Ultrastructural endometrial changes in IUD users

Endometrial biopsies from 20 patients using intrauterine devices (IUD) having different modes of action were taken in order to study the ultrastructural changes related to the different types of devices. 11 patients presented with spotting and/or pelvic discomfort; the others were asymptomatic. The tissue biopsies were observed with electron microscopy. The epithelium appears to be constituted by cells with abnormal nuclei cilia and microvilli and infiltrated by numerous white cells. The vascular structures of the stroma show changes that explain the frequent bleeding; edema and stromal cell necrosis are also noted. The presence of white cells actually appears to be partially responsible for the efficacy of the devices; the vessel abnormalities are more marked among those using copper-based devices and devices made of inert material. The secretory function of the endometrium appears more significantly diminished in copper-based devices than in the inert devices. Progesterone-based devices cause longer menses and more frequent intermenstrual spotting but an altogether smaller periodic blood loss. These results confirm the findings of previous studies and the advisability of using medicated IUDs.