Effect of copper intrauterine device vs. injectable contraceptive on serum hormone levels and cell mitotic activity in endometrium

AimsTo compare changes in serum estradiol and progesterone level, endometrium cell mitotic activity and Ki67 in women using copper intrauterine device (Cu-IUD) with DMPA users 9 months after use.MethodsOne hundred and fifty women having no contra indication to either IUD or injectable contraceptive were studied. Office Endometrial biopsies and serum samples for estradiol and progesterone levels were taken on the 7th day of the menstrual cycle at recruitment and after 9 months. The endometrial samples were subjected to cell mitotic study and Ki67 estimation using morphology and proliferative indices.ResultsThe mean glandular mitotic index was 1.69 ± (0.39) for IUD user vs. 1.1 ± (0.69) for Injectable contraceptive user at first visit respectively and it was 0.57 ± (0.34) vs. 0.25 ± (0.11) at second visit after 9 months respectively. Similarly, Ki-67 count in glands was 11.79 ± 1.59 for IUD user vs. 12.03 ± 0.58 for injectable contraceptive user at first visit and 4.20 ± (0.24) vs. 2.27 ± (0.65) at second visit respectively. In the stroma, Ki67 decreased from a mean of 0.85–0.05 in 9 months for IUD user vs. 0.92–0.02. For injectable users suggesting a statistically significant decrease in proliferative and mitotic indices in the endometrium of women using either injectable contraceptives or IUD for more than 9 months. Non significant changes were observed in serum hormone levels in IUD users, while injectable contraceptive users showed a significant increase in serum progesterone level with insignificant change in the serum estrogen level.ConclusionEither copper intrauterine device or injectable contraceptive usage for more than 9 months results in significant decrease in endometrial proliferative or cell mitotic activity. While copper IUD has no effect on serum estradiol or progesterone levels, DMPA usage increased serum progesterone level with no effect on serum estradiol.