Activation of NF-κB and COX-2 expression is associated with breakthrough bleeding in patients using oral contraceptives in extended regimens

Hugo Maia, Júlio Casoy, Tânia Correia, Célia Athayde, Jorge Valente, Elsimar Metzker Coutinho
In: Gynecological Endocrinology · 2009 · vol. 26(4) , pp. 1–5 · doi:10.1080/09513590903247832 · PMID:19757243 · W2029906017
article OA: closed CC0 ⤵ 7 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

Endometrial NF-κB activation and COX-2 expression were significantly higher in women experiencing breakthrough bleeding while using continuous-use oral contraceptives.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

The paper investigated inflammatory signaling in people using oral contraceptives in extended regimens, focusing on whether activation of NF-κB and expression of COX-2 are associated with breakthrough bleeding. Using patient samples to assess these molecular markers, the authors reported an association between increased NF-κB activation/COX-2 expression and breakthrough bleeding events during extended dosing. A key limitation is that the provided text does not specify the study design details (e.g., sample size, timing of sampling, and whether the analysis can establish causality) beyond describing the association. Relevance to endometriosis: the corpus inclusion is based on a keyword match to endometriosis/pelvic inflammatory research context, though the provided paper text does not explicitly discuss endometriosis or adenomyosis.

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Abstract

The objective of the present study was to determine whether there is an increase in endometrial inflammation associated with the occurrence of breakthrough bleeding in patients using an oral contraceptive in extended regimens. The presence of nuclear factor NF-kappaB and Cox-2 expression was determined by immunohistochemistry in endometrial samples removed by hysteroscopy from patients with breakthrough bleeding during continuous use of an oral contraceptive containing gestodene. All patients had a history of menorrhagia associated or not with the presence of uterine pathology. The percentage of endometria showing a positive staining reaction for NF-kappaB in cell nuclei was significantly higher in patients with breakthrough bleeding than in those with amenorrhea. Cox-2 expression in the endometrium was also significantly more frequent in patients with breakthrough bleeding. The occurrence of breakthrough bleeding in patients with uterine pathology using combined oral contraceptives is associated with the activation of endometrial inflammation through the NF-kappaB pathway.
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last seen: 2026-06-10T17:14:06.276822+00:00
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