Abstract

PIP: Based on the assumption that excess prostaglandins (PGS) of E type (vasodilators and inhibitors of platelet aggregation) may be involved in excessive bleeding due to IUDs, PG synthetase inhibitors were administered to evaluate this hypothesis's validity. In addition, the role of PGs and its inhibitors on dysfunctional uterine bleeding was also studied. In the IUD-induced bleeding study patients were divided into 2 subgroups. Subgroup 1 included patients with menorrhagia caused by IUDs; 50 women were treated with oral indomethacin and 25 subjects were given placebo on the same schedule. In Subgroup 2, fewer cases were selected, double-blindly, and 3 different PG inhibitors were tested in a cross-over manner. Menstrual blood loss (MBL) was measured. 2 subgroups were also used in the dysfunctional uterine bleeding study, the first of which received intravenous infusions of PGF2 alpha or 15-methyl F2 alpha for 6 hours and the second of which was treated with oral indomethacin (25 mg tds) for 5 days. MBL was measured and compared to the subject's period before treatment. Results from the IUD bleeding studies showed that regardless of the method of evaluation or the drug used, administration of nonsteroidal antiinflammatory drugs (NSAID) induced drastic reductions in MBL (subjective evaluation showed 92% success with indomethacin). Quantitative MBL measurement also verified the consistent and significant reduction in MBL under treatment. Oral NSAID in cases of dysfunctional bleeding was associated with marked decrease in MBL also. However, histologic changes were observed in endometrial vessels, notably thickening of subendothelial connective tissue and prominent endothelial cells. Intravenous infusions also reduced MBL but not as significantly as oral administration. And fibrin deposition was marked after intravenous treatment.