SONOGRAPHIC ASSESSMENT OF OVARIAN AND ENDOMETRIAL CHANGES DURING LONG-TERM NORPLANT USE AND THEIR CORRELATION WITH HORMONAL LEVELS

Objective: To study the probability of ovulation and subclinical abort ion during long-term use of Norplant and to assess the concomitant end ometrial development. Design: This was a prospective nonrandomized com parative study. The ovaries and endometrium were assessed daily by ult rasonography during 59 menstrual cycles in 50 women who were using Nor plant for >1 year. Serum concentrations of E2, P, FSH, LH, pregnancy s pecific beta1 glycoprotein (Spl), and hCG were also daily measured. Th e findings were compared with those in 35 ovulatory cycles in normal f ertile women not using contraception. Setting: Clients of the Family P lanning Clinic of Assiut University Hospital (Norplant users) and the hospital women staff (controls). Results: Sonographic and hormonal evi dence of ovulation were observed in one third of Norplant users; two o f them resulted in conception. However, the majority of these ovulator y cycles showed low midcycle peaks of E2, FSH, and LH and evidence of luteal phase defect (LPD). Excessive follicular enlargement was observ ed in 46% of the cycles. Norplant users had significantly thinner endo metrium that did not exhibit the normal phasic changes in sonographic texture. Apart from conceptive cycles, no rise in Sp1 or hCG was obser ved. Conclusions: Norplant acts mainly by inhibiting ovulation, but wh en this occurs, it is associated with LPD and subnormal endometrial de velopment. Subclinical abortion does not contribute to the contracepti ve effect.