الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
INTRODUCTION
Injectable agents for contraception consist of
progestogen acetates or esters formulated in a microcrystalline
solution (med~oxy progesterone acetate,
DMPA, Depo~rovere), or as an oily solution (norethisterone
oenanthate; NET-OEN, Noristerat), (WHO, 1982).
When contraception is based on continuous progestogen
administration, the histologic appearance of
the endometrium shows much greater variation than in
other types of hormonal contraception and ranges from
inactive to secretory with fair amount of irregular
secretory types. The administration of l~ng acting injectable
preparation results in a slight to extreme
glandular involution and endometrial atrophy, especially
in case the injectable does not contain a long acting
estrogenic component. When the effect of the combination
of estradiol enanthatE an~ 16, 17 dihydroxy progesterone
acetophenide was studied, approximately one
third of the biopsies showed secretory activity whereas
two thirds exhibited no evidence of glandular secretion
(Diczfalusy, 1968).
Medroxyprogesterone has a profound influence on
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hu1nan endometrial gland cells. Initially the effect is
one of maturation then inhibition and finally recovery.
Ultrastructure evaluation of the endometrium 90 days
after exposure to medroxyprogesterone suggests that the
tissue is similar to that in the late proliferative phase.
Unpredictable disturbance of the menstrual cycle is the
major problem associated with use of all progestogen only
methods of contraception. The commonest changes include amenorrhea
and irregular, scanty and infrequent bleeding but may
sometimes involve episodes of prolonged or frequent spotting
or light bleeding, heavy bleeding is 1·are. The high
dose injectable DMPA frequently produces a progressively
more and more highly suppressed endometrium with successive
injections and this is clearly causally related to
the high incidence of amenorrhea and oligon•enorrhea. It
is known that there are abnormalities of endometrial vascular
architecture . Several authors have re~orted thin
.,;all ed vascular sinusoids very close to the endOiiiEtrial
surface, (Jan S. Fraser, 1986).