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Effect of a hormone-releasing intrauterine system (Mirena®) on aromatase and Cox-2 expression in patients with adenomyosis submitted or not, to endometrial resection

Authors Maia Jr. H, Haddad C, Casoy J, Maia, Pinheiro, Coutinho EM

Received 21 January 2012

Accepted for publication 10 February 2012

Published 12 April 2012 Volume 2012:4 Pages 175—183


Review by Single anonymous peer review

Peer reviewer comments 3

Hugo Maia Jr1,2, Clarice Haddad1, Julio Casoy1, Rebeca Maia1, Nathanael Pinheiro3, Elsimar M Coutinho1
1Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), 2Itaigara Memorial Day Hospital, 3IMAGEPAT, Salvador, Bahia, Brazil

Objective: To investigate the effect of a levonorgestrel-releasing intrauterine system (Mirena®) on aromatase and cyclooxygenase-2 (Cox-2) expression in the endometrium of patients with adenomyosis who were submitted to endometrial resection at the time of insertion, compared to a group not submitted to endometrial resection and a group of controls with adenomyosis not submitted to any previous hormonal treatment.
Patients and methods: Patients with adenomyosis (n = 89) were included in this study. Twenty-two patients had been using Mirena® for 5 years but had not been submitted to endometrial resection prior to insertion of the device. Twenty-four patients were submitted to endometrial resection at the time of Mirena® insertion. The remaining 43 patients with adenomyosis had undergone no previous hormonal treatment and served as a control group. Cox-2 and aromatase expression were determined in the endometrium by immunohistochemistry.
Results: Use of Mirena® for 5 years reduced aromatase expression in the endometrium; however, this reduction was significantly greater in the uteri previously submitted to endometrial resection. The reduction in Cox-2 expression was significant only in the uteri submitted to endometrial resection followed by the insertion of Mirena®.
Conclusion: Endometrial resection followed by the insertion of Mirena® was associated with greater rates of amenorrhea in patients with adenomyosis, which in turn were associated with a more effective inhibition of aromatase and Cox-2 expression in the endometrium.

Keywords: aromatase, Mirena®, adenomyosis, Cox-2, endometrium, levonorgestrel

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