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Original ArticleOpen Access
Relationship between Progesterone Receptor Level in Endometrium and Bleeding Pattern in Depot Medroxyprogesterone Acetate Users
Chotnopparatpattara P 
,
Taneepanichskul S ,
Treratanachat S ,
Charuruks N
,
Taneepanichskul S ,
Treratanachat S ,
Charuruks N SURASAK TANEEPANICHSKUL, MD*,
NA V APUN CHARURUKS, MD**
Bleeding disturbance is the major reason for discontinuation among depot medroxyproges-
terone acetate (DMPA) users. However, the causes of progestin-induced bleeding are not well under-
stood. The aim of the study was to examine the correlation between the occurrence of uterine bleed-
ing and progesterone receptor (PR) levels in the endometrium. Forty-five matched pairs of age and
body mass index in DMPA users with bleeding and amenorrhea were studied. The endometrial PR
levels were evaluated. The PR score was assessed semi-quantitatively. Forty-two subject pairs met the
criteria. There was no difference in serum estradiol and progesterone levels between the groups. No
correlation between the number of bleeding days and PR score nor between the number of bleeding
days and serum estradiol and progesterone level was detected. The stromal PR score in DMPA sub-
jects with amenorrhea was significantly higher than those with bleeding (p
<
0.05). By contrast, the PR
score in glandular endometrium was not significantly different between the groups (p
>
0.05). In
conclusion, after a second dose of DMPA, subjects with amenorrhea had a higher stromal PR score
than those with uterine bleeding.
Key word : DMPA, Endometrium, Uterine Bleeding, Progesterone Receptor, Amenorrhea, Stroma
NA V APUN CHARURUKS, MD**
Bleeding disturbance is the major reason for discontinuation among depot medroxyproges-
terone acetate (DMPA) users. However, the causes of progestin-induced bleeding are not well under-
stood. The aim of the study was to examine the correlation between the occurrence of uterine bleed-
ing and progesterone receptor (PR) levels in the endometrium. Forty-five matched pairs of age and
body mass index in DMPA users with bleeding and amenorrhea were studied. The endometrial PR
levels were evaluated. The PR score was assessed semi-quantitatively. Forty-two subject pairs met the
criteria. There was no difference in serum estradiol and progesterone levels between the groups. No
correlation between the number of bleeding days and PR score nor between the number of bleeding
days and serum estradiol and progesterone level was detected. The stromal PR score in DMPA sub-
jects with amenorrhea was significantly higher than those with bleeding (p
<
0.05). By contrast, the PR
score in glandular endometrium was not significantly different between the groups (p
>
0.05). In
conclusion, after a second dose of DMPA, subjects with amenorrhea had a higher stromal PR score
than those with uterine bleeding.
Key word : DMPA, Endometrium, Uterine Bleeding, Progesterone Receptor, Amenorrhea, Stroma
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