Prostaglandin mediated action of IUD's. II. F-prostaglandins (PGF) in the uterine horn of pregnant rats and hamsters with intrauterine devices

Nonsteroidal antiinflammatory drugs and reproduction

The role of nonsteroidal antiinflammatory drugs in human reproduction and reproductive disorders is reviewed. Nonsteroidal antiinflammatory drugs inhibit the biosynthesis of prostanoids and can cross the placental barrier into the fetal circulation. Nonsteroidal antiinflammatory drugs are the treatment of choice in primary dysmenorrhea and intrauterine contraceptive device-induced dysmenorrhea and menorrhagia. Nonsteroidal antiinflammatory drugs can be used for effective control of menorrhagia, preterm labor, and polyhydramnios and for prevention of preeclampsia, but larger definitive clinical trials are needed. Prostaglandin inhibition with some nonsteroidal antiinflammatory drugs appear promising in the relief of some premenstrual symptoms and in the prevention of postoperative pelvic adhesion formation, but more studies are needed in women. Whereas implantation and tubal mobility are mediated by local prostaglandins, the potential use of nonsteroidal antiinflammatory drugs to suppress prostaglandin in these reproductive processes for enhancing or reducing fertility warrants further studies. In the last 2 decades nonsteroidal antiinflammatory drugs have been used increasingly in the treatment of some reproductive disorders and are promising for many others.

Role of plasminogen activators and leukocytes in IUD-induced inflammation: effect of some anti-inflammatory agents

Insertion of an IUD causes a persistent inflammatory reaction, evident from an increase in the vascular dilatation and permeability of IUD-exposed endometrium. IUD-induced inflammatory changes can be checked by using anti-inflammatory drugs. In this study in rats, we report that IUD-induced inflammatory changes were partially checked by the use of anti-inflammatory drugs, in order of effectiveness, indomethacin greater than naproxen greater than ibuprofen. Histologically, IUDs provoke mild degeneration of uterine epithelium and necrotic changes in the endometrial glands. Heavy infiltration of polymorphonuclear leukocytes (PMNs) in the uterine lumen was also noticed. IUD-induced degenerative changes in the histoarchitecture of uterine epithelium were partially repaired following treatment with anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea

Dysmenorrhea, which may be primary or secondary, is the occurrence of painful uterine cramps during menstruation. Until a decade ago, medical and social attitudes toward dysmenorrhea were shrouded with folklore, psychoanalytical profiles, or psychosomatic bases. In secondary dysmenorrhea, there is a visible pelvic lesion to account for the pain, whereas only a biochemical abnormality is responsible for primary dysmenorrhea. Recent advances in the biochemistry of prostaglandins and their role in the pathophysiology of primary dysmenorrhea and intrauterine device (IUD)-induced dysmenorrhea have now firmly established a rational basis for the disorder. In primary dysmenorrhea, menstrual prostaglandin release is significantly increased but can be readily suppressed to normal levels when nonsteroidal anti-inflammatory drugs (NSAIDs) capable of inhibiting cyclo-oxygenase are given during menstruation. Many clinical trials (controlled and uncontrolled) have demonstrated the efficacy of NSAIDs such as the fenamates, indole-acetic acid derivatives, and arylpropionic acid derivatives in relieving primary dysmenorrhea as well as IUD-induced dysmenorrhea that is also due to elevated prostaglandin levels. With a few of these NSAIDs, it has been shown that the relief of pain is associated with a significant decrease in menstrual fluid prostaglandin levels. Cumulative data of clinical trials indicate that with the effective NSAIDs, 80 percent of patients with significant primary dysmenorrhea can be adequately relieved. Ongoing studies suggest that in some women, endometrial leukotriene, but not PGF2a production, is increased. With the official approval and availability of several effective NSAIDs for the specific treatment of primary dysmenorrhea in the United States, women who have primary dysmenorrhea have been greatly relieved and their productivity increased. Primary dysmenorrhea affects 50 percent of postpubescent women and absenteeism among the severe dysmenorrheics has been estimated to cause about 600 million lost working hours or 2 billion dollars annually. Thus, an effective, simple, and safe treatment of primary dysmenorrhea for two to three days during menstruation will not only have a positive economic impact but will also enhance the quality of life. The availability of effective dysmenorrhea therapy with NSAIDs has induced greater expectations of relief by the patient, as well as greater willingness to seek medical help, a more rational approach to patient management by physicians, changes in attitude toward women with primary dysmenorrhea, and the debunking of myths about dysmenorrhea that often have been perpetuated as fact.(ABSTRACT TRUNCATED AT 400 WORDS)

Influence of local release of indomethacin from a silastic device on uterine prostaglandins F2 alpha and E

Delivery of indomethacin (approximately 120 micrograms over 23 days) from a unilateral silastic intrauterine device in the rat caused a reduction in the wet weight of the IUD-bearing horn when compared to that of animals with a plain silastic device. The exposure of the uterus to the sustained local release of indomethacin also resulted in a lowering of basal levels of prostaglandins PGF2 alpha and PGE in the tissue as determined by radioimmunoassay. For PGF2 alpha, no marked difference was found in the capability of the tissue to produce it when the IUD horns of the two groups of experimental animals were compared.

Intrauterine contraceptive devices: failure of unilateral intrauterine device in inducing luteolysis in rabbits, rats and mice

Insertion of a unilateral intrauterine device (IUD) on day 1 pc in rabbits and rats or day 2 pc in mice is found to interrupt pregnancy in the device-bearing uterine horn, but does not affect blastocyst implantation or fetal development of the contralateral side. It is also evident that following surgical ablation of the ovary of the non-IUD side, the ovary of the IUD-bearing side can effectively maintain pregnancy and fetal growth as in controls. The possible mode of action of the IUD has been discussed.

The effect of prostaglandins F2alpha and E2 on pregnancy in mice during implantation

The uterine content of prostaglandins (PGs) increases following insertion of an intrauterine device (IUD). Such IUD-bearing uteri also exhibit impaired decidualization. Although prostaglandins have been shown to be luteolytic in several species, it is not clear that inhibition of decidualization is mediated solely through alterations in ovarian steroidogenesis. In these experiments, ovariectomized, hormone-replaced pregnant mice, as well as intact mice, were treated systemically with either PGE2 or PGF2alpha so that the extraovarian actions of prostaglandins upon decidualization could be segregated from effects mediated by alterations in ovarian steroidogenesis. The results suggest that the effect of PGF2alpha upon decidualization was mediated via an alteration in ovarian steroidogenesis, but that PGE2 acted independently of the ovary. The hypothesis is presented that alterations in the ratio of E to F prostaglandins elicited within the endometrium by an IUD inhibit decidualization at the uterine level, and that this effect might be mediated by impairment of histamine release from endometrial mast cells.

Anti-prostglandin therapy in prevention of side-effects of intrauterine contraceptive devices

The efficacy of an anti-prostaglandin, tolfenamic acid (T.A.), in the prevention of side-effects after insertion of a copper-T200 intrauterine contraceptive device (I.U.D.) was evaluated in a double-blind trial in 160 women. T.A. relieved pain and reduced bleeding after insertion and during three subsequent menstruations without serious side-effects. A scoring system for the assessment of I.U.D. side-effects showed that the acceptability of I.U.D. was significantly better in women treated with T.A. than in those given placebo.

New concepts in dysmenorrhea

The etiology of primary dysmenorrhea, which is the most common gynecologic complaint and cause of lost working hours, remains obscure but merits careful scientific investigation. Recent studies suggest that increased endometrial prostaglandin production and release may be responsible for dysmenorrhea. Prostaglandins cause myometrial contractility that, if excessive, leads to uterine ischemia and pain. This hypothesis has led to clinical trials of antiprostaglandin agents such as indomethacin and fenamates, which inhibit the synthesis of prostaglandin through the prostaglandin synthetase system as well as antagonize their action at the cell receptor level. The good response of dysmenorrhea to other conventional forms of therapy such as oral contraceptives and dilatation of the cervix can be partly explained on the basis of a reduced level of prostaglandins in the menstrual fluid with such therapy. There is a definite need for further evaluation of the antiprostaglandin compounds in the treatment of dysmenorrhea so that sound formulations can be evolved for the elimination of this incapacitating disorder.

The effect of ligation or separation between the intrauterine device horn and adjacent ovary on implantation in the hamster

The purpose of this study was to determine whether the luteolytic action of an intrauterine device (IUD) is suppressed following interruption of the continuity between the IUD uterine horn and the adjacent ovary. After several estrous cycles, a silk IUD was placed in the cervical end of one uterine horn of adult hamsters. The animals were then mated, and on day 6 of gestation the ovary and oviduct contralateral to the IUD were removed and a ligature was placed between the IUD horn and the adjacent ovary. The hamsters were killed on day 9 or day 13 of gestation. Fetal development in the contralateral horn was suppressed on day 13 but not on day 9. In the second study the animals were treated as in the first study except that the communication between the IUD horn and the adjacent ovary was severed completely. The hamsters were killed on day 9 or day 13. On both days 9 and 13 normal fetal development was observed in the control horn; no implantation sites were present in the IUD side. In the control (non-IUD) animals of each study, normal fetuses were present in both uterine horns. The study demonstrates that luteolysis does not occur if there is complete disruption of the communication between the IUD horn and ovary. The study also demonstrates that, since implantation did not occur in the IUD horn with a normally functioning ipsilateral ovary, the luteolytic action of the device is not the prime factor in suppressing implantation in the hamster.