Secretory and decidual changes induced in the endometrium of oophorectomized women by administration of estrogen and progesterone.

Abstract

THERE have been relatively few studies of the histologic response of the human endometrium to progesterone and only one or two in which serial biopsies have been employed to demonstrate the endometrial histology before and during progesterone therapy. Earlier studies of Neustaedter (1) and of Elden (2) using total doses of 12 to 60 rabbit units ofprogestin, produced largely negative results. Kaufmann (3) used corpus luteum extracts indoses of 10 rabbit units daily for eight days and reported the induction of secretory changes in the uterus of a castrate woman. Salmon, Walter and Geist (4) reported 5 patients treated with oral anhydro-hydroxy-progesterone (pregneninolone) in whom, even though there was only one biopsy, a good secretory endometrium seemed to have been induced after eight days. These women had been given estrogen for ten weeks prior to the pregneninolone treatment. Ryden (5) in a comparative study of several estrogens, terminated some of his study intervals by giving a total dose of 25 to 65 mg. of progesterone during the last week. He had serial endometrial biopsies to control his observations but he obtained only incomplete secretory changes. Szarka (6) reported the recovery of a decidual cast after twenty-eight days of progesterone therapy in an ovariectomized woman. She had received 5 mg. of estradiol benzoate daily in the month prior to and during the period of progesterone injections. The progesterone dosage was started at 10 mg. on alternate days and then increased to 20 mg. daily for three weeks. The estrogen dosage was decreased and discontinued during the last week of progesterone; then bleeding started and the endometrium was shed as a decidual cast. This indicated that the estrogen was equally as important as the progesterone in maintaining the decidua.