Journal of Medicine and Life Science

  • 제21권2호
  • /
  • Pages.21-30
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  • 2024
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  • 1738-1010(pISSN)
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  • 2671-4922(eISSN)
제주대학교 의과학연구소 (Institute for Medical Science)
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Hysteroscopic evaluation of endometrial changes and fallopian tubal functions in women using progestin-only contraceptives

  • Atef Darwish (Department of Obstetrics & Gynecology, Woman's Health University Hospital, Assiut University Faculty of Medicine) ;
  • Ibrahim Mohammad (Department of Obstetrics & Gynecology, Woman's Health University Hospital, Assiut University Faculty of Medicine) ;
  • Samuel Gendy (Department of Obstetrics & Gynecology, Woman's Health University Hospital, Assiut University Faculty of Medicine) ;
  • Dina Darwish (Department of Obstetrics & Gynecology, Woman's Health University Hospital, Assiut University Faculty of Medicine) ;
  • Mohammad Ramdan (Department of Obstetrics & Gynecology, Woman's Health University Hospital, Assiut University Faculty of Medicine)
  • 투고 : 2023.11.16
  • 심사 : 2024.02.09
  • 발행 : 2024.05.31
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초록

The purpose of this prospective study was to investigate whether office hysteroscopy (OH) can be used to assess the mechanisms of action of progestogen-only contraceptives (POCs), diagnose possible local causes of abnormal uterine bleeding (AUB), and support the treatment plan of symptomatic patients using POCs compared with those who do not use hormones. The study included 140 women who were divided into two groups. Group A consisted of 70 women who used POCs, whereas group B consisted of 70 women who did not use hormones. They were successively examined using transvaginal ultrasonography (TVS), OH, and endometrial sampling. The TVS results were consistent with those of OH and histopathology. The changes in endometrial thickness and vasculature, as well as fallopian tube (FT) functions, were significantly more pronounced in POC users than in non-POC users. There was a significant reduction in the peristalsis of the proximal part of the FT, as well as a reduction in the bubble flow test in group A compared with group B. In addition, the combination of peristalsis and the bubble flow test (Darwishscope test) was significantly lower in group A. It was concluded that using OH as a simple diagnostic tool in women with POCs would contribute to a better understanding of the mechanisms of endometrial and FT effects and explain some local endometrial causes of AUB. This ensures that the combination of TVS and OH would limit routine endometrial sampling in POCs users.

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참고문헌

  1. Monterrosa-Castro A, Redondo-Mendoza V, Monterrosa-Blanco A. Current knowledge of progestin-only pills. Electron J Gen Med 2021;18:em320. 
  2. Ayalon NV, Segev L, Samson AO, Yagel S, Cohen SM, Green T, et al. Norethisterone reduces vaginal bleeding caused by progesterone-only birth control pills. J Clin Med 2022;11:3389. 
  3. Dilbaz B, Bulbul M, Dilbaz S, Yilmaz N, Sanisoglu S. The efficacy, acceptability and continuation of postpartum, post-abortive progestin-only pill: a pioneering prospective multicentric study from Turkey. J Turk Ger Gynecol Assoc 2022;23:255-62. 
  4. Fei YF, Smith YR, Dendrinos ML, Rosen MW, Quint EH. Considerations in adolescent use of the etonogestrel subdermal implant: a cohort study. Front Reprod Health 2021;3:780902. 
  5. Falase EA, Otolorin EO, Ladipo OA. Experience with the use of depo-medroxyprogesterone acetate in a Nigerian population. Afr J Med Med Sci 1988;17:209-13. 
  6. Romero SA, Young K, Hickey M, Su HI. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst Rev 2020;12:CD007245. 
  7. Shoupe D, Mishell DR Jr. Contraception. In: Goldman MB, Troisi R, Rexrode MK, editors. Women and health. 2nd ed. Cambridge (MA): Academic Press; 2013. pp.209-34. 
  8. Zigler RE, McNicholas C. Unscheduled vaginal bleeding with progestin-only contraceptive use. Am J Obstet Gynecol 2017;216:443-50. 
  9. Schrager S. Abnormal uterine bleeding associated with hormonal contraception. Am Fam Physician 2002;65:2073-80. 
  10. Darwish AM, Sayed EH, Mohammad SA, Mohammad II, Hassan HI. Reliability of out-patient hysteroscopy in one-stop clinic for abnormal uterine bleeding. Gynecol Surg 2012;9:289-95. 
  11. Darwish AM, Hassanin AI, Aleem MAA, Mohammad II, Aboushama IH. Routine vaginoscopic office hysteroscopy in modern infertility work-up: a randomized controlled trial. Gynecol Surg 2014;11:185-9. 
  12. Darwish AM, Hassanin AI, Aleem MAA, Aboushama IH, Mohammad II. A novel use of vaginoscopic office hysteroscopy for prediction of tubal patency and peristalsis among infertile women: a preliminary study. Gynecol Surg 2016;13:187-92. 
  13. Darwish AMM, Darwish DA. Hysteroscopic Darwishscope test versus bubble flow patency test for normal and hydrosalpingeal fallopian tubes. J Gynecol Surg 2022;38:49-56. 
  14. Marikinti K. Hysteroscopic findings in women with a history of very thin endometrium during assisted conception treatments. Fertil Steril 2005;84:S364-5. 
  15. Garuti G, Cellani F, Garzia D, Colonnelli M, Luerti M. Accuracy of hysteroscopic diagnosis of endometrial hyperplasia: a retrospective study of 323 patients. J Minim Invasive Gynecol 2005;12:247-53. 
  16. Darwish AMM. Darwish hysteroscopic triad: a missed anatomic landmark. J Gynecol Surg 2021;37:94-5. 
  17. United Nations (UN). Contraceptive use by method 2019: data booklet [Internet]. Geneva: UN-iLibrary; c2019 [cited 2021 May 15]. Available from: https://doi.org/10.18356/1bd58a10-en. 
  18. Bastianelli C, Farris M, Bruni V, Rosato E, Brosens I, Benagiano G. Effects of progestin-only contraceptives on the endometrium. Expert Rev Clin Pharmacol 2020;13:1103-23. 
  19. Dinh A, Sriprasert I, Williams AR, Archer DF. A review of the endometrial histologic effects of progestins and progesterone receptor modulators in reproductive age women. Contraception 2015;91:360-7. 
  20. Jensen JT, Hanna C, Mishler E, Lim JY, Slayden OD. Effect of menstrual cycle phase and hormonal treatments on evaluation of tubal patency in baboons. J Med Primatol 2018;47:40-5. 
  21. Patrizi L, Ticconi C, Borelli B, Finocchiaro S, Chiaramonte C, Sesti F, et al. Clinical significance of endometrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery. BMC Womens Health 2022;22:106. 
  22. Pandey D, Kunamneni S, Inukollu PR, Su H. Establishing patterns on hysteroscopy in abnormal uterine bleeding (AUB). Gynecol Minim Invasive Ther 2017;6:178-82. 
  23. Hickey M, Fraser IS. Surface vascularization and endometrial appearance in women with menorrhagia or using levonorgestrel contraceptive implants. Implications for the mechanisms of breakthrough bleeding. Hum Reprod 2002;17:2428-34. 
  24. Li C, Zhang HY, Liang Y, Xia W, Zhu Q, Zhang D, et al. Effects of levonorgestrel and progesterone on oviductal physiology in mammals. Reprod Biol Endocrinol 2018;16:59. 
  25. Wanggren K, Stavreus-Evers A, Olsson C, Andersson E, Gemzell-Danielsson K. Regulation of muscular contractions in the human fallopian tube through prostaglandins and progestagens. Hum Reprod 2008;23:2359-68. 
  26. Jensen JT, Patil E, Seguin J, Thurmond A. Tubal patency during the menstrual cycle and during treatment with hormonal contraceptives: a pilot study in women. Acta Radiol 2017;58:1020-5. 
  27. Hickey M, Fraser I, Dwarte D, Graham S. Endometrial vasculature in norplant users: preliminary results from a hysteroscopic study. Hum Reprod 1996;11(Suppl 2):35-44. 
  28. Kayisli UA, Basar M, Guzeloglu-Kayisli O, Semerci N, Atkinson HC, Shapiro J, et al. Long-acting progestin-only contraceptives impair endometrial vasculature by inhibiting uterine vascular smooth muscle cell survival. Proc Natl Acad Sci U S A 2015;112:5153-8. 
  29. Essam M, Alhalabi A, Hamza H, Al-Sarag M. Role of transvaginal Doppler sonography in cases of irregular uterine bleeding with depot medroxyprogesterone acetate. Menoufia Med J 2019;32:1355-8. 
  30. Zuniga C, Forsberg H, Grindlay K. Experiences of progestin-only pill users in the United States and attitudes toward over-the-counter access. Perspect Sex Reprod Health 2023;55:104-12. 
  31. Eiran E. Hysteroscopy: endometrial vascular dystrophy: misnomer. Int J Reprod Contracept Obstet Gynecol 2022;11:636-8.