Endothelial function in women using levonorgestrel-releasing intrauterine system (LNG-IUS)

Selim, Mohamed Fouad; Hussein, Adnan Fathey

doi:10.1016/j.contraception.2012.12.008

Cited by 16 publications

(8 citation statements)

References 47 publications

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“…The use of long-acting reversible contraceptives (LARC), such as levonorgestrel intrauterine devices (IUD) or contraceptive implants, yields a state of extended exogenous hormone exposure. There is limited data regarding the impact of IUDs on markers of vascular or endothelial function, but studies that have been conducted suggest no changes in IUD users compared to non-users (Selim and Hussein, 2013;Zueff et al, 2017). To our knowledge, there are no studies that directly assess vascular or endothelial function and contraceptive implant use.…”

Section: Pharmacological Conditionsmentioning

confidence: 99%

Female Sex Hormone Effects on the Vasculature: Considering the Validity of Restricting Study Inclusion to Low-Hormone Phases

2020

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Many studies of vascular function limit the testing of premenopausal female participants to periods when female sex hormones, either endogenous or exogenous, are at their lowest concentration. This practice, when not part of the specific research question, may limit data surrounding the predominant physiological state of premenopausal females and pose a threat to external validity. In this Perspective, we briefly review the literature on the effect of female sex hormones on vascular function and discuss when limiting experimental testing to a certain phase of the menstrual cycle (MC) or oral contraceptive (OC) use may be appropriate. The goal of this Perspective is to open a dialog that may enhance data validity and the overall understanding of vascular function in premenopausal females.

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Section: Pharmacological Conditionsmentioning

confidence: 99%

Female Sex Hormone Effects on the Vasculature: Considering the Validity of Restricting Study Inclusion to Low-Hormone Phases

2020

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“…Levonorgestrel is a progestin or a synthetic form of the naturally occurring female sex hormone, progesterone [ 8 ]. Although the exact mechanism remains elusive, the mechanisms by which levonorgestrel may cause vasoconstriction are suggested as follows: (1) Endothelin-1 decreases during the menstrual cycle when estrogen is elevated [ 9 ]. Endothelin-1 is an endothelial-derived vasoconstricting substance [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Endothelin-1 is an endothelial-derived vasoconstricting substance [ 10 ]. Levonorgestrel reduces estrogen secretion, which increases the production of endothelin-1 and can cause vasoconstriction [ 9 , 10 ]. (2) Maintenance of nitric oxide (NO) bioavailability through the activation of endothelial NO synthesis is essential for maintaining vascular homeostasis [ 9 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Levonorgestrel reduces estrogen secretion, which increases the production of endothelin-1 and can cause vasoconstriction [ 9 , 10 ]. (2) Maintenance of nitric oxide (NO) bioavailability through the activation of endothelial NO synthesis is essential for maintaining vascular homeostasis [ 9 , 11 ]. Estrogen causes vasodilation by increasing the endothelial NO synthase expression and NO production [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Reversible Cerebral Vasoconstriction Syndrome Associated with Levonorgestrel-Releasing Intrauterine System

Choi,

Lee,

Bae

et al. 2021

Brain Sciences

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Reversible cerebral vasoconstriction syndromes (RCVS) is a rare disease that is characterized by reversible multifocal stenosis of the cerebral arteries with various clinical manifestations. Though the pathomechanism of RCVS was unclear, we reported RCVS related to the levonorgestrel-releasing intrauterine system (IUS). A previous healthy 36-year-old woman had thunderclap headache after implanting the levonorgestrel-releasing IUS a year ago. In the serial angiography, we initially found left vertebra artery (VA), and then additionally new stenosis of both anterior cerebral arteries and middle cerebral arteries (MCA). Bilateral MCA stenosis improved but developed stenosis of right VA after a week. The mean flow velocities of both MCA increased in the first transcranial doppler (TCD), but normalized in the follow up TCD. Levonorgestrel might act as the vasoconstrictitve factor that increased the level of endothelin-1, diminished the release of NO and raised oxidative low-density lipoprotein (LDL). Although the exact pathological mechanisms for RCVS were not yet elucidated, this case might help clinicians understand the mechanisms of RCVS.

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“…Analysing the physiopathological aspects of morphological alterations in the endometrium after LNG-IUS insertion, recent studies show that exposure to the levonorgestrel concentrations released by this kind of device would result in increased expression of tissue factor (TF), interleukin-8 (IL-8), interleukin-13 (IL-13) and interleukin-15 (IL-15), cyclooxygenase-2 and matrix metalloproteinases (MMPs). These markers could facilitate leukocyte infiltration, especially of natural killer cells specific for uterine endometrium, and epithelial degradation, with posterior formation of foci of necrosis and calcification 4,6,[7][8][9][10][11][12] . There would also be increased expression of vascular endothelial growth factor (VEGF), which would act as to increase vascular permeability, promoting aberrant angiogenesis and resulting in haemorrhages, microthromboses and ulceration of the epithelium 4,7,10,12 .…”

Section: Discussionmentioning

confidence: 99%

Morphological alterations in endometrium after use of levonorgestrel-releasing intrauterine system: a case report

et al. 2020

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Relato de Caso: Paciente de 44 anos compareceu ao serviço de ginecologia para consulta de rotina. Relatou implante de dispositivo intrauterino com liberação de levonorgestrel (DIU-LNG) há cinco anos. Durante o exame físico, o fio do dispositivo não foi visualizado. À histeroscopia, para remoção do dispositivo, não foram evidenciadas alterações na cavidade endometrial. Material foi, então, colhido para biópsia. O estudo histopatológico evidenciou um endométrio com estroma expandido por pseudodecidualização e alterações mucoides, formando pequenos aglomerados de mucina, também se apresentando com endentações polipoides, vasos ectásicos, focos de células linfoides e depósitos de sais de cálcio. A presença de DIU-LNG na cavidade uterina causa uma série de alterações histopatológicas e funcionais no endométrio, as quais não são relacionadas, exclusivamente, ao efeito contraceptivo do dispositivo. Conclusão: Com o aumento da utilização desse método anticoncepcional, o conhecimento das alterações provocadas pelo seu uso se torna cada vez mais relevante para avaliação de sua eficácia e segurança em longo prazo.

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Endothelial function in women using levonorgestrel-releasing intrauterine system (LNG-IUS)

Cited by 16 publications

References 47 publications

Female Sex Hormone Effects on the Vasculature: Considering the Validity of Restricting Study Inclusion to Low-Hormone Phases

Female Sex Hormone Effects on the Vasculature: Considering the Validity of Restricting Study Inclusion to Low-Hormone Phases

Reversible Cerebral Vasoconstriction Syndrome Associated with Levonorgestrel-Releasing Intrauterine System

Morphological alterations in endometrium after use of levonorgestrel-releasing intrauterine system: a case report

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