Transvaginal Doppler sonography for evaluation of irregular uterine bleeding with DMPA

Protective effect of green tea on tunica adventitia and endothelial changes resulting from depot medroxy progesterone acetate

Objective

This study aimed to analyse the effects of green tea in inhibiting uterine atrophy and vascular changes due to the use of depot medroxy progesterone acetate (DMPA).

Methods

Twenty-five female Wistar rats aged one to two months were randomly assigned to five treatment groups: control group, DMPA-induced group, and DMPA-induced group orally treated with green tea extract (at 10.8 mg/day, 21.6 mg/day, or 43.2 mg/day). Histologic analysis of uterine and vascular tissues was performed with haematoxylin-eosin staining.

Results

DMPA decreased the thickness of endometrium and tunica adventitia, as well as significantly decreased endothelial cell count (p < 0.05). DMPA-induced decreases in the thickness of tunica adventitia and endothelial cell count could be significantly inhibited by green tea extract (p < 0.05).

Conclusion

This study concluded that DMPA triggered the depletion of uterine endometrium and vascular tunica adventitia and decreased endothelial cell count. Green tea extract at the highest dose normalized tunica adventitia and endothelial changes to the basal value.

Correlation between uterine artery Doppler indices and menstrual irregularities among levonorgestrel releasing intrauterine system and depot medroxyprogesterone acetate users: a prospective observational study

OBJECTIVE

To ascertain whether menstrual irregularities among users of levonorgestrel releasing intrauterine system (LNG-IUS) and depot medroxyprogesterone acetate (DMPA), were associated with changes in uterine artery Doppler indices or not.

METHODS

This three-year prospective observational study included 102 women using LNG-IUS and 104 women using DMPA for contraception. Participants were followed at regular intervals over three years with performance of transvaginal ultrasound to measure uterine artery pulsatility index (PI) and resistance index (RI) before starting the method and at six months, 12 months, two and three years thereafter. Data was collected and tabulated.

RESULTS

Significant changes in uterine artery PI and RI were detected. PI indices were reduced after six months of use in both groups and elevated significantly at 12 months in both groups compared to initial values (p < .001) while RI significantly reduced after six months in both groups and elevated significantly at 12 months, two and three years in both groups compared to initial values (p < .001). Both PI and RI significantly reduced in women suffered abnormal uterine bleeding and significantly elevated in women experienced amenorrhea irrespective of the method used (p < .001).

CONCLUSIONS

LNG-IUS and DMPA induce hemodynamic changes in the uterine arteries denoting positive correlation with menstrual irregularities. Larger multicentre studies are warranted to potentiate our findings.