Effects of levonorgestrel‐releasing intra‐uterine system on the expression of vascular endothelial growth factor and adrenomedullin in the endometrium in adenomyosis

Author： Laoag‐Fernandez J.B.

Publisher： Oxford University Press

ISSN： 1460-2350

Source： Human Reproduction, Vol.18, Iss.4, 2003-04, pp. : 694-699

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Abstract

BACKGROUND: The levonorgestrel‐releasing intra‐uterine system (LNg‐IUS) has been used to control menorrhagia, but irregular bleeding during the first 3 months of use was the most notable side effect. Endometrial angiogenesis is believed to be regulated by angiogenic factors. The study aim was to evaluate the effects of LNg‐IUS on vascular endothelial growth factor (VEGF) and adrenomedullin (AM) expression in the endometrium. METHODS: VEGF and AM expression were analysed using the avidin‐biotin immunoperoxidase method on endometrial curettage specimens from menorrhagic women associated with adenomyosis before and 3 months after LNg‐IUS insertion. RESULTS: VEGF expression was abundant both in the endometrial glands and stroma before LNg‐IUS insertion, but became scanty 3 months after insertion. No immunostaining for AM was noted in the endometrial glands and stroma before LNg‐IUS insertion, whereas AM immunostaining became prominent in the endometrial glands and stroma 3 months after LNg‐IUS use. CONCLUSIONS: This is the first study to demonstrate that LNg‐IUS insertion results in decreased expression of VEGF and increased expression of AM in the endometrial glands and stroma after 3 months of use. The results obtained suggest that the increase in AM expression in the endometrium may be responsible for the frequent occurrence of irregular bleeding during the initial 3 months of LNg‐IUS use.