We studied in twenty women the effectiveness of a new type of intrauterine device, which is coated with progesterone. Since the progesterone-coating is estimated to last one year, we studied the women for that period of time. None of them became pregnant. Most complained of some disturbances of menstrual bleeding during the first three months. A few experienced these disturbances for the whole year of observation. No other side effects developed like those experienced with oral contraceptives. Six hysterectomy specimens and one complete curettage became available for us to examine the histological changes produced by this new type of intrauterine device. The endometrium in all revealed a distinct division into two horizontal layers produced by progesterone absorbed from the device. The upper layer of endometrium next to the device showed a decidual change with sparse atrophic glands, like those of an arrested secretion. The underlying layer exhibited either normal proliferative or secretory changes consistent with the phase of the menstrual cycle. The remarkably circumscribed decidual change led us to refer to it as "perifocal arrested secretion", a term emphasizing that the gestagen inserted into the uterine cavity acts locally on the endometrium. Foci of endometrium in the myometrium (adenomyosis) are not affected.

Adolescent↗

PubMed1975

[The histological reaction of the endometrium to gestagens applied locally].

To study the histologic changes produced by a new type of progesterone-medicated intrauterine device we examined the endometria of six hysterectomy specimens and one complete curettage. After being in place for 1 month the device induced a mild perifocal "arrested secretion" of the upper layers of the endometrium; after 3 months the change was pronounced, with decidually transformed stromal cells and atrophic glands. After 12 months these changes had partially progressed to fibrous atrophy. The endometrium underlying the perifocal-arrested secretion showed either proliferative or secretory changes almost like those of the lower functionalis of a normal menstrual cycle. A generalized atrophy of glands developed only when the patient had used oral contraceptive agents before the device was inserted. The perifocal arrested secretion thus differs from the generalized arrested secretion of the endometrium that follows use of oral or injected gestagens and from the decidualization produced mechanically by the local effect of an intrauterine device. The contraceptive effectiveness of the medicated intrauterine device, as compared with that of a simple device, is increased by the glandular atrophy of the arrested secretion. It avoids the dangers of the generalized effects of progestational agents by limiting the changes to the upper layers of the endometrium which are so important for implantation.

Administration, Topical↗

PubMed1975

[Legal abortions at the University-Gynecological Clinic Mannheim during 1971-1974].

Between 1971 and 1974 142 legal abortions were performed. Methods used were determined by gestational age, size of the uterus and whether or not abortion in conjunction with sterilization was indicated. Dilatation and evacuation was employed in 46% of cases; in 8% of these sterilization was performed at a later date. A further 55% were treated by means of primary hysterectomy, 38% via the vaginal route, 17% via the abdominal route. Complications were observed in 4 cases (3 perforations, 1 post-operative haemorrhage, 1 case of endometritis). The complication rate was not higher than in non-pregnant women.

Abortion, Induced↗

PubMed1974