Abstract:

AIM: To observe the therapeutic effect of levonorgestrel intrauterine system on anovulatory dysfunctional uterine bleeding (DUB) and its impact on endometrial vascular endothelial growth factor（VEGF）, estrogen receptor（ER） and progesterone receptor(ER).  METHODS: 78 patients with DUB from June 2015 to September 2016 were divided into control group and observation group, 39 cases in each group. On the basis of conventional treatment, the control group was given dexyprogesterone ethinyl estradiol tablets orally, the observation group levonorgestrel intrauterine system of treatment. The levels of gemoglobin (HGB), serum estradiol (E2), progesterone (P), secretion of follicle stimulating hormone (FSH), luteinizing hormone (LH) hormone in the two groups were measured before and after treatment. The expression of VEGF, ER and PR in the endometrial glands and stroma were measured by SP immunohistochemical method before and 12 months after treatment. The clinical efficacy and side effects were compared between the two groups. RESULTS: Control bleeding and complete hemostasis were significantly shorter in the observation group than in the control group (P<0.01). After treatment, the levels of hemoglobin in both groups were significantly higher than those before treatment (P<0.01), the endometrial thickness was significantly decreased (P<0.01), E2 was significantly lower than before treatment, P was significantly increased, and the observation group improved more than the control group, and the difference was statistically significant (P<0.01). The positive rate of VEGF in endometrial glands and stroma of observation group was significantly higher than that of before treatment (P<0.01), and the positive rates of ER and PR in gland and stroma were significantly lower than those before treatment (P<0.01). The positive rates of VEGF and VEGF in the observation group were higher than those in the control group. The positive rates of ER and PR were lower than those in the control group (P<0.01). The total effective rate of the observation group was 94.9%, which was significantly higher than that of the control group (79.5%, P<0.05). There were no statistically significant differences in adverse events between the two groups. CONCLUSION: Levonorgestrel intrauterine sustained release system can improve the expression of endometrial ER, PR and VEGF by DUB, and it is more, safe and effective than oral administration of dexyprogesterone ethinyl estradiol tablets.

Key words: levonorgestrel, anovulatory dysfunctional uterine bleeding, vascular endothelial growth factor, estrogen receptor, progesterone receptor