Endometrial Regeneration in Patients Discontinuing Oral Contraceptives

This is a report of the findings in 711 cases of endometrial biopsies and their relationship to the antecedent hormonal exposure. All biopsies were obtained in the first posttreatment cycle. A number proved to have been taken too soon to assess the endometrial response to the endogenous luteal phase. A total of 578 remained. Biopsies were classified as: 1) inactive; 2) Proliferative; 3) irregular secretory; and 4) normal secretory. Several combination regimens had been used by patients. There were no differences in the pattern of recovery from 1 combination agent to another. Biopsies were grouped by duration of contraceptive usage. As a control group 50 patients were given 1 cycle of therapy. The results in this group were not appreciably different from the control group. In the women who had discontinued after 2 years or less of therapy ovulation occurred in 82% of the first cycles. However the incidence of irregular secretory endomentria increased to 20% as compared to 2% of controls. In this group 2 biopsies yielded inactive endometrium. In the group using combination therapy for over 2 years before discontinuing the changes were more marked. The frequency of normal secretory endometria was reduced to 41% and the frequency of ovulation as judged by secretory change had fallen to 65%. The number of proliferative and inactive endometria increased proportionately. In this group 2 biopsies showed marked hyperplasia of the endometrium with squamous metaplasia 1 after Lyndiol and the other after Ovulen. Complete endomentrial recovery was seen in the majority of women who had received the combined or sequential schedules although it was somewhat delayed in the former group. Prolonged amenorrhea was seen almost exclusively with the combination agents. Endometrial regeneration is slower after the injectable method.