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

R Maia, Haddad,Clarice, Júlio Casoy, Casoy,Julio, Clarice Haddad, Maia Jr H, Coutinho Em, Coutinho,Elsimar M
2012 · W4388787253
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Mirena use for 5 years reduced aromatase and Cox-2 expression in adenomyosis patients, with greater reductions observed after endometrial resection.

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This study investigated the impact of a levonorgestrel-releasing intrauterine system on aromatase and cyclooxygenase-2 expression in the endometrium of patients with adenomyosis. The research compared 89 participants across three groups: those using the device for five years without prior resection, those undergoing endometrial resection at insertion, and an untreated control group. Results indicated that while the hormone-releasing system reduced aromatase expression overall, the combined approach of endometrial resection followed by device insertion significantly enhanced the suppression of both aromatase and Cox-2. The authors concluded that this combined treatment strategy leads to greater amenorrhea rates and more effective molecular inhibition within the uterine tissue. This paper is centrally about adenomyosis — specifically evaluating how combining endometrial resection with a levonorgestrel intrauterine system affects inflammatory and hormonal markers in affected patients.

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Abstract

Hugo Maia Jr1,2, Clarice Haddad1, Julio Casoy1, Rebeca Maia1, Nathanael Pinheiro3, Elsimar M Coutinho11Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), 2Itaigara Memorial Day Hospital, 3IMAGEPAT, Salvador, Bahia, BrazilObjective: 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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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 © 2012 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms and incorporate the Creative Commons Attribution - Non Commercial (unported, 3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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