Page 20 - PRECONGRESS COURSE 04

Targeting the PR: modulation of P action on endometrial morphology
Normal secretory phase endometrium
Endometrium post LNG IUS insertion atrophic glands and decidualised stroma
• down regulation of endometrial sex steroid receptors • changes in blood vessel integrity
Endometrial response to intrauterine LNG
• Endometrial atrophy
• Extensive decidualization
• Altered spiral artery formation
• Superficial thin-walled dilated blood vessels
• Down-regulation of ER, PR and AR
• Increased leukocyte infiltration (uNK, macrophages)
• Cytokine and prostaglandin up-regulation • Altered angiogenesis (VEGF ↑)
• MMP up-regulation TF ↑, IGFBP-1 ↑
Intracrinology
• 17βHSD-2 up-regulated • E2↓,E1↑
(reviewed in - Guttinger and Critchley 2007; Contraception 75(6 Suppl):S93-8)
Histology
Immunohistochemistry
Local factors
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