis patients showed reduced and shortened microvilli covering the surface of the secretory cells, with obviously increased, elongated and irregularly aligned cilia of ciliated cells projecting into the lumen. Numerous microvilli and cilia broke off from the cell surface and shed into the lumen. The mitochondria were enlarged, and multiple polyribosomes were present on the surface of RER. The Golgi apparatus with electron-lucent vacuoles was seen frequently. The glandular cells contained many lysosomes, lipofuscins and myelinosomes, and the cell nuclei showed varying shape and size. The nuclear membrane of the epithelial cells was irregularity. Cytoplasm protrusion containing a few organelles occurred and shed into the lumen. Some ectopic epithelial cells showed characteristic features of necrosis. The basement membrane became markedly tortuous and focal lysis of the extracellular matrix was seen. Ultrastructurally, the ectopic glandular epithelium in ovarian endometriosis showed short and sparse microvilli on the free surface of the secretory cells. Some microvilli broke off from the surface. The short cilia of the ciliated cells were seldom seen. The mitochondria were enlarged. The glandular cells contained small amounts of RER, many free ribosomes, Golgi apparatus, lipofuscins and myelinosomes. The nuclear membrane showed obvious irregularity. Some ectopic epithelial cells had giant nuclei. Cytoplasmic protrusions containing small amounts of organelles were observed in some ectopic epithelial cells. Apoptotic cell death occurred in some ectopic glandular epithelium cells. The basement membrane became markedly tortuous, and the decidual-like cells containing abundant short and club-shaped RER were observed. The number of macrophages was obviously increased.

CONCLUSIONThe ultrastructural change of the ectopic glandular epithelium in endometriosis promotes its transformation into endometriotic lesions.

Adult ; Endometriosis ; pathology ; Endometrium ; ultrastructure ; Female ; Humans ; Microscopy, Electron, Transmission ; Middle Aged

OBJECTIVETo investigate the apoptosis-related mechanisms of levenorgestrel-releasing intrauterine system (LNG-IUS), oral medroxyprogesterone (MPA), and injective gonadotrophic hormone releasing hormone agonist (GnRHa) on eutopic endometrium of patients with endometriosis. Methods We collected the samples of endometrium from patients with endometriosis before operation and after insertion of LNG-IUS, administration of oral MPA, or injection of GnRHa. The ultrastructure of endometria was observed and compared by electron microscopy. Apoptotic cells were assessed by the terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick-end labeling (TUNEL) assay, and the expressions of Bax, Fas, and Fas-L mRNA were determined by semi-quantitative reverse transcription-polymerase chain raction. Results After have been exposured to LNG-IUS, the apoptotic rate of endometrial epithelial cells and stromal cells increased from (24. 4 +/- 35.0)% to (51.0 +/- 37.8)% (P = 0.027) and (35.3 +/- 30.2)% to (76.4 +/- 11.2)% (P = 0.008), respectively. The degree of apoptosis under transmission electron microscopy was in an order of GnRHa > LNG-IUS > MPA. The expression of Fas-L mRNA in eutopic endometrium of patients with endometriosis was significantly higher than that of the normal control (P < 0.05). The expressions of three apoptosis-related proteins had no significant difference.

CONCLUSIONMedical treatments can increase the apoptosis of eutopic endometrial cells, and such effect was strongest in GnRHa and relatively weaker in LNG-IUS and MPA.

Apoptosis ; Endometriosis ; drug therapy ; pathology ; Endometrium ; drug effects ; pathology ; ultrastructure ; Female ; Gonadotropin-Releasing Hormone ; agonists ; Humans ; Intrauterine Devices, Medicated ; Levonorgestrel ; therapeutic use ; Medroxyprogesterone ; therapeutic use