Endometrial effects of hormonal contraception

Centchroman: is unsupervised long-term use warranted? Case report

OBJECTIVES

Centchroman (Ormeloxifene) is a synthetic non-steroidal compound used as an oral and a post-coital contraceptive. It is currently under trial for treatment of breast cancer and postmenopausal osteoporosis. Centchroman has been reported to induce only minimal side effects and no hormonal imbalance.

CASE

A young woman who used centchroman for a long time in an unsupervised fashion presented with menorrhagia, which was controlled with norethisterone. Her massively enlarged uterus showed extensive decidual changes in a hyperplastic endometrium, and diffuse microglandular cervical hyperplasia.

CONCLUSIONS

The case suggests a prominent oestrogenic effect of centchroman on the uterus. This could be a significant adverse effect related to prolonged therapy. Lengthy intake of centchroman requires medical surveillance and long-term studies are needed.

Hormone receptor dynamics in a receptive human endometrium

The text herein is an overview of hormone receptor dynamics in human endometrium as presented at the Society for Gynecologic Investigation Summit on Implantation. It is not an in-depth review. Endometrial function is modulated by circulating steroids that bind ligand-activated receptors and initiate a cascade of molecular and cellular events. Cell-specific targets for steroid hormone action have been defined using immunohistochemistry. Local ligand availability is modulated by steroid metabolizing enzymes expressed within endometrial tissue. Insight on impact of progestogens on endometrial function has derived from studies of pharmacological withdrawal using progesterone receptor antagonists. Microarray analysis of human endometrium, studies in mouse models and in vitro have documented gene expression changes regulated by progesterone and implicated this hormone in determining uterine receptivity. Understanding of the impact of local and peripheral steroids on endometrial function is important for fertility control and for understanding how disturbances of endometrial structure and function play a role in subfertility.