Abstract
Purpose
This double-blind, placebo-controlled study was conducted to evaluate the molecular
mechanism of mifepristone controlling breakthrough bleeding (BTB) in new depot-medroxyprogesterone
acetate (DMPA) users.
Method
A total of 50 regularly cycling women who were new starters of DMPA were randomized
to receive 50 mg of mifepristone or placebo once every 14 days for six cycles. Endometrial
biopsies were obtained on each patient before, during and after treatment. Endometrial
matrix metalloproteinase 1 (MMP-1) and MMP-9 protein and mRNA were determined by immunohistochemistry
and real-time PCR, respectively. The number of T lymphocytes (CD3-positive) and mast
cells (mast tryptase-positive) was evaluated by immunohistochemistry.
Results
MMP-1, MMP-9, CD3-positive and mast tryptase-positive cells increased following the
DMPA treatment. Addition of mifepristone to DMPA-exposed endometrium for 1 week significantly
decreased stromal MMP-9 expression and numbers of CD3-positive and mast tryptase-positive
cells.
Conclusion
The decreased rates of BTB in new users of DMPA by mifepristone are associated with
decreased MMP-1 and MMP-9 expression and fewer mast and T cells.
Keywords
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Article info
Publication history
Published online: May 21, 2007
Accepted:
March 19,
2007
Received in revised form:
February 2,
2007
Received:
September 29,
2006
Footnotes
���This work was supported by grants from the National Institute of Child Health and Human Development (NIH RO-1 HD 43189 and NIH-1 RO3 HDO 47322).
Identification
Copyright
© 2007 Published by Elsevier Inc.