The Studies On Endometrial Estrogen Receptor And Progesterone Receptor Isoforms In Women With Prolonged Uterine Bleedin

The drug of Mifepristone compound Misopristol to induce medical abortion has been widely taken recently. It's side effect-prolonged uterine bleeding has not been resolved. The uterine bleeding after medical abortion is usually longer than that after manual vacuum aspiration to terminating early pregnancy. The mean bleeding period of manual vacuum aspiration is 9 days. In contrast, that of medical abortion is 14days or 12.3?3.9days. Prolonged uterine bleeding may result in disease such as anemia, pelvic inflammation, secondary infertility and so on.To seek for the mechanism of prolonged uterine bleeding after medical abortion, investigators have studied on decidua blood supply, fibrinolysis system, growing factors, estrogen receptor and progesterone receptor. Some investigators found that there were decidua residuals and poor endometium proliferation in the uterine of prolonged bleeding. Then they found that the estrogen receptor and progesterone receptor in the endometiumdecreased after medical abortion. And thought that may be related to prolonged uterine bleeding after terminating early pregnancy by mifepristone. Usually the estrogen receptor a can active transcription and stimulate endometrium proliferation. The estrogen receptor P inhibits transcription, But in the estrogen receptor a knocked out mouse, the estrogen receptor 3 can still stimulate endometrium proliferation. Like estrogen receptor a , the progesterone receptor B can also active transcription and stimulate endometrium proliferation. Some transfected cell culture experiments suggested that the human and rat oxytocin gene promoter can be regulated by both ER a and ER P through a major hormone response element at -160 bp upstream of the transcription start site. In the granulosa cells up regulation of the oxytocin gene is mediated by an autocrine loop involving endogenous progesterone and the progesterone receptor. In the uterus, the progesterone receptor concentrations of myometrium were significantly lower in oxytocin-resistant dystocia compared with those of normal labor and before labor. These suggest the estrogen receptor and progesterone receptor are related to uterine contraction. But there has no research on the endometrium estrogen and progesterone receptors isoforms change after mefipristone induced medical abortion.The purpose of present study was to determine the expression and location of estrogen and progesterone receptor isoforms in the wemen's endometrium after medical abortion and discuss the relationship between the changes of isoforms and prolonged uterine bleeding.45 women aged 20-40 years old, with regular menstruation cycles, with normal menstruation bleeding quantity, and confirmed early pregnancy intro uterine by Type B Ultrasound Graph, amenorrhea less than 49 days, were involved.The SP immunohistochemical techniques with monoclonal antibodies specific to ERa , ER P PR-A and PR-B was employed to locate the ER a , ER P , PR-A and PR -B in endometrial paraffin-embedded sections. The history score were counted under microscope. We assessed ER a % ER P % PR-A and PR-B within individual cells (glandular and stromal cells) of endometrium in 15 women with prolonged bleeding after medical abortion (mifepristone 25mgX6, accompanied with misopristol 600 u g, medical abortion group), and 15 women with prolonged bleeding after manual vacuum aspiration (manual abortion group) and 15 without prolonged bleeding after manual vacuum aspiration as control group.The results showed that ER^ PR isoforms located in both glands and stroma of endometrium. ER a and PR-B mainly located in the nuclear, and a few of them were diffused in the cytoplasm of glands. ER P and PR-A mainly located in the cytoplasm and cell membrane of glands ,but there were still quite low levels of ER P and PR-A locating in the stroma.The endometrial ERa , PR-B H-Scores (median=166.7, QR=88.5; median=136.5, QR=119) of medical abortion group were significantly lower than those of control group (median=306.7, QR=45.9; median=389.6, QR=106.6). And...