ENDOMETRIAL THICKNESS AND ESTRADIOL CONCENTRATION IN WOMEN WITH BLEEDING COMPLAINTS DURING USE OF NORPLANT(R) IMPLANTS

The objective of this study was to measure oestradiol, progesterone an d endometrial development among Norplant(R) implant users with bleedin g complaints, Seventy-six volunteers complaining of prolonged/frequent bleeding were enrolled. Oestradiol, progesterone and endometrial thic kness (assessed by vaginal ultrasound) were determined at that visit, Two thirds of the women had low oestradiol (<50 pg/ml) and all except one had low progesterone concentrations (<3 ng/ml), A total of 68% had a very thin endometrium (<3 mm). A subgroup of 21 women were followed twice a week for 8 consecutive weeks, Oestradiol and progesterone con centrations remained low during the continuous bleeding episodes or sh ort bleeding-free intervals (less than or equal to 15 days), yet incre ased five-to sixfold (253.4 +/- 142.2 pg/ml) in long bleeding-free int ervals. Endometrial thickness remained thin irrespective of the differ ences in bleeding patterns and oestradiol. We conclude that Norplant(R ) implant users with bleeding complaints are usually characterized by low oestradiol concentrations, absence of luteal activity and thin end ometrium. A good correlation exists with increasing oestradiol concent rations and longer bleeding-free intervals, but this is not manifested by increased endometrial thickness. However, few subjects bleed with relatively high oestradiol concentrations, therefore a better understa nding of the intimate disturbances related to endometrial bleeding in users of long-acting progestins is still pending.