Hormonal contraception can suppress natural antimicrobial gene transcription in human endometrium

Abstract

Objective To determine the effect of hormonal contraception with a combined oral contraceptive pill and levonorgestrel intrauterine system on the expression of the natural antimicrobials secretory leukocyte protease inhibitor, β-defensins 1 and 2, and granulysin in human endometrium. Design Observational study. Setting Day case ward in a department of obstetrics and gynecology. Patient(s) Fifty seven women undergoing gynecologic procedures for benign conditions; 24 received no contraception for more than 3 months, 20 received a combined oral contraceptive for more than 3 months, and 13 wore a levonorgestrel intrauterine system for more than 3 months. Main outcome measure(s) Endometrial samples were collected from all women. Messenger RNA was extracted and quantitative polymerase chain reaction was used to investigate expression of secretory leukocyte protease inhibitor, β-defensin 1, β-defensin 2, and granulysin. Immunohistochemistry for secretory leukocyte protease inhibitor was performed. Result(s) All antimicrobials varied cyclically. The level of secretory leukocyte protease inhibitor was maximal in the late secretory and menstrual phase, β-defensin 1 in the mid secretory phase, granulysin in the late secretory phase, and β-defensin 2 in the menstrual phase. Use of a combined oral contraceptive or levonorgestrel intrauterine system use decreased messenger RNA expression of β-defensin 1 and 2 and granulysin but not secretory leukocyte protease inhibitor. Conclusion(s) Endogenous and exogenous sex-steroid hormones, in the form of a combined oral contraceptive or levonorgestrel intrauterine system, influence gene transcription of secretory leukocyte protease inhibitor, β-defensin 1, β-defensin 2, and granulysin in the endometrium.