抄録
The human endometrial response was studied under various endogenous hormonal environments on administering several synthetic progestins. In this study, 104 amenorrhoic patients in 141 cycles and 140 women with normal menstrual cycle in 154 cycles were included. Of the amenorrhoic patients, the endometrical response was investigated under the 1st and the 2nd grade amenorrhea. The 1st grade amenorrhea was considered presumably as having sufficient estrogen and insufficient progesteronelevel ; the 2nd grade amenorrhea as having insufficient estrogen and progesterone level.
Following synthetic progestins were used in these studies :
A) Pregnane derivatives
1) 6-dehydro-retroprogesterone (Δ6RP)
2) 17α-hydroxyprogesterone capronate (17OHPc)
3) 17α-acetoxyprogesterone derivatives i) 6-dehydro-6-chloro-17α-acetoxyprogesterone (Δ6CAP)
ii) 6-dehydro-6-methyl-17α-acetoxyprogesterone (Δ6MAP)
B) Estrane derivatives
1) 19-nortestosterone derivatives i) 17α-ethyny1-19-nortestosterone (EtNT)
ii) 17α-ethynyl-Δ5-estrene-17β-01-3-one (EtEO)
iii) 17α-ethyny1-19-nortestosterone acetate (EtNTAc)
iv) 17α-ethyny1-4-estrene-3β, 17β-diol-diacetate (EtEDA)
v) 17a-methyl-19-nortestosterone (MNT)
2) Estrenol derivatives i) 17α-ethynyl-estrenol (EtEL)
ii) 17a-allyl-estrenol (AlEL)
The estrogenicity of these compounds is the most important factor to the endometrial response. These compounds were classified estrogenic progestins and non-estrogenic progestins as judged by its effect on mouse uterine. Pregnane derivatives and AlEL in estrenol derivatives belonged to non-estrogenic progestins and other progestins to estrogenic progestins.
The endometrical response to the synthetic progestins in the 2nd grade amenorrhoic patients showed the atrophic pattern, but estrogen priming to the 1st grade amenorrhoic patients on administering non-estrogenic progestins was most significant. i.e. Δ6RP and 17OHPc produced the physiological changes of late secretory phase. The branching in glandular cavity was produced by Δ6CAP. The endometrial response to AlEL was minimal.
On the other hand, the endometrial response produced by estrogenic progestins and non-estrogenic progestins mixed with estrogen, showed the atypical glandular pattern of early secretory phase and the atypical stromal pattern of late secretory phase. The branching of endometrial gland produced by MNT was not so prominent as that of Δ6CAP. The endometrium on long term administration of EtNT tended to be atrophic.
On administering several synthetic progestins in late luteal phase. it showed generally slight atrophic pattern.
By postovulatory administration of non-estrogenic progestin, endometrium showed the atypical pattern of late secretory phase in both gland and stroma, but by administration of estrogenic progestins and non-estrogenic progestins mixed with estrogen, endometrium showed the atypical pattern of early secretory phase in gland and the atypical pattern of late secretory phase in stroma.
